Ross Hauser, MD, MD; Nicole M. Baird, CHFP; Joe J. Cukla, LPN. A Retrospective Observational Study on Hackett-Hemwall Dextrose Prolotherapy for Unresolved Hand and Finger Pain at an Outpatient Charity Clinic in Rural Illinois. Journal of Prolotherapy. 2010;2(4):480-486.
Hand and finger pain and stiffness are common problems that can affect the productivity of those afflicted, especially in regard to their activities of daily living. Prolotherapy is an injection treatment used to initiate a healing response in injured connective tissues such as tendons and ligaments, tissues commonly involved with hand and finger injuries. A retrospective observational study on prolotherapy for hand and finger pain was done at an outpatient charity clinic.
Design: Forty patients, who had been in pain an average of 55 months (4.6 years), were treated quarterly with Hackett-Hemwall dextrose Prolotherapy. Patients were contacted an average of 18 months following their last Prolotherapy session and asked questions regarding their levels of pain and stiffness before and after their last Prolotherapy treatment.
Results: In these 40 patients, 98% had improvements in their pain. Eighty-two percent had 50% or more pain relief. Dextrose Prolotherapy caused a statistically significant decline in patients’ pain and stiffness. Prolotherapy helped all but one patient on pain medications reduce the amount of medications taken. All 40 patients have recommended Prolotherapy to someone.
Conclusion: In this retrospective observational study, Hackett- Hemwall dextrose Prolotherapy treatments helped reduce the pain and stiffness in patients with unresolved hand and finger pain.
The optimal long-term, symptomatic therapy for chronic hand and finger pain has not been established. Symptomatic hand pain and stiffness due to Osteoarthritis (OA) effect approximately 6-8% of the US adult population.1, 2
The prevalence of hand OA tends to be higher in women and elderly persons.3-5 It may be diagnosed via radiological tests (eg. X-ray), reported joint symptoms, or a combination, with the most commonly affected sites being the distal interphalangeal (DIP) and first carpometacarpal (CMC) joints, followed by the proximal interphalangeal (PIP) and other CMC joints.6
While hand osteoarthritis is a common cause of hand and finger pain and stiffness in older populations, athletic injuries, overuse, and excessive forces are the causes typically associated with younger populations.7-9 Hand and finger pain may effect activities of daily living and quality of life enough that they seek medical attention.
The traditional and conservative treatments for unresolved hand and finger pain can include topical and oral analgesics, non-steroidal anti-inflammatory (NSAIDS) medications, rest, exercise, splints and taping, corticosteroid injections, and surgery, though each has its own risks or lack of efficacy.10-15 Two of the more widely used pain treatments include corticosteroid injection and NSAID medications, however, these can accelerate osteoarthritis and further damage the joint.16, 17 In addition, anti-inflammatories may not provide much long term pain relief, as seen in a randomized controlled trial which showed that corticosteroid injections in the carpometacarpal joint of the thumb for osteoarthritis were no better than a placebo in reducing pain when compared at 24 weeks.18 Because of the limited response of chronic joint pain to traditional therapies, many people are turning to alternative therapies, including Prolotherapy, for pain control.19, 20
Dextrose Prolotherapy is becoming more widely used for symptoms related to pain and joint dysfunction in both integrative and allopathic medicine. Its primary application is in pain abatement associated with tendinopathies and ligament sprains in peripheral joints.21, 22 It is also being used in the treatment of spine and joint degenerative arthritis.23, 24 The effectiveness of Prolotherapy is still being debated, with promising but mixed results being reported.25-27
George S. Hackett, MD, coined the term Prolotherapy.28 As he described it, “The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the “weld” of fibrous tissue and bone to stabilize the articulation and permanently eliminate the disability.”29 Dr. Hackett introduced Prolotherapy to Gustav Hemwall, MD, in the mid-1950s. Dr. Hemwall continued Dr. Hackett’s work after his death in 1969 and trained the majority of the physicians who practiced the technique over the next 30 years.30 Hence the designation Hackett-Hemwall dextrose Prolotherapy.
Animal studies have shown that Prolotherapy induces the production of new collagen by stimulating the normal inflammatory reaction.31, 32 In addition, animal experiments using dextrose Prolotherapy injections at the fibro-osseous junction have shown measurable increases in ligament and tendon diameter and strength, as evidenced upon post-mortem exam.33 K. Dean Reeves, MD, has conducted two human studies that showed Prolotherapy has the potential to reverse degenerative arthritis. One of his studies involving 150 finger joints on 27 patients, indicated that after six series of Prolotherapy injections a statistically significant improvement in joint narrowing scores as revealed by X-rays, compared to a placebo, was seen in the dextrose Prolotherapy group one year after treatment.34, 35 Prolotherapy is commonly taught and used for unresolved hand and finger pain.36
However, other than Dr. Reeves’ aforementioned study, no other analysis regarding Prolotherapy and hand and finger pain has been done. This observational study was undertaken to evaluate the effectiveness of Hackett- Hemwall dextrose Prolotherapy in regards to reducing the subjects’ previously unresolved hand and finger pain and stiffness and also its effectiveness in reducing or eliminating their need for pain medications.