Comparison of intraarticular injection of depot corticosteroid and hyaluronic acid for treatment of degenerative trapeziometacarpal joints

Background: Trapeziometacarpal joint arthritis is a disabling condition presenting with pain at the base of the thumb causing impairment of hand function. Nonoperative treatment at an early stage includes intraarticular steroid injection. Although this treatment may bring about prompt symptomatic relief, its efficacy is unpredictable. Objectives: There is previous evidence that injection of sodium hyaluronate is effective and safe in the treatment of knee arthritis. We proposed that intraarticular injection of sodium hyaluronate, for the symptomatic treatment of trapeziometacarpal joint arthritis, could provide symptomatic relief without the adverse effects of steroids. Methods: Fifty-two patients with trapeziometacarpal joint grade 11 arthritis were randomized prospectively either for methylprednisolone or hyaluronate intraarticular injections. Initial evaluation included an estimation of pain, grip, pinch strengths and the functional Purdue Pegboard Test (PPT). This evaluation was repeated after 1, 3, and 6 months and statistically compared with the initial evaluation. Results: In both groups, the intraarticular injection produced a relief of pain after I month. Grip strength improved significantly in the group treated by the steroid during the whole evaluation period. The patients treated by hyaluronate showed improvement in grip strength after 6 months and in the pinch and the PPT after 3 months. Conclusions: Steroids and hyaluronate injections were found effective in reducing pain. Hyaluronate was more effective in the improvement of some aspects of fine hand function.