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WRIST INJURIES AND PROLOTHERAPY
Ross Hauser, M.D.
The wrist is one of the most complicated areas of the musculoskeletal system. It
is comprised of 15 bones, 27 articular surfaces, and an elaborate system of
ligaments that maintain these bones and surfaces in proper relation to one
another.
The wrist is one of the most common areas where
ligament
injury occurs, causing
the athlete pain in the area. All 27 articular surfaces in the wrist are covered
in a sea of ligaments.
Throwing injuries to the wrist are associated with throwing, racquet sports, and
often overuse injuries. Weight-bearing injuries are seen in gymnasts and weight
lifters who experience high compressive forces on the wrist. Twisting injuries
may occur in any sport, whereby the wrist undergoes a rapid rotation, which
disrupts the ligaments and stability of the wrist. Impact injuries are the most
common injury, and result from either a direct impact or fall on the wrist.
Stability of the wrist is provided by the tight-fitting anatomic design of the
individual
carpal bones and by the ligamentous interconnections that control
movement of one bone on another. Wrist instability results from a disruption of
the ligamentous support between the individual carpal bones (intrinsic
ligaments) and between the radius and the carpus (extrinsic ligaments). Once the
normal soft tissue constraints are lost, the carpal bones assume a pathologic
orientation based on the remaining ligamentous forces. If the
ligamentous injury
is incomplete, the bones can assume a normal alignment at rest, but collapse
under applied load. This is termed dynamic instability of the wrist. Static
carpal instability occurs when enough restraints are lost that the bones assume
an abnormal alignment on standard x-rays of the wrist.
The diagnosis of wrist instability or wrist ligament injury is best done by
direct palpation. The wrist bones are very superficial. The weakened ligament(s)
can be palpated and positive "jump signs" elicited. The weakened ligament(s) can
then be treated with
Prolotherapy
(link to general information articles) and pain eliminated.
MRI and standard x-rays are not yet sensitive enough to show ligament injuries
in the wrist. Some orthopedists advocate
arthroscopic examination of the wrist.
The standard response by orthopedists is that diagnostic
arthroscopy of the
wrist is indicated when noninvasive imaging procedures and clinical examination
are insufficient to provide a conclusive diagnosis. (Whipple, T. The role of
arthroscopy in the treatment of wrist injuries in the athlete. Clinical Sports
Medicine. 1998; 17:623-634.) They are thus saying that arthroscopy is used to
obtain a diagnosis.
A better approach, in our opinion, is to press on the painful area with the
thumb and reproduce the patient's pain. The painful structure has been located
and the diagnosis is made.
Prolotherapy injections
to the scapholunate or other wrist ligaments causes a
strengthening of the ligaments and the stabilization of the three wrist bones
typically involved, resulting in a complete healing of the pain. Furthermore,
individuals who have already had wrist surgery, but who have experienced
degeneration as a result of the surgery, have found tremendous relief from
Prolotherapy treatments supplemented with chrondoitin and
glucosamine sulfate.
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