Treatment of Wrist Pain
The wrist is a complex joint formed by the distal ends of the radius and the ulna, and the carpal bones. The radius is located at the thumb side of the wrist, and the ulna at the little finger side. There are eight carpal bones arranged in two rows between the forearm and the hand bones. The scaphoid bone is the largest carpal bone. The scaphoid and another carpal bone, the lunate both articulate with the radius and ulna to form the wrist joint. The wrist connects the forearm to the hand and allows a good range of motion.
The wrist represents one of the most complicated regions of the musculoskeletal anatomy. It is made up of 15 bones and 27 articular surfaces, that is, surfaces related to a joint, all in a sea of ligaments.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. Each bone within the wrist is joined to the one next to it by one or more ligaments. Tough bands of ligament connect the wrist bones to each other and to the forearm bones and hand bones. This results in a large number of ligaments, an elaborate system that maintains these bones and articulating surfaces in proper relation to one another. Two of the largest ligaments of the wrist are the medial (ulnar) and lateral (radial) collateral ligaments. The MCL passes from the distal end of the ulna and crosses the wrist to attach to the triquetrum and pisiform bones. The LCL passes from the end of the radius, across the joint to the scaphoid.
Weakened ligaments are a common cause of chronic wrist pain. They may also make an individual more susceptible to injuries. Because of its complexities, the wrist is one of the most common areas where ligament injury occurs. 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.
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
Rest, activity modification, and support braces are frequent initial recommendations in traditional medicine. It is important to note that rest and immobility of a joint can cause more problems in the long run.
Anti-inflammatory medications are some of the most commonly prescribed medications. Along with cortisone injections, another common recommendation for wrist pain, these medications eventually inhibit healing and have adverse effects on long term health of the joint.
Arthroscopic wrist surgery is actually used for both diagnosis and treatment of wrist pain. MRI and standard x-rays are not yet sensitive enough to show ligament injuries in the wrist. Therefore, arthroscopy is an option used by orthopedic physicians to examine the wrist and obtain a diagnosis.
Prolotherapy for Wrist Pain
Rather than surgical arthroscopy to diagnose wrist pain, it is better to examine the wrist and apply gentle pressure to the painful area with the thumb to reproduce the pain. The painful structure has then been located and the diagnosis is made. The diagnosis of wrist instability or wrist ligament injury is best done by direct palpation. The wrist bones are very superficial, and thus the weakened ligament(s) can be easily palpated and positive “jump signs” elicited. Once the injured wrist ligaments are located and a diagnosis is made, Prolotherapy treatments would be recommended. Prolotherapy to the injured wrist ligaments causes a strengthening of the ligaments and a stabilization of the wrist joint.
Comprehensive Prolotherapy to the wrist joint is comprised of multiple injections of a dextrose-based solution to strengthen the affected ligaments supporting the wrist. Dextrose is used because it is the sugar the body naturally utilizes. When an injury occurs the cells break open to release D-glucose or dextrose. D-glucose activates the immune system. Therefore, the Prolotherapy injections are applied to all of the injured wrist ligaments. Applied to the source of injury, Prolotherapy injections cause a localized, mild inflammation stimulating the body’s natural healing response. Blood supply to the weakened ligament increases and the body responds by sending reparative cells and by laying down new collagen. This new collagen will naturally shrink as it matures, and the ligament that was stretched out and unstable from wrist injury will tighten up. Prolotherapy heals these structures that were damaged due to overuse injuries, sports injuries, falls, carpal tunnel, or wear and tear.
Prolotherapy treatments to the scapholunate ligament, for example, causes a strengthening and stabilization of the three wrist bones typically involved, resulting in a complete healing of the wrist pain. Furthermore, individuals who have already had wrist surgery, but who have experienced degeneration as a result of the surgery, have also found tremendous relief from Prolotherapy treatments. The regenerative injections are targeted at the source of the injury effectively eliminating the wrist pain.
Prolotherapy research on wrist pain
You can read our study on patients using Dextrose Prolotherapy for Unresolved Wrist Pain, published in the journal Practical Pain Management.