We have seen many patients over the years who were looking for options to an arthroscopic wrist surgery for their unresolved wrist pain. They, like you perhaps, had a wrist pain that an MRI could not explain and their doctors felt that exploratory arthroscopic surgery may help find this pain. While the surgeons explored, the hope is that they may come upon something that they could repair. Whether or not that was the cause of the patient’s wrist pain, could not be confirmed until after the recovery period.
This type of surgical option is also one that many parents are trying to avoid for their young athlete. You may imagine that an athlete, with a small time table to return to sport would not want to chance a surgery and recovery where the outcome may be in doubt.
We offer non-surgical options to unresolved wrist pain. Stem cell therapy and Platelet Rich Plasma Therapy. In this article I want to present our research findings on the effects of Platelet Rich Plasma Therapy on unresolved chronic wrist pain published in the journal Orthopedic & Muscular System: Current Research (March 2019).
The objective of our study, was to share with the medical community our observations on pain and function in 6 patients who had their wrists (one patient had both wrists treated), who underwent PRP injections to the ligaments and joints of the wrist. We hypothesize that by strengthening the ligaments and regrowing tissue within the wrist joints, we may provide patients improved quality of life and pain relief.
You can download the entire study
These findings have been summarized here:
- Platelet-Rich Plasma (PRP) is a minimally invasive surgical alternative that uses components from a patient’s own blood to regrow tissue and relieve pain. This study investigated the clinical effect of PRP on unresolved wrist pain.
- Six patients and seven wrists underwent a series of two to four PRP injections for unresolved wrist pain.
- Outcomes of resting pain, active pain, upper functionality scale, and overall improvement percentage were measured and compared to baseline.
- The final follow-up was performed an average of 6.57 months after injection.
- All patients included in the study experienced decreases in pain and improvement in functionality score at final follow-up.
Here are the six patient cases we presented:
Patient case: 1 – 28 year old female:
- The first patient was a 28-year-old Caucasian female with 2 years of left wrist pain, most prominent when in flexion. The injury occurred when the patient fractured her left humerus in a snowboarding
accident. - She had tried pain medications and heat to relieve pain which provided minimal relief.
- The patient’s baseline characteristics were:
- a resting pain of 3/10,
- an active pain of 7/10,
- and a functionality score of 4/20.
- The patient received 4 PRP treatments over the course of four months.
- During the course of treatment, the patient steadily improved feeling 50% overall improvement after the third treatment.
- At her final treatment, she reported an 80% overall improvement with a 0/10 resting pain, a 0/10 active pain, and a functionality score of 32/40. The patient stated that the pain was not as frequent nor as
intense as it was prior to treatment.
Patient case: 2 – 42 year old male:
- The second patient was a 42-year-old Caucasian male with four months of right wrist pain.
- He described the pain he was suffering from as an achy feeling on the lateral aspect (the outer side) of his right wrist, typically aggravated during his daily activities.
- The patient had previously received a Celestone (steroid) injection three months prior to his first PRP treatment. The Steroid injection provided no relief.
- The patient also reported that he had tried dry needling treatment, NSAIDs, ice, and stretching with no relief of symptoms.
- An MRI displayed right wrist tendonitis and ulnar sided right wrist pain that may represent Extensor Carpi Ulnaris (ECU) tendonitis and a lunate triquetral ligament tear.
- The patient’s baseline characteristics were:
- a resting pain of 0/10,
- an active pain of 3/10,
- and a functionality score of 33/40.
Нe patient was treated with two PRP treatments within four days of each other. Shortly after the first treatment, the patient stated that the wrist continued to be tender but feeling significant better compared to prior to treatment. He then felt 100% improvement at a short follow-up aіer the second PRP treatment.
- A year aіer the second PRP treatment, the patient stated that he had sustained:
- 100% improvement,
- and reported 0/10 resting pain,
- 0/10 active pain,
- and a 40/40 functionality score.
Patient case 3: 31 year old female
- The third patient was a 31-year-old Caucasian female with two years of left wrist pain. The patient had felt a “pop” when she fell when lifting a heavy box.
- The patient saw a hand specialist who prescribed a splint and recommended arthroscopic surgery.
- She reported wrist edema and had a sharp pain when lifting heavy objects or doing bicep curls.
- She had undergone heat, massage, and Arnica gel to relieve pain in addition to wearing a wrist brace.
- An MRI showed findings consistent with partial tears of the ulnar attachment of the triangular fibrocartilage.
- Her baseline characteristics were:
- 7/10 resting pain,
- 9/10 active pain,
- and a 16/40 functionality score.
The patient received a series of two PRP treatments approximately two weeks apart.
- After her first PRP treatment, she noticed her resting pain had improved compared to prior to treatment. She continued to use heat four times a day, which momentarily helped to relieve pain.
- Five months after her last treatment, she reported a
- 20% improvement,
- a 5/10 resting pain,
- a 7/10 active pain
- and a functionality score of 21/40.
Patient case 4: 45 year old female
- The fourth patient was a 45-year-old Hispanic female with suffered with bilateral wrist pain for nine years.
- The patient had treated her wrist with deep tissue massage, acupuncture, ice, heat, and numbing cream, however, she felt only temporary relief.
- An X-ray of the right wrist showed advanced arthritis of the radiocarpal joint. It also showed possible erosions involving the triquetral bone, and a probable zone of subchondral cystic change involving the distal radius.
- Her baseline characteristics for both wrists were
- 3/10 resting pain,
- 7/10 active pain,
- and 20/40 functionality score.
The patient received two PRP treatments a month apart.
- After treatment, she stated a 25% improvement to both wrists.
- The patient’s final outcome scores for her right wrist were:
- a 2/10 resting pain,
- a 3/10 active pain,
- and a 24/40 functionality score.
The patient’s final outcomes for her left wrist were:
- a 2/10 resting pain,
- a 5/10 active pain
- and functionality score was a 23/40.
Patient case 5: 38 year old male
- The fifth patient was a 38-year-old Hispanic male with one year of left wrist pain.
- The patient stated that he heard his wrist “pop” while moving an object at work.
- He described the pain as sharp with numbness that was progressively worsening.
- He also stated that his primary doctor recommended surgery. An MRI on the left wrist showed a sprain of the dorsal intercarpal ligament and degenerative changes in the intercarpal joint between the distal scaphoid and trapezium.
- His baseline characteristics were
- a 0/10 resting pain,
- 4/10 active pain,
- and 31/40 functionality score.
The patient received 2 PRP treatments over a 3 week period.
- After the first treatment, he noticed an 80% improvement and stated that he was able to drive without as much discomfort compared to prior to treatment. He also noticed a decrease in the amount of clicking in his left wrist.
- Nine months after the second PRP treatment, he experienced additional benefit, including
- a 95% overall improvement,
- with a 0/10 resting pain,
- a 1/10 active pain,
- and a 40/40 functionality score.
Patient case 6: 59 year old female
- The sixth patient was a 59-year-old female with right wrist pain lasting the course of one year.
- A radiograph of his right wrist showed a Scapholunate Advanced Collapse (SLAC) wrist with radioscaphoid osteoarthritis.
- The patient had a limited range of motion and felt achy pain when supinating (hand with palm up) her wrist. She had previously received five cortisone injections, which had no improvement of pain and caused her to wear a brace daily. The pain had been so severe that it had prevented her from sleeping.
- Her baseline characteristics were
- 3/10 resting pain,
- 8/10 active pain,
- and 22/40 functionality score.
The patient received a series of 3 PRP treatments over a two month period.
- After the first treatment, the patient noticed a decrease in pain and a slight increase in the range of motion. She continued to have difficulties opening jars and performing daily tasks.
- Six months aіer her third PRP treatment, she reported a 50% overall improvement and noticed a substantial decrease in active pain and was able to perform her daily activities with less difficulties.
- Her final pain outcomes were:
- a 2/10 resting pain,
- a 4/10 active pain,
- and a 33/40 functionality score.
Summary
We found that all patients included in this study experienced improvements in resting pain, active pain, improvement percentage, and functionality score compared to baseline outcomes. It is also encouraging that none of these patients reported any adverse effects.
- On average, patients reported a 11% decrease in resting pain,
- a 53.33% decrease in active pain,
- a 55.64% total overall improvement
- and a 45.89% increase in functionality score.
Our results indicated improvement in all measurable outcomes for wrist pain and function aіer a minimum of two PRP treatments and continued improvement aіer a series of three or more treatments. To that end, patients in Cases 2 and 5 experienced the most notable results, with 100% and 95% overall improvement respectively following two rounds of PRP treatment. However, patients in Cases 3 and 4 experienced milder total improvements, at 20% and 25% respectively, under the same protocol of two PRP treatments.