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Diseases
treated by Prolotherapy - Peripheral Joints
JAY W. NIELSEN, M.D.
TMJ
Tempero-Mandibular
Joint Syndrome is more often diagnosed by the dentist than the doctor.
Symptoms include clicking of the jaw joint in front of the ear, fatigue with
chewing, jaw locking and spasms in the throat. Symptoms at a distance include
all the symptoms of Barre'-Lieou, headache and vague dizziness.
The dentist
can grind down a high tooth with occasional relief. A denture designed to put
a space between the back molars can also help. It these fail, major medical
centers will cut the jaw and re-align it though not with very good success. A
single injection into the joint once every two weeks for five visits can
relieve most if not all the symptoms in a majority of cases. If the ligament
is completely torn, it cannot be repaired because Prolotherapy only
strengthens existing ligament; it will not bridge a gap.
Shoulder
Pain and the Rotator Cuff Tear
The shoulder
starts at the sternum and thoracic spine. Ligament injury to the shoulder is
usually broad and weakens all structures. Therefore, Prolotherapy works best
on the shoulder when it is all inclusive of these areas. Ligaments of
importance attach the collarbone to the breastbone, the collarbone to the
scapula (shoulder blade), and the scapula to the humerus (the upper arm bone).
There are a dozen small ligaments holding the acromion process, coracoid
process, clavicle and humerus in position. It these are weakened, the space is
narrowed with subsequent Thoracic Outlet Syndrome. The humeral head drops in
the socket causing arthritis and clicking and grinding begin. Many injured
shoulders are associated with a ruptured cervical disc in the neck. Shoulders
pain evaluation should always include a neck x-ray. A large rotator cuff tear
on MRI in the middle of the ligament cannot be repaired with Prolotherapy. The
healing effect will not reach that far across the long ligament. Surprisingly,
many patients with mid-belly tears improve anyway because the Prolotherapy
lifts the humerus back into the fossa relieving pressure on the cuff. Tennis
Elbow or Lateral Epicondylitis is one of the simplest things to repair with
Prolotherapy. Because we have recently (five million years!) become bipedal or
upright, we have restructured our elbow to allow better use of tools rather
than knuckle walking.
This
resulted in the forearm muscles attaching at the elbow over a very small
surface area. Wrenching at heavy objects such as knobs, pliers or repeatedly
hammering with the fingers on a keyboard rips the attachment off the bone
partially leaving a chronic tendonitis. It the tendonitis that makes this easy
to fix. Since the ligament is already inflamed, the Prolotherapy shots don't
need as many injections to start the fibroblast formation. The injections
permanently make the attachment wider and stronger.
Carpal
Tunnel Syndrome
Carpal
Tunnel Syndrome is the number two cause of missed work after back pain in the
American worker. The cause of CTS is that repetitive use of the forearm and
wrist as with Tennis Elbow tears the ligaments over the back of the wrist. The
wrist is an arch of bones in two rows that create a tunnel through which pass
the tendons, arteries, nerves and veins to the hand in order of
compressibility.
The most
sensitive structure in the arch is the median nerve supplying the index
through ring fingers. As this arcade collapses, the patient starts to suffer
numbness and tingling at night, shooting pains in the hand and forearm, minor
hand swelling and finally weakness and muscle loss as the nerves are
permanently ruined.
Remember
that the back of the wrist is injured as proven by many autopsy studies. The
surgeon goes in and cuts the only good tendon on the front of the wrist so the
bones are equally weak front and back to relieve the pressure! He even warns
you will be weaker after surgery. No surprise the surgery has a high failure
rate. Injections into the ligaments on the back of the wrist can rebuild the
damage and correct the problem in most cases.
Early
management is superior to waiting until the muscles are ruined. The same wear
and tear that wears the elbow and wrist can break down the delicate ligaments
stabilizing the joints in the fingers and especially the thumb. Years of
continued use wears the cartilage in these joints causing pain and weakness.
Prolotherapy can create remarkable relief in even badly worn joints.
Hip Pain
Hip pain is a very complicated work-up. The obviously worn hip on x-ray
frequently is not the cause of hip pain. Before performing Prolotherapy on the
hip or surgical joint replacement, thorough attention needs to be paid to the
lumbar discs, sacroiliac joint and knee. Every one of these diseased joints
can refer to the hip. Sometimes, remarkable relief comes just from inserts for
a fallen arch or a shoe lift for a short leg. Hip pain also can arise from
inflamed structures in the pelvis such as ovarian cysts, diverticulitis or
bowel cancer.
Knee Pain
The knee is
the most common joint to undergo joint replacement after the hip. A
disappointing number of patients are dissatisfied with the results. The
rehabilitation is long, the surgery is expensive and the socket comes loose
and needs redone with injury as minor as a fall. Once the knee is replaced,
there is no going back, the joint has been disposed of and if the implant
infects, the knee is useless and months of antibiotics will be required.
