How to Treat the Wrist with Stem Cells
Harvested adult adipose derived stem cells are meticulously injected into the wrist joint under guidance of fluoroscopic x-ray, utilizing local anesthesia. Once it is inside the wrist joint, the stem cells have the ability to repair the cartilage in numerous ways.
Stem cells secrete many different soluble factors which transform the tissue microenvironment in ways such as:
- Controlling joint inflammation.
- Growth factors which stimulate repair of cartilage.
Stem cells can differentiate into cartilage cell lines.
Osteoarthritis is also known as degenerative joint disease. This occurs when the cartilage that covers the top of the bones, known as articular cartilage, degenerates or wears down. This causes swelling, joint pain, stiffness, and decreased range of motion. Damage from mechanical stress with insufficient self-repair by joints is believed to be the primary cause of osteoarthritis.
Osteoarthritis most often occurs in people who are over 50. In younger people, osteoarthritis can result from an injury or trauma such as a fractured or dislocated joint. Rarely, osteoarthritis may also be hereditary.
Osteoarthritis of the wrist is mostly seen as a posttraumatic condition. There are different types of posttraumatic arthritis. Scapholunate advanced collapse (SLAC) is the most common form, followed by scaphoid nonunion advanced collapse (SNAC). Other posttraumatic causes such as intra-articular factors of the distal radius or ulna can also lead to wrist osteoarthritis.
The most common initial symptom of wrist osteoarthritis is joint pain. This pain is brought on by activity and increases when there is activity after resting. Other signs and symptoms affected by osteoarthritis include morning stiffness, swelling, crepitus (crackling), joint locking, and joint instability. These symptoms can lead to loss of function of the wrist and hand and less daily activity capabilities.
A ligament is the tissue which attaches bone to bone, and holds them in position to perform all of the necessary functions. Injuries to the scapholunate ligament, triangular fibrocartilage complex, and ulnocarpal ligaments always disrupt normal function of the wrist and can lead to post traumatic degenerative arthritis (see section on wrist osteoarthritis).
Rheumatoid arthritis (RA) is a long-lasting autoimmune disorder that primarily affects joints. It commonly results in warm, swollen, and painful joints. Although most commonly, the wrist and hand are involved, the disease also affects other parts and joints of the body.
Although the cause of rheumatoid arthritis is not completely clear, it involves a combination of genetic and environmental factors. The underlying mechanism involves the body’s immune system attacking joints. This affects the underlying bone and cartilage. The diagnosis is primarily based on the person’s signs and symptoms, with the assistance of x-rays and laboratory testing. The goal of treatment is to reduce pain, decrease inflammation, and improve the individual’s overall functioning. This is assisted by balancing rest and exercise, uses of splints, braces, or assistive devices, and use of various medications, including steroids, NSAIDs, or the use of disease-modifying anti-rheumatic drugs to slow the progression of disease.
RA typically presents with signs of inflammation with the affected joints being swollen, warm, painful and stiff, particularly early in the morning upon awakening, or following prolonged activity. Increased stiffness early in the morning is a prominent feature of this disease, and typically last for more than an hour. As the pathology progresses, the inflammatory activity leads to tendon tethering with erosion and destruction of the joint surface. This ultimately impairs range of movement and can lead to deformity. RA also can involve the skin, lungs, kidneys, heart and vessels, as well as multiple other body systems. RA reduces lifespan an average from 3 to 12 years, but a positive response to treatment may indicate a better prognosis.
RA symptoms most commonly affect the smaller joints of the wrists and hands. RA inflammation causes wrist swelling and allows the fluid into the joint cavities, causing puffiness and stiffness of the wrist and hand.
Tendonitis / Tendinosis
Tendinosis, however, is a chronic injury caused by an accumulation of small tears in the tendon that have failed to heal properly over time. Patients commonly find it almost impossible to keep from restraining the tendon, because even when the pain is gone, the tendon still hasn’t fully healed.
Tendinitis refers to inflammation of a tendon, a flexible band of tissue that connects the muscles to the bones. The pull of the muscles is transmitted to the bone by the tendons which allow movement. When the tendons are inflamed and irritated, the pulling action of the muscle is impaired with loss of function of the joint. Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and a tendon and joint area can become stiff the following day, as muscles tighten from the movement of the tendon.
Tendinitis injuries are particularly common in the upper extremity, including the wrist. Individual variation in frequency and severity of tendinitis will vary depending on the type, frequency and severity of the exercise or use; for example, rock climbers, mechanics, plumbers, and gymnasts tend to develop tendinitis in the wrist and fingers.