Chiropractor Chandler AZ
PLATELET RICH PLASMA PROLOTHERAPY FOR WRIST AND HAND PAIN
PLATELET RICH PLASMA PROLOTHERAPYPlatelet rich plasma Prolotherapy is an alternative treatment method that heals the musculoskeletal injuries and chronic pain by accelerating the body's own healing system. In this method, the patient's own platelets are injected at the site of injury or pain.
These platelets have alpha granules which contain growth factors that speed up the cell growth and proliferation. Platelets activate the epithelial growth factors (EGF) which attract the cell migration and accelerate replication at the site of damage, causing the damaged tissues to heal.
The platelet-rich plasma injection is followed by three stages of healing:
- Inflammation phase that lasts for 2-3 days. In this phase, growth factors are released
- Proliferation phase that lasts for 2-4 weeks. It is vital for musculoskeletal regeneration
- Remodeling phase which lasts over a year. In this phase, collagen is matured and strengthened
Different blood separation devices are used that have different preparation steps involved, achieving the same goal. Around 30-60ml of venous blood is drawn from the patient and centrifuged for 15 minutes at 3,200 rpm to prepare platelet-rich plasma. About 3-6 cc of platelet-rich plasma is prepared from 30-60 ml of the blood.
The site of injection is located and marked by clinical examination and imaging techniques such as MRI and X-ray. Injection is administered by using dynamic musculoskeletal ultrasound for complete accuracy. After injection, the patient is observed for some time and discharged if no pain or side effects are observed. The patient is re-examined after 2-6 weeks of the injection to follow infection, injection site, pain or any other side effect.
SAFETY ISSUESPlatelet rich plasma Prolotherapy is an invasive technique and the risks involved in any invasive technique are immunogenic reactions, disease transfer, hyperplasia and Cancer. Platelet rich plasma Prolotherapy uses the blood of the patient thus there are no chances of immunogenic reaction or blood-related disease transfer. No studies have documented that platelet rich plasma Prolotherapy causes tumor growth or cancer.
PLATELET RICH PLASMA PROLOTHERAPY FOR WRIST AND HAND PAINWrist and hand are the most active part of the body and because of that, they are extremely vulnerable to injuries. Any injury to wrist or hand affects all the functions performed by hands. According to a survey, 3-26% of the general population in the UK was affected by wrist and hand pain. Hand and wrist injuries have a great economic impact than any other musculoskeletal injury. For carpal tunnel syndrome alone, treatment costs in the United States are estimated at $1 billion.
WRIST AND HAND ANATOMYBONES: Wrist and hand are made up of 27 bones. The wrist contains 8 bones that are called carpels. Palm contains 5 bones that are called metacarpals. 14 bones make figures and thumb and those are called phalanges.
MUSCLES, TENDONS, AND LIGAMENTS: Bones are held together by ligaments, tendons and 2 sets of muscles. Flexors muscles are used to bend the thumb and fingers. Extensor muscles are used to straighten up the fingers and thumb.
CAUSES OF WRIST AND HAND PAINWrist and hand pain is caused by several reasons. Some of the important causes are listed below:
HAND:ARTHRITIS: Arthritis is inflammation of the joints. Two most common types of arthritis are rheumatoid arthritis and osteoarthritis. It is a long term condition and its symptoms are swelling, redness, tenderness, and pain.
CARPAL TUNNEL SYNDROME: It is a very common condition. It is caused by median nerve at the base of the palm getting compressed. Early symptoms are numbness at night, tingling in figures and thumb and weakness in hands. Treatments include activity modification such as keeping the wrist at the right position while working, using night wrist splints, anti-inflammatory medicines, cortisone injections and surgery.
SKIER'S THUMB: Skier's thumb is a strain of the ligament in the thumb. It is common when the thumb is bent in the extreme direction during a fall. Symptoms include pain, bruising, and swelling. Treatment includes icing, rest, and anti-inflammatory medicines.
CUBITAL TUNNEL SYNDROME: it is a musculoskeletal disorder caused by putting too much pressure on the ulnar nerve which is one of the three major nerves in the arm. When pressure is exerted on the ulnar nerve for long period of time, it can cause burning sensation or numbness in the elbow, arm, hand or fingers. Treatment may include changing the way elbow is used, non-steroidal anti-inflammatory medicines, bracing and hand therapy exercises. Surgery to adjust the position of the nerve may be recommended if conservative treatments fail.
