Chiropractor Chandler AZ
PLATELET RICH PLASMA (PRP) PROLOTHERAPY FOR THUMB PAIN
PREVALENCE OF MUSCULOSKELETAL INJURIESAccording to the World Health Organisation (WHO), musculoskeletal injuries are the most common cause of long-term pain and disability which affect millions of people across the globe. Musculoskeletal diseases, ranging from thumb and wrist injuries to osteoarthritis and osteoporosis are the biggest health complaint among US patients. In 2004, the total cost of musculoskeletal disease treatment was estimated to be 849$ billion. In 2005, the majority of work loss and bed rest was attributed to the conditions related to musculoskeletal diseases. The increased popularity of sport-related activities has increased the chances of sport-related injuries. 45% of all musculoskeletal injuries in the US are sport-related injuries and ligament and tendon traumas.
PRP PROLOTHERAPYWith an increase in the number of musculoskeletal injuries, the cost of the treatment is also going up. Therefore, there is a dire need to find less-expensive and more effective alternative treatment methods. Platelet-rich plasma (PRP) Prolotherapy is one of the alternative treatment methods that fulfill these requirements. PRP Prolotherapy is a minimally invasive, cost-effective and efficient method in which the blood of the patient is used to heal the injury. The percentage of blood components is reversed and plasma containing 93% platelets is injected at the site of injury. Platelets have the ability to induce tissue regeneration and repair by activating the body's own repair mechanism.
STAGES OF HEALINGThe healing process takes the following steps to heal the injury.
- 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 which lasts over a year. In this phase, collagen is matured and strengthened
PRP Prolotherapy is a very safe method as it uses the patient's own blood; the chances of disease transfer and allergic reaction are eliminated. Research shows that PRP Prolotherapy is not related to the tumor development. Like other invasive methods, there are risks of scar tissue formation, needle breakage, no relief of pain and infection.
PLATELET RICH PLASMA PROLOTHERAPY FOR THUMB PAINThe ability to touch the tip of each finger with the thumb is what makes humans unique among primates. According to the anatomists, the human thumb is the result of an evolutionary process which allowed the humans to develop the control over the small movements of hand and fingers such as picking up objects between finger and thumb and writing carefully.40% of the hand function is provided by the thumb and complete disability of the thumb is devastating and can be equal to the loss of 22% of the body function. Because thumb is so extensively used, it gets injured very easily and can cause acute or chronic pain.
Of all the structure in the hand, thumb joints are the most susceptible to mechanical and work-related injuries. The physiotherapists are very susceptible to thumb pain as a survey done by the members of Musculoskeletal Physiotherapy Australia showed that out of 155 members, 83% had experienced thumb pain in the year 2000. Basal thumb arthritis is another cause of thumb disability. According to the Arthritis Research Institute of America, 21% of people above age 40 have Basal thumb arthritis and it is more prevalent in women than men. Data suggests that by 2020, millions of people will have daily activities limited by thumb arthritis.
Hand thumb also called pollex. The thumb is the first among the five digits of the hand but it is not typically referred to as a finger. The thumb has 3 joints; Metacarpophalangeal, interphalangeal and carpometacarpal joints. The three bones found in the thumb are the following:
Thumb Metacarpal: The thumb metacarpal is the hand bone in line with the thumb which has more mobility as compared to the other metacarpals.
Thumb Proximal Phalanx: It is the thumb's closest bone to the hand. Unlike the fingers, the thumb does not have a middle phalanx.
Thumb Distal Phalanx: It is the thumb's farthest bone from the hand.
Muscles controlling the movements of the thumb are located in the forearm as well as in the palm of the hand.
Blood supply of provided by digital arteries from the Palmer arches and blood drains into corresponding veins.
CAUSES OF THUMB PAIN:There are many causes of thumb pain. Some of the most common causes are the following:
Arthritis: Almost 75% people above the age of 75 have thumb arthritis. The patients with arthritis experience pain and weakness while pinching and grasping. The thumb arthritis is diagnosed by physical examination and X-ray. Treatment options include non-surgical methods and surgery. Non-surgical methods include ice/heat, splinting and pain medication. In surgery, the joint is removed by either removing the bone or by joining the two bones.
Class IV Cold Lasers treatments are very effective for decrease hand and thumb arthritic pain.
