540 - Novel Treatment of a Chronic Right Index Finger Radial Collateral Ligament Sprain with Platelet Rich Plasma

Case Diagnosis: Novel Treatment of a Chronic Right Index Finger Radial Collateral Ligament Sprain with Platelet Rich Plasma

Case Description: A 67-year-old, blind, male pianist with a collagen vascular disease (COL42 mutation) presented with a 5-month-history of right index finger ulnar deviation and persistent pain over the radial aspect his MCP joint following a fall onto his right hand. Symptoms were refractory to bracing and rest and disrupted his ability to play piano. MRI of the hand demonstrated findings consistent with a chronic index finger MCP RCL sprain. The patient was seen by an orthopedic hand subspecialist, but because of healing concerns secondary to his COL4A2 mutation, was referred to our ambulatory clinic to discuss orthobiologic treatment options. He was treated with a single ultrasound guided RCL fenestration and leukocyte poor PRP injection. He used a splint for two weeks after the procedure followed by buddy straps until week six. At twelve weeks post-procedure, he demonstrated significant improvements in VAS and QuickDASH outcome measures and had returned to playing piano.

Discussions: Orthobiologic treatments have gained attention for their potential to modulate inflammation and promote healing in various musculoskeletal pathologies, which may be particularly useful for patients with conditions that compromise connective tissue integrity and healing, like a collagen vascular disorder. Our patient’s underlying condition made him a poor surgical candidate, as the ideal surgical plan included using his own collagen. Other therapeutic options, including prolotherapy and corticosteroids, were considered, though PRP was chosen for these reasons.

Conclusions: This case demonstrates an alternative treatment strategy for a chronic ligamentous injury in a unique patient. It highlights the importance of individualized therapeutic interventions in the management of musculoskeletal injuries. The excellent outcomes seen in our patient provide insight into novel therapeutic applications for PRP in the treatment of complex ligamentous injuries of the hand.