Ultrasound-guided procedure for the treatment of trapeziometacarpal osteoarthritis

Abstract

Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular injection of corticosteroids or hyaluronic acid. Several studies have shown that ultrasound (US)-guided injections demonstrate greater precision and effectiveness when compared to blind techniques. The aim of our study was to describe a simple and reliable procedure of US-guided intra-articular injection of hyaluronic acid solution in patients with TMO. Thirty-one patients with TMO received one administration per week, for 3 weeks, of US-guided intra-articular injection with 1 ml of hyaluronic acid solution. Patients were evaluated before treatment and at 1, 3, and 6 months after the first injection with visual analog scale (VAS) score and Duruöz Hand Index (DHI). One month after the end of treatment, subjective patient response to therapy was evaluated using a 6-point Likert scale. A statistically significant VAS score reduction was observed at 1 and 3 months after the end of treatment (P<0.01) but not at 6-month follow-up (P=0.6). No statistically significant difference was found on the DHI total score at 1- (P=0.08), 3- (P=0.1) and 6-month (P=0.9) follow-ups. One month after the end of treatment, 29 (93.5%) patients reported a Likert scale score of "1" or "2." The described US-guided technique of trapeziometacarpal joint injection is easy to perform and revealed excellent accuracy. Nevertheless, intra-articular injections of hyaluronic acid provided significant pain relief only for a 6-month follow-up period and did not improve hand function. No pain relief was detected at 6-month follow-up, suggesting that periodic injections should be required to gain long-term effectiveness.