TENDON INJURIES: Tendons are injured by a deep cut on the palm side of the hand or fingers or a sports injury that pulls tendons from the bone. Tendon injury takes very long to heal completely. Symptoms are pain and problems moving the hand or fingers, or a complete inability to move the affected area. Splints and surgery are treatment options for tendon injuries.
HAND/FINGER FRACTURES: A fracture is caused by falling, sports injury or a car accident. Symptoms of hand or figure fracture are a pain, swelling, bruising, deformity, loss of motion and numbness. Treatments include splints, pain killers, hand therapy exercises and surgery.
WRIST:WRIST SPRAINS AND WRIST FRACTURE: Sprain is an injury to a ligament. Wrist sprains and wrist fractures are caused by falling on an outstretched hand. Symptoms include pain, bruising, deformity, swelling and tenderness. Treatment includes rest, ice and anti-inflammatory medicines and surgery.
SCAPHOID NONUNIONS: It is a fracture of a scaphoid bone in the wrist that does not heal due to low blood supply to this bone. This can cause the bone to die. Treatment may include using a bone graft to encourage healing.
DE QUERVAIN'S DISEASE: It is inflammation of tendons that extend the thumb. Pain in thumb or forearm, swelling, pain and difficult thumb movements are the symptoms of De Quervain's disease. Treatments include splints, ice, anti-inflammatory drugs, cortisone injection, and surgery.
DIAGNOSIS OF WRIST AND HAND PAINTo diagnose the cause of wrist and hand pain, the physician will take a medical history and perform a physical examination. Blood tests, X-ray, and CT scan are performed to find the location and extent of the injury.
PLATELET RICH PLASMA PROLOTHERAPY FOR WRIST AND HAND PAINThe conventional treatment methods for treating wrist and hand pain are rest, sprints, painkillers and anti-inflammatory medicines and if these methods are unresponsive then surgery is performed.
When the conventional treatment methods and surgery fail to reduce the pain in wrist and hand, alternative treatment methods come forward. These methods include acupuncture, yoga, physical therapy and platelet rich plasma Prolotherapy. Platelet rich plasma Prolotherapy is under-recognised but highly effective and minimally invasive technique to treat the chronic pain by manipulating the body's own healing mechanism.
The hand and wrist are full of many small joints each of which can be injured and cause pain. Prolotherapy can safely and effectively treat each of them. To treat unresolved wrist and hand pain, the cause of the pain is diagnosed by clinical history, physical examination or by using imaging techniques. After the diagnosis, the platelet-rich plasma is prepared by using the patient's own blood. The site of injection is cleaned and mild anesthesia is applied. Platelet-rich plasma is then injected at the site of the injury/pain where it starts the healing process. Pain killers are prescribed in case of discomfort at the site of injection. It takes 4-6 treatments, 4-6 weeks apart to heal the injury completely.
Animal studies have shown an increase in collagen production after administration of PRP injection. Another study on animals showed the increased tendon and ligament diameter and strength after Prolotherapy. A research conducted on patients with unresolved wrist pain showed that PRP Prolotherapy was very effective in eliminating pain, stiffness and improving the quality of life.
Ligaments are notorious for not healing and ligament injury is one of the major causes of degenerative osteoarthritis in joints. Prolotherapy effectively stimulates healing in sprains, arthritis, tendons and ligaments of the wrist and hand joints. RPR Prolotherapy has shown a decrease in pain by stimulating tissue regeneration in tendons and ligaments. To treat cartilage damage, PRP prolotherapy has shown positive results by reducing the amount of pain in patients within 6-12 months. This technique has shown positive results in healing bone fractures.
Platelet rich plasma Prolotherapy is a new hope for the patients with chronic, unresolved pain and it is a requirement of time to establish optimal protocols for its procedure.
Combining Conservative Treatments with PRPCombing prolotherapy and stem cell treatments with physical therapy, sports therapy, massage therapy, and exercises enhances recovery and pain free function. People have often tried many of these treatments prior to injection therapy. Combining these treatments with PRP and stem cells maximizes recovery and tissue repair.