Thumb sprain: A sprain is an injury to the ligament that connects the bones at the joint. It is caused by a sports injury or fall. The most common thumb sprain is ulnar collateral ligament sprain. Injury to a ulnar collateral ligament is also called skier's thumb because it is the most common injury caused by ski poles. In this sprain, the ligament that connects the thumb to the hand is damaged. The symptoms are swelling, bruises, pain, and trouble in writing and holding things. X-ray is performed to make sure that the pain is a thumb sprain and not a broken bone. Either splints are used or surgery is performed to treat the thumb sprain which involves reconnecting the ligament to the bone.
Trigger Thumb: This condition is also known as stenosing tenosynovitis. In this condition, the thumb is locked in the bent position. It is common in people whom work involves repetitive gripping action. It is caused by inflammation between the sheaths that cover the tendons in the thumb. The symptoms of trigger thumb are stiffness, tenderness, and thumb locked in bend position. Treatment options for trigger thumb involve cortisone injection, anti-inflammatory medicine, heat and in extreme cases, surgery is required.
De Quervain's Disease: it is the inflammation of tendons in the thumb that can extend to the wrist. The causes of De Quervain's disease are overuse, a direct blow to the thumb, repetitive clutching and rheumatoid arthritis. It affects the women 10 times more than the men. The most common symptom of De Quevain's disease is the pain at the back of the thumb. Other symptoms include pain and swelling at the base of the thumb. Finkelstein test is performed by the doctor for the diagnosis of disease. Treatment options are splints, ice, anti-inflammatory medicine, steroids, physical therapy and surgery.
Thumb Fracture: Thumb fracture can occur to any of the three bones in the thumb but almost 80% of the thumb fractures occur at the base of the thumb near the joint. The joint fracture is difficult to heal properly. Thumb fracture is caused by direct injury to the thumb such as fall or sports injuries or indirect injuries such as twist or muscle contraction. Bone disease or calcium deficiency increases the risk of fracture. Symptoms include pain, swelling, limited mobility, tenderness, and thumb deformation. Thumb fracture is diagnosed by physical examination and X-ray. Treatment options are cast, surgery, and physical therapy.
Thumb pain is mostly caused by tendon and ligament damage/breakage, inflammation and fractures. It leads to pain, swelling, and loss of motion, deformity and economic burden due to higher treatment cost. Treatment options such as surgery can sometimes cause more complications that can lead to the use of antibiotics and reopen the injury site.
Research shows that platelet rich plasma Prolotherapy is a safe option to treat the causes of thumb pain such as osteoarthritis. In a clinical research, the patients felt continuous relief after two PRP injections at 3 and 6 months follow-up. Platelet rich plasma Prolotherapy is also successful in decreasing the degree of deformity in the thumb caused by rheumatoid arthritis.
PRP Prolotherapy is effective in reducing thumb pain caused by tendon and ligament injury. A double-blind animal research performed by Dr. Liu showed that RPR Prolotherapy increased ligament mass by 44%, thickness by 27% and ligament-bone juncture strength by 28%. Increased ligament thickness and strength lead to the ligament healing and reduction in pain. Prolotherapy is more effective than the surgery in the treatment of biomechanical injuries that damage the ligaments.
Prolotherapy repairs and regenerate tissues and restore the normal motion without the risk of surgical trauma, scarring, and infection. Steroid injections are used to reduce thumb pain. These injections reduce the pain by inhibiting the inflammation process but do not treat the underlying cause of the pain as compared to PRP Prolotherapy which accelerates the inflammation process and heals the underlying cause of pain which leads to long-term pain relief.
For PRP Prolotherapy, the cause of thumb pain is diagnosed, the pain site is marked and the RPR injection is applied under sterile conditions. It takes from 3 to 6 months to completely eliminate the thumb pain after 2-3 PRP injections and it offers a long-term pain relief.
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.
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
Hauser, R. A., & Feister, W. A. (2013). Treatment of Basal Thumb Osteoarthritis: A Retrospective Study of Dextrose Prolotherapy Injections as an Alternative Treatment. Journal of Prolotherapy, e913-e921.
Loibl, M., Lang, S., Dendl, L. M., Nerlich, M., Angele, P., Gehmert, S., et al. (2016). Leukocyte-Reduced Platelet-Rich Plasma Treatment of Basal Thumb Arthritis: A Pilot Study. BioMed Research International.