Wrist Instability and Osteoarthritis
Doctors is Europe recently had harsh words for wrist replacement surgery in performing a five year review of 15 patients:
- Four patients had postoperative complications, three of whom required arthrodesis (wrist fusion surgery) (of the 15 patients overall this represented 26% complications 20% fusion surgery).
- While the remaining patients obtained satisfactory pain relief they noted:
- Grip strength decreased
- mobility was reduced
- Radiological assessment revealed carpal implant loosening in eight patients. (More than half).
The doctors of this study basically filed their research under this doesn’t make sense. They confirmed “the discordance generally observed between patients’ subjective satisfaction and mediocre clinical and radiological results over the medium term.”1
Mediocre clinical and radiological results in three wrist procedures
Other research has attested to the high rate of failure of the wrist replacement. Dutch research appearing in the medical journal Acta Orthopaedica documented 25% of replacements needing revision and 2/3 of the implants becoming loose.2 While other research tried to quell criticism and fears by suggesting wrist fusion surgery as a fall back plan. “A failed wrist arthroplasty still leaves the option of a well-functioning arthrodesis.”3
Despite studies like this, despite the loss and elimination of natural wrist movement, wrist fusion surgery has been the traditional treatment for the osteoarthritic damaged wrist.
It should be clear that this is why doctors are calling for forms of treatment which allow the preservation of movement. And as pointed out it is not wrist replacement that do not restore the normal movements of the wrist.4
Yet, despite the concern of researchers and a desire to provide treatments that can rebuild and restore normal function of the wrist, three wrist surgeries are favored for the following problems of the wrist:
- Total wrist fusion: The procedure is performed in young patients who have arthritis in one wrist and high physical demands on the wrist. The operation will lead to good pain relief but loss of movement of the wrist.
- Total wrist replacement: Performed in patients with arthritis in both wrists but with relatively low manual demands. The operation results in good pain relief and a functional range of movement.
- Wrist denervation: In this procedure, nerve branches that take sensations from the wrist to the brain are cut, which will reduce pain perception and improve symptoms temporarily.5
Treating Wrist Instability
Weakened ligaments are a common cause of chronic wrist pain. Weakened ligaments cause joint instability and rapid deterioration of the joint – accelerated osteoarthritis.
When a patient visits their doctor for chronic wrist pain and instability, they are typically diagnosed as problems of overuse and continuous impact from sports or demanding work.
In sports there are four principle mechanisms of injury described: throwing, weight-bearing, twisting, and impact injuries.
- 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 falls.
These activities can lead to chronic injuries which often begin as acute tendonitis or ligament sprain and frequently turn into degenerative arthritis. Conservative treatments include rest, physical therapy, NSAIDs, splinting, cortisone injections, and ergonomic modification of work stations.
When these treatments don’t provide the goals of treatment the patient desires, patient is then often referred to a surgeon and options like those mentioned above are discussed – which are not designed to treat ligament instability.
They may also make an individual more susceptible to injuries. When weakened ligaments allow the wrist bones to become unstable and shift positions, wrist instability results. In addition, any one of the ligaments may be torn due to an injury and become a source of pain.
In search of an alternative to wrist surgery
Since wrist fusion after wrist replacement do not treat ligament instability and in fact can cause it (see again above mediocre results), we have to disagree with surgical treatment except in rare cases where wrist replacement is needed.
Prolotherapy for Wrist Pain
In research conducted, Prolotherapy showed itself to be very effective in eliminating pain, stiffness and improving the quality of life in this group of patients with unresolved wrist pain.
Prolotherapy is the injection of a solution for the purpose of tightening and strengthening weak tendons, ligaments, or joint capsules. Prolotherapy works by stimulating the body to repair these soft tissue structures.
As we discussed above, one explanation for the lack of response of chronic wrist pain sufferers to traditional conservative therapies is that their underlying problem, ligament laxity, is not being addressed. Typically in the early stages of wrist arthritis, the problems are mainly caused by carpal instability from ligament injury. Prolotherapy has been shown to decrease pain by stimulating tissue repair in degenerated tissues such as ligaments and tendons.
Research: Please refer to our study on patients using Dextrose Prolotherapy for Unresolved Wrist Pain, published in the journal Practical Pain Management.
In this research, thirty-one patients with an average pain duration of 52 months, were treated quarterly with Prolotherapy.
Included in this group were:
- nineteen patients (61%) who were told by their medical doctor(s) that no other treatment options for their pain were available or that surgery was their only option.
Patients were contacted an average of 22 months following their final prolotherapy session and asked questions via telephone interview regarding levels of pain, stiffness, other physical and psychological symptoms, as well as questions related to activities of daily living, before and after their last prolotherapy treatment.
Improvements in many quality of life parameters were achieved in this patient population who received the Prolotherapy for their wrist pain.
- Ninety percent of patients had 50% or more pain relief and 88% felt improvement in their stiffness levels. All patients who were taking pain medications prior to receiving prolotherapy were able to reduce the frequency of required medications after receiving prolotherapy.
1 Chevrollier J, Strugarek-Lecoanet C, Dap F, Dautel G. Results of a unicentric series of 15 wrist prosthesis implantations at a 5.2 year follow-up. Acta Orthop Belg. 2016 Mar;82(1):31-42. PubMed PMID: 26984652.
2. Harlingen D, Heesterbeek PJ, J de Vos M. High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis: 32 wrists followed for 6 (5–8) years. Acta Orthop. 2011 Dec;82(6):721-6. Epub 2011 Nov 9.
3. Krukhaug Y, Lie SA, Havelin LI, Furnes O, Hove LM. Results of 189 wrist replacements. A report from the Norwegian Arthroplasty Register. Acta Orthop. 2011 Aug;82(4):405-9.
4. Logan JS, Warwick D2. The treatment of arthritis of the wrist. Bone Joint J. 2015 Oct;97-B(10):1303-8. doi: 10.1302/0301-620X.97B10.35717.
5. Biswas S. Persistent Wrist Pain. Eplasty. 2015 Jul 28;15:ic43. eCollection 2015.