Low Level Laser Treatments- ACCELERATED TISSUE REPAIR AND CELL GROWTH
- FASTER WOUND HEALING
- REDUCED FIBROUS TISSUE FORMATION
- ANTI-INFLAMMATION
- PAIN RELIEF
- INCREASED BLOOD FLOW
- INCREASED REPAIR AND REGENERATION
- NERVE FUNCTION AND REPAIR
- INCREASED ENERGY PRODUCTION - ATP
- ACUPRESSURE AND TRIGGER POINTS
Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.
Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.
Low level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.
Laser therapy causes vasodilatation (increases size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.
Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby; eliminating your pain.
Low level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensation. Overall laser therapy reduces painful nerve signals and reducing your perceived pain.
Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated, to enhance injury repair.
Low level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.
Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.
ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have more ATP for healing and repair. Increased mitochondrial production is very important with nerve pain.
Low level laser therapy decreases trigger points and stimulates acupuncture points to decrease muscle and joint pain.
We combine low level laser therapy with a variety of techniques and treatments. Cold laser therapy can be used alone as a single treatment modality, or in conjunction with other Chiropractic, Physical Therapy, massage therapy, or medical treatments.
Conservative TreatmentsTherapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
When these treatments are incorporated into a treatment plan patients heal faster and are less likely to have long-term pain or soft tissue fibrosis or scar tissue in the injured muscle. These soft tissue treatments are incorporated with cold laser, therapeutic exercise, and flexibility programs.
Treatment for shoulder injuries often requires a variety of exercises, stretches, conservative treatments, medical treatments, and home therapies. Shoulder injuries can become chronic if the appropriate steps are not taken.
Elbow injuries often occur in people with severe or chronic shoulder injuries. People begin trying to alter their shoulder motions to protect it. Unfortunately these altered body mechanics tend to overwhelm the muscles and tendons around the elbow. People often develop a secondary cubital tunnel syndrome, lateral epicondylitis, tricep tendonitis, medial epicondylitis, pronator teres syndrome, double crush, carpal sprains, wrist tendinitis, de quervain's tendonitis, finger extensor strains, or carpal tunnel syndrome.
Treatment for elbow injuries can be extensive if the tendinosis is severe. Mild strains can be treated at home with PRICE, home stretches, and exercises. Don't wait for damage to both the shoulder and elbow to seek treatment and therapy.
Many people do have arthritis or degenerative changes in their elbow, wrist, finger, or thumb joints. Arthritis does not mean you will always have pain in the joints. Degenerative arthritis means the structural Integrity of the bones have changed which alters its gliding, sliding, and hinging motions.
The more severe the arthritic changes the easier it becomes to aggravate the joint and produce pain. Low level laser therapy is excellent at decreasing pain and inflammation in arthritic hand and wrist joints. Especially when cold lasers are combined with prolotherapy or stem cell treatments.
The upper extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the elbow flexor muscles. Isometric exercises are often the initial treatment exercises. Followed by single plane rubber band exercises for elbow flexion, extension, pronation, and supination movements. Dynamic exercises involving stability ball push-ups can be performed on the wall or floor. The more unstable of the surface the more effort and stabilization is required of all the upper extremity muscles.
Push-ups on a stability ball enhances neuromuscular learning throughout the neck, scapula, shoulder, upper arm, and lower arm muscles. Additional strength exercises can be found on the arm and shoulder strengthening pages.
BIBLIOGRAPHY:
Forman, T. A., Forman, S. K., & Rose, N. E. (2005). A Clinical Approach to Diagnosing Wrist Pain. American Family Physician , 1753-1758.
Hauser, R. A., Hauser, M. A., & Holian, P. (2009). Dextrose Prolotherapy for Unresolved Wrist Pain. Practical Pain Managment, 72-89.
Mautner, K., Colberg, R. E., Malanga, G., Borg-Stein, J. P., Harmon, K. G., Dharamsi, A. S., et al. (2013). Outcomes After Ultrasound-Guided Platelet-Rich Plasma Injections for Chronic Tendinopathy: A Multicenter, Retrospective Review. The American Academy of Physical Medicine and Rehabilitation, 169-175.
Forman TA et al. A clinical approach to diagnosing wrist pain. Am Fam Physician. 2005 Nov 1;72(9):1753-8.
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Andréu JL et al. Hand pain other than carpal tunnel syndrome (CTS): the role of occupational factors. Best Pract Res Clin Rheumatol. 2011 Feb;25(1):31-42