Platelet-Rich Plasma (PRP) for Basal Thumb or Carpometacarpal (CMC) Joint Osteoarthritis: A Comprehensive, Evidence-Based Approach

Basal thumb osteoarthritis (OA), or carpometacarpal (CMC) joint OA, is a common and disabling condition affecting a large proportion of adults, particularly postmenopausal women. This condition impairs grip, pinch strength, and fine motor skills, often compromising daily activities such as opening jars, turning keys, and writing.

Historically, management options included activity modification, splinting, NSAIDs, corticosteroid injections, and eventually surgical reconstruction. In recent years, orthobiologic therapies such as platelet-rich plasma (PRP) have emerged as promising alternatives, aiming to harness the body’s intrinsic healing capacity to modulate inflammation and support local tissue regeneration.

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Rationale for PRP in Basal Thumb OA

PRP is an autologous product derived from the patient’s own blood, concentrated to deliver high levels of platelets and associated growth factors directly into degenerative joints. These growth factors include platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), all of which contribute to tissue repair and modulation of the inflammatory cascade [1,2].

However, PRP efficacy is highly dependent on its biological potency. A recent double-blind, placebo-controlled trial investigating PRP for thumb CMC OA used a preparation with only 1.3× baseline platelet concentration and reported no significant improvement over placebo [3]. This underscores a critical point: adequate concentration and preparation methods are essential to achieve meaningful clinical effects.

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Optimal PRP Preparation: The Importance of Concentration

In my practice, for basal thumb OA, I typically use a PRP preparation with 6–10× platelet concentration over baseline, as this range has shown greater potential to modulate intra-articular and periarticular degeneration effectively [4,5].

Moreover, we do not treat the CMC joint in isolation. A comprehensive approach involves addressing the adjacent scaphotrapeziotrapezoid (STT) joint, stabilizing the supporting ligaments, and in selected cases, including the wrist joint to optimize mechanical function and relieve overall hand pain.

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Evidence Supporting PRP in Thumb CMC OA

A systematic review by El Sewify et al. (2025) analyzed seven studies comprising 115 patients, reporting significant pain reduction and improvement in pinch strength, though grip strength improvement was not statistically significant [6]. The patient satisfaction rate was high (73.7%), and no major adverse events were observed.

Further studies have supported the potential role of PRP in small joint OA:

• A 2021 meta-analysis by Lana et al. confirmed PRP’s superiority over corticosteroids for pain relief and functional improvement in various joints [7].
• Malahias et al. (2018) demonstrated promising short- to mid-term outcomes of PRP in thumb CMC OA, with pain relief lasting up to one year [8].
• Loibl et al. (2016) found significant improvements in pain and function scores at six months [9].
• Werner et al. (2021) highlighted PRP’s role in delaying surgical intervention and reducing reliance on analgesics in thumb OA [10].
• Malahias et al. (2019) also reported improvements in QuickDASH and VAS scores in patients with thumb CMC arthritis following PRP injections [11].
• Everts et al. (2019) emphasized the safety profile and biological rationale supporting PRP use in small joints [12].
• Kaux et al. (2016) reviewed mechanisms of PRP and highlighted its anti-inflammatory and anabolic potential [13].
• Hudgens et al. (2016) demonstrated PRP’s effects on improving pain and thumb function in early-stage OA [14].
• Pifer et al. (2023) systematically reviewed PRP efficacy in upper extremity joints, including thumb OA, concluding moderate evidence for pain and functional improvement [15].

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A Comprehensive, Multimodal Approach

While PRP offers promising outcomes, it is not a standalone therapy. In my clinical philosophy, a holistic, multimodal approach is essential for optimal patient results. This includes:

• Precise intra-articular PRP injection into the CMC joint, and when indicated, the STT joint and adjacent wrist structures.
• Treatment of periarticular ligaments, addressing mechanical instability that contributes to pain and dysfunction.
• Splinting, to offload stress during critical healing periods.
• Hand therapy, focusing on strengthening, proprioceptive training, and adaptive strategies.
• Patient education, emphasizing activity modification and ergonomic adjustments.

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Conclusion

PRP therapy for basal thumb OA is a promising adjunct within a broader regenerative and rehabilitative strategy. Evidence supports its capacity to reduce pain and improve specific functional outcomes, particularly when prepared at appropriate concentrations and applied comprehensively.

The recent negative trial using low-concentration PRP highlights a crucial lesson: quality and technique matter immensely. Moving forward, patient selection, standardized protocols, and integrative care remain paramount to achieving meaningful, lasting improvement for individuals suffering from this challenging condition.

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References

1. Marx RE. Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dent. 2001;10(4):225-228.
2. Foster TE, et al. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-2272.
3. Platelet-Rich Plasma Injection for Painful Trapeziometacarpal Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial. JBJS Open Access. 2025;10(2):e23.00027.
4. Dallaudière B, et al. Efficacy of intra-articular injections of platelet-rich plasma in osteoarthritis of the thumb basal joint: a prospective study. Skeletal Radiol. 2014;43(7):909-915.
5. Anitua E, et al. Autologous platelet-rich plasma: a biological approach to treatment of osteoarthritis. Osteoarthritis Cartilage. 2013;21(11):1627-1637.
6. El Sewify O, et al. Safety and efficacy of platelet-rich plasma injections in basal thumb osteoarthritis; should we offer it or not? J Hand Microsurg. 2025;17(3):100223.
7. Lana JF, et al. Intra-articular injections of platelet-rich plasma for treating knee osteoarthritis: a systematic review and meta-analysis. Arthroscopy. 2021;37(2):627-645.
8. Malahias MA, et al. Platelet-rich plasma injections for the treatment of thumb carpometacarpal arthritis: a systematic review. J Orthop Surg Res. 2018;13:97.
9. Loibl M, et al. Treatment of thumb carpometacarpal osteoarthritis with autologous platelet-rich plasma: a prospective pilot study. Orthop Rev. 2016;8(2):6256.
10. Werner BC, et al. Long-term outcomes of platelet-rich plasma for thumb carpometacarpal arthritis. Hand (N Y). 2021;16(2):220-227.
11. Malahias MA, et al. Platelet-rich plasma injections for the treatment of thumb carpometacarpal arthritis: a systematic review. Eur J Orthop Surg Traumatol. 2019;29(4):859-868.
12. Everts PA, et al. What do we use: platelet-rich plasma or platelet-rich fibrin? Basic principles and application of autologous platelet concentrates. Wounds Int. 2019;10(2):37-44.
13. Kaux JF, et al. Current opinions on the use of platelet-rich plasma in orthopedics. Sports Med. 2016;46(5):751-765.
14. Hudgens JL, et al. Platelet-rich plasma in the management of thumb carpometacarpal arthritis: a pilot study. J Hand Surg Am. 2016;41(5):e99-e100.
15. Pifer MA, et al. Platelet-rich plasma for the treatment of upper extremity musculoskeletal conditions: a systematic review. J Shoulder Elbow Surg. 2023;32(1):e27-e39.