Prolotherapy For Golfing Injuries And Pain (P5)
Unusual Causes of Wrist or Hand Pain. While fractures are uncommon, the physician should consider the possibility of a hamate fracture(the bone behind the ring and little finger) as these type of fractures are a golfing specialty. Often overlooked, damage to the hook of the hamate is caused by a direct blow from the handle of the golf club during a “fat shot” (hitting the ground). Patients complain of vague, deep-seated pain or weak grip. There is local tenderness and pain to resisted flexion of the little finger. A carpal tunnel X-ray view or a CT scan is necessary to show the fracture radiographically and should be ordered if there is a suspicion of this injury. Surgery is needed to remove the hook bone fragment. To prevent these types of fractures, the butt of the club should be of appropriate size and length, extending beyond the palm of the leading hand.
As with any physical evaluation, a thorough and careful history and exam of the golfing injury are important in making an accurate diagnosis. Having the golfer explain during which phase of the swing the symptoms are worst can be helpful in diagnosis.83 For example, with shoulder injuries, pain during the backswing can exacerbate subacromial impingement or acromioclavicular issues because of the positioning of the leading arm (internally rotated, forward flexed and abducted). If pain occurs during the follow-through where the leading arm is abducted and externally rotated, a diagnosis of anterior instability or biceps tendonitis/osis is supported. Before a diagnosis is made, standard orthopedic testing should be done, along with a thorough history of the injury, exacerbating or mitigating factors, and review of previous treatments and success of those treatments.
MRI’s may sometimes be useful but, as discussed in previous articles, may also be misleading in diagnosing musculoskeletal pain. As many pain practitioners know, an MRI may show nothing wrong and yet the patient is still in pain. And, because MRI’s may also show abnormalities not related to the patient’s current pain complaint, these MRI findings should always be correlated to the individual patient’s presentation. Many studies have documented the fact that abnormal MRI findings exist in large groups of pain-free individuals. A study published in the New England Journal of Medicine showed that out of 98 pain-free people, 64% had abnormal back scans. Many other studies have also shown abnormal neck MRI scans in asymptomatic subjects. A study of elite athletes performing repetitive overhead activity also demonstrates this point. At the study’s start, none of the athletes had any shoulder pain or problems. Yet on MRI, 40% showed partial or full thickness tears of the rotator cuff, and 20% showed other abnormalities. After five years, none of the athletes interviewed had any complaints or had had any evaluation or treatment for shoulder-related problems during the previous five years. The conclusion of the study was that an MRI alone should not be used for diagnosis.
Prolotherapy is an effective non-surgical treatment option for golf related injuries, including low back pain, lateral and medial epicondylitis, wrist ligament injuries, shoulder injuries as well as other musculoskeletal joint pain. Because many golf related injuries are a result of repetitive strain—whereincomplete healing has occurred—prolotherapy makes even more sense as a treatment modality to stimulate connective tissue repair. Prolotherapy should only be done by a practitioner trained in the procedure and any physician interested in learning the procedure should seek out appropriate instruction. Otherwise, the practitioner should refer to a physician thoroughly trained in the procedure. Prolotherapy can be a very effective option for the golfer who wants to play at peak levels unencumbered by musculoskeletal pain.