Elbow, Wrist and Carpal Tunnel Pain 
Ross Hauser, M.D.

Eighty percent of chronic elbow pain is due to a sprain of the annular ligament, a ligament rarely examined by a family physician or an orthopedic surgeon.

Nearly all of our patients with chronic elbow pain tell us their doctors told them they have tennis elbow (lateral epicondylitis) and not a sprain of the annular ligament. The latest treatment for tennis elbow is the dreaded cortisone shots! Cortisone weakens tissue, whereas Prolotherapy strengthens tissue. 
    
Cortisone has temporary effects in regard to pain control whereