Wrist Pain

Wrist pain is a common complaint and many types are caused by sudden injuries that result in sprains or fractures as well as more long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome.

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand. Tough bands of ligament connect your wrist bones to each other, to your forearm bones and hand bones. Tendons attach muscles to the bone. Damage to any of the wrist structures can cause pain and affect your ability to use your wrist and hand.

Wrist pain may vary, depending on the cause. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing pain. The precise location of your wrist pain can also give your doctor clues as to what might be causing your symptoms.

Injuries

  • Sudden impacts:

    The most common method of injuring your wrist is when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures.

  • Repetitive stress:

    Any activity that involves repetitive wrist motion such as hitting a tennis ball, bowing a cello, or driving cross-countrycan inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours without a break.

  • De Quervain’s

    disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

  • Osteoarthritis:

    In general, osteoarthritis in the wrist is uncommon, usually occurring only in people who have injured that wrist in the past. Osteoarthritis is caused by wear and tear on the cartilage that cushions the ends of your bones. Pain that occurs at the base of the thumb may be caused by osteoarthritis.

  • Rheumatoid arthritis.

    A disorder in which the body’s immune system attacks its own tissues, rheumatoid arthritis is common in the wrist. Usually both wrists become affected.

Other diseases and conditions

  • Carpal tunnel syndrome:

    Carpal tunnel syndrome develops when there’s increased pressure on the median nerve, which passes through the carpal tunnel, a passageway in the palm side of your wrist.

  • Ganglion cysts:

    These soft tissue cysts occur most often on the top of your wrist opposite your palm. Smaller ganglion cysts seem to cause more pain than larger ones.

How Is Wrist Pain Diagnosed?

History and Examination:

A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays:

Plain X-rays can reveal changes in and around the joint as it relates to the bone. X-ray will reveal the extent and severity of arthritis in the joint. X-ray does not show soft tissue such as ligaments, tendons, cartilage, muscle or nerve.

MRI (Magnetic Resonance Imaging):

Is a noninvasive procedure that can reveal the detail of joints structures such as the bone, ligaments, tendons, cartilage, muscle and nerve.

Myelography/CT scanning:

Sometimes used as an alternative to MRI

Diagnostic ultrasound Imaging:

Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your wrist pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors that is contributing to your pain. With this information in hand, specific treatment options can be established immediately!

Treatment

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis in the Wrist and Hand:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in thewrist causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, squeezing, holding objects, fine movement of the fingers and hand, lifting and carrying are often painful. Pain is often increased during or after activity.

What is Hyalgan?

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Hyalgan is a naturally derived lubricant that is FDA approved, safe and effective atinstantly cushioning and lubricating painful arthritic joints.

By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

Lipogems Regenerative Medicine: Healing Damage – Tears and Chronic Tendinitis:

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

– See more at: http://optimumjointmd.com/index.php/2015/12/10/shoulder-pain/#sthash.rfJRy7sh.dpuf

 

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

    Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

    Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

    Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

    Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

    The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

 You should see your doctor if:

  • Your wrist pain continues for more than three weeks
  • The pain is restricting use of your hand
  • The pain is getting worse
  • There is swelling of the wrist and hand
  • Your experience numbness or tingling into the fingers
  • Your grip is getting weaker
  • You are dropping objects within your grip
  • You awaken in the morning with your hands feeling numb

Our Mission Statement

We want to make a difference. We are dedicated to providing our patients with updated and current treatment alternatives for adults suffering with joint and spine pain. Our staff regularly attends several conferences per year on ultrasound guided interventional medicine addressing new and innovative, as well as traditional techniques in treating joint pain. This allows us to utilize and implement the practices and techniques of leaders in diagnostic ultrasound imaging and ultrasound guided treatment from Europe, Asia, Canada and the United States at prestigious institutions including the Mayo Clinic.

We remain on the cutting edge of treatment objectives to help our patients feel better!

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.