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Wrist and metacarpal
injuries are more common in contact sports, racquet sports, and gymnastics.
The wrist
represents one of the most complicated regions of the musculoskeletal anatomy.
It is comprised of 15 bones,
27 articular surfaces, and an elaborate system of ligament
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.
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 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
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 poke on the painful area with the
thumb and reproduce the athlete's pain. The painful structure has been located
and the diagnosis is made. Wrist arthroscopy for the athlete is not a good
idea. We do not know of any Prolotherapy
doctor who has ever referred even one patient for this procedure. If an
athlete wants to have surgery of the wrist, or for that matter anywhere in the
body, the best first step will be an arthroscopy. Prolotherapy treatments 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 chrondroitin and glucosamine sulfate.
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