Prolotherapy For Golfing Injuries And Pain (P4)
SLAP Lesions Biceps Tendonitis/Tendonosis. Superior labral (SLAP) lesions also occur in golfers. These patients complain of pain affecting the lead shoulder during the end of the backswing or beginning of the downswing. Sometimes there are complaints of clicking or catching or subjective weakness at ball contact during the swing. For isolated biceps tendonitis/ tendonosis, anterior shoulder pain is most marked during the latter part of the follow-through phase. No definitive studies have been done on prolotherapy and SLAP lesions, although some clinical experience has demonstrated improvement with prolotherapy treatment (see Case Report 3). Bicipital tendonitis/ tendonosis lends itself well to prolotherapy treatment and this should be tried prior to surgery unless there is a rupture or detachment requiring surgery.
Transverse Humeral Ligament. Often forgotten is the small but important transverse humeral ligament (THL). The THL is a small ligament holding the long head of the biceps tendon in its groove. It is described in Gray’s Anatomy as: “a broad band of fibrous tissue passing from the lesser [tuberosity] to the greater tuberosity of the humerus, which maintains the position of the tendon of the long head of the biceps within the bicipital groove” (see Figure 7). With repetitive use and or trauma, the THL may become stretched and lax, causing excessive biceps tendon motion.76 The patient will complain of a twinge-like feeling anteriorly and pain during motions that use the biceps, such as anterior pain during portions of the golf swing. Prolotherapy is very effective in stimulating the repair of this small ligament, stabilizing the biceps tendon, and resolving pain.
Adhesive Capsulitis. Adhesive capsulitis (frozen shoulder) is another shoulder presentation that may occur when the golfer has suffered an injury, then limited shoulder motion afterwards. This can be particularly troublesome if it has advanced. However, if caught early, aggressive physical therapy to break the adhesions and restore range of motion, followed by prolotherapy on a subsequent visit for the underlying injured tendon, is effective. Initially, local anesthetic to the shoulder joint can be used in the office and manipulation/stretching of the joint done there to start the process of breaking the adhesions. Exercises based on osteopathic muscle energy technique for this purpose can also be helpful (see Figure 8). The patient should be instructed to do these exercises two to three times daily, and should also be sent for aggressive physical therapy to continue mobilization of the joint where possible. Followup visits include reevaluation of range of motion, and continued prolotherapy treatments to the underlying injury, with many patients resolving within the typical four to six treatment average.
Wrist and Hand Injuries
The wrist is a sea of ligaments (see Figure 9). These ligaments are injured most typically by hyperextension of the wrist during the golf swing and occur most commonly in the left (leading) wrist or hand. Stability of the wrist is dependent on the stability of the wrist ligaments. Overuse or poor wrist control during the swing can cause excessive joint movement leading to wrist ligament injury. Wrist ligamentous injuries can be successfully treated with prolotherapy. Common areas treated with prolotherapy include the distal radioulnar joint, dorsal intercarpal ligaments, and ulnar collateral ligaments (see Figures 10-12).