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Dextrose Prolotherapy for Unresolved Wrist Pain

Authors: Ross A. Hauser, MD; Marion A. Hauser, MS, RD; and Patricia Holian, RN

The wrist is a very complex structure and is composed of eight small bones which are connected by ligaments. When these structures are injured, pain may result along with the inability to use the hand and/or the upper extremity—including the shoulder. Obviously, most people would consider use of the hands an essential function, thus properly treating the wrist pain/injury can greatly affect a patient’s quality of life. The articulation afforded the hand and the upper extremity by the wrist is essential for mobility, strength, and dexterity that most patients need to function in their daily lives.

Interestingly enough, primary care physicians frequently see patients in their offices with complaints of wrist pain. The causes of wrist pain are typically related to overuse, as well as repetitive and high impact injuries that may be work or sports related. These injuries often start as an acute tendonitis or ligament sprain and, if not effectively treated, can result in chronic pain due to the formation of degenerative arthritis. Symptoms are frequently gradual at first—with mild aching but full range of motion—and then typically progress to more acute pain along with impaired movement of the hand and upper extremity. Approximately one person in seven (13.6%) of the U.S. population has degenerative wrist arthritis.¹

Typical treatments for unresolved wrist pain, including degenerative arthritis, are conservative in nature. These treatments include rest, physical therapy, NSAIDs, splinting, cortisone injections, and ergonomic modification of work stations. Though these treatments are commonly prescribed, they often produce only temporary results. Objective proof to support the use of these treatments is lacking.^2,3 When the pain does not remit—especially pain related to carpal instability—the patient is then often referred to a surgeon to assess for surgery. Surgery is usually arthroscopy or a fusion.⁴ As surgery can be fraught with complications—such as plate tenderness, nonunion, distal radioulnar joint pain or dysfunction, persistent unexplained pain, and carpal tunnel syndrome—patients often look for other options.⁵ However, because traditional wrist pain therapies often do not result in positive remission of symptoms, many patients are turning to alternative therapies such as prolotherapy to achieve positive outcomes.⁶

Prolotherapy, an injection therapy that stimulates the body to repair weak/injured areas of the body, is fast developing into a recognized form of pain management in both the complimentary and allopathic medicine fields. Its primary use has been related to the pain management associated with tendinopathies and ligament sprains in peripheral joints.^7,8 Prolotherapy is also effectively used in the treatment of spine and joint degenerative arthritis.^9,10 In double blind human studies, the evidence to support the effectiveness of prolotherapy has been considered encouraging but varied.^11-14

George S. Hackett, MD coined the term prolotherapy and was one of the originating prolotherapy pioneers back in the 1940s. Hackett wrote, “The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the ‘weld’ of fibrous tissue and bone to stabilize the articulation and permanently eliminate the disability.”¹⁵

Animal studies have shown that prolotherapy stimulates the production of new collagen by initiating the normal inflammatory reaction.^16,17 Animal studies have also revealed ligament and tendon diameter and strength improvements with prolotherapy.^18-20 While prolotherapy is commonly taught and used for unresolved wrist pain,²¹ no study has been done to date related to effectiveness. This observational study’s purpose was to evaluate the effectiveness of Hackett-Hemwall dextrose prolotherapy—not only on unresolved wrist pain but on quality of life measures, and its ability to reduce or eliminate the need for pain medications.

Figure 1. Typical prolotherapy injection sites for Hackett-Hemwall prolotherapy of the wrist.