The role of
knee ligaments is to keep the flat plane of the tibia in perfect alignment
with the moving curved surface of the femur. If the medial or collateral
ligaments in the knee are stretched by injury or repetitive use, the joint
starts to wear on one edge rapidly eroding the cartilage and then bone.
As the joint narrows,
the process is compounded by instability, as the ligaments that spanned the
joint are now too long to keep the joint tight.
Prolotherapy directly
addresses the problem by restabilizing the joint ligaments. The kneecap or
patella also becomes loose and rides erratically down the groove wearing out
the back of the kneecap. All these ligaments are rebuilt together with
surprising success. Continuous use of Glucosamine keeps the little remaining
cartilage continually healing to allow the patient to avoid surgery. No knee
joint is too damaged to try Prolotherapy in our experience. While Prolotherapy
cannot repair a torn cruciate ligament, the knee ligaments are rarely injured
one at a time. If the cruciate is no more than torn half through, stabilizing
the other ligaments can postpone or completely cancel surgery. Prolotherapy is
commonly used by veterinarians to keep thoroughbred horses racing after
significant injuries. James Matthews MD of New York is an Orthopedic Surgeon
who has principally been performing Prolotherapy for decades in his practice
prior to surgical management. He published a fascinating study in the Journal
of Orthopedic Medicine.
ABSTRACT: "This
is a preliminary report on a new approach to the treatment of osteoarthritis
(OA) of the knee. Patients with OA of the knee, having no history of
significant injury or inflammatory arthritis, were examined for evidence of
sacroiliac joint (SIJ) ligament laxity and SIJ mal-alignment. Sixteen patients
meeting these criteria were treated with ligament Prolotherapy of the SIJ
ligaments. Improvement in knee pain was noted in 15 of 16 patients. In the 8
cases with significant loss of range of motion and effusion (fluid in the
joint), objective improvement occurred in 7.
This is the reason
why hip and knee pain evaluation must include x-rays all the way up to the
back. Every one of these patients had pain directly as a result of back
pathology. Knee replacement would most likely have failed in every case.
Ankle Pain: The most
common cause of adult chronic ankle pain is failure to follow instructions at
the time of relatively simple ankle sprains in youth. The ligament ceases to
be painful in 10-14 days but the ligament is not healed for weeks after. If
the patient doesn't rest and wear and Aircast for eight weeks, the ligament
heals in a lengthened position and now the ankle is even more prone to
re-injury.
Chronic weight
bearing on the joint out of alignment causes premature arthritis. The second
cause of adult chronic ankle pain is ligament injury at the time of fracture.
While the bones knit nicely, the associated ligaments are disrupted by the
swelling and callous formation of the fracture. Ankles show excellent response
to Prolotherapy regardless of age. Foot pain and deformity is most often better
handled by the Podiatrist with inserts in the shoes but when conservative
measures fail, the foot should be evaluated for permanent ligament laxity.
Heel spurs, bunions and mid- foot pain can all be partially relieved by
Prolotherapy.
Introduction to Prolotherapy
Why Get Prolotherapy? Donna Alderman, D.O.
What is Prolotherapy?
Alvin
Stein, M.D.
Introduction to Prolotherapy
Ross
Hauser, M.D.
How
Safe Is Prolotherapy? Ross
Hauser, M.D.
The
Importance of an Experienced Prolotherapist Ross
Hauser, M.D.
Non-Surgical
Tendon, Ligament and Joint Reconstruction William J. Faber, D.O.
How Does Prolotherapy Work? Marc
Darrow, M.D.
When Prolotherapy May Not Work David Harris, M.D.
Twenty
Common Questions About Prolotherapy
David
Harris, M.D.
The History of Prolotherapy Ross
Hauser, M.D.
Curing Chronic Pain with Prolotherapy Scott
Greenberg, M.D.
Why So Many Turn To Prolotherapy
David Harris, M.D.
Prolotherapy
and Chronic Pain Ross Hauser, M.D.
Peripheral Joints
& Prolotherapy
Jay W. Nielsen, M.D.
Orthopedic Medicine: A
Non-Surgical Approach to Chronic Pain Lawrence
Cohen, M.D.
The Difference
Between Prolotherapy, Trigger Points, and Acupuncture Marc Darrow,
M.D.J.D.
Prolotherapy: Creating
Inflammation in an Area that is Already Inflamed Marc Darrow,
M.D.J.D.
Growth Factor Basis of
Prolotherapy
David Harris, M.D.
What
Does It Take To Heal Connective Tissue?
Dave
Harris, M.D.
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