Wrist Injury 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 (watch where do Prolotherapy injections go and do they hurt?) 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.