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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 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.
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 Prolotherapist 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 chrondoitin and glucosamine sulfate.
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