Platelet-Rich Plasma for an Adductor Pollicis Injury in a Baseball Player: A Novel Non-Operative Approach

Case Diagnosis: A 20-year-old baseball catcher with a high-grade tear of the distal myotendinous junction of his right adductor pollicis.

Case Description or Program Description: The patient developed right-hand pain after a game without a distinct traumatic event. Initial evaluation localized pain to the dorsum of the first web space with swelling and tenderness. X-ray was unremarkable. Conservative management included rest, bracing, and therapy, but persistent pain six weeks post-injury prompted an MRI, which demonstrated an isolated high-grade tear. An orthopedic hand surgical subspecialist advised against surgery due to the myotendinous location. Given ongoing symptoms, the patient opted to trial a platelet-rich plasma (PRP) injection. Under ultrasound guidance, 4 mL of leukocyte-rich PRP was injected using a fanning technique into the myotendinous junction of the adductor pollicis. He followed a six-week protocol with progressive splinting, occupational therapy, and activity progression.

Setting: Orthopedic sports medicine specialty care clinic.

Assessment/Results: At six weeks postprocedure, pain and function improved, allowing supervised return to play. At six months, he was pain-free and fully resumed baseball, including catching and hitting, without symptoms.

Discussion (relevance): Injuries to the adductor pollicis are rare but have been reported in baseball players. Myotendinous injuries, particularly in small, deep muscles like the adductor pollicis, are challenging to treat surgically due to their delicate anatomy. PRP may help augment normal healing when traditional conservative measures fail. Our patient had persistent pain and functional deficits despite extensive conservative management, and he was not an ideal surgical candidate. He achieved complete symptom resolution and full return to sport following a single PRP injection, which provides insight into orthobiologic treatments of musculotendinous injuries in the hand.

Conclusions: This case demonstrates a novel orthobiologic approach to an uncommon injury. It highlights the potential of PRP as an effective non-operative treatment option for refractory musculotendinous injuries of the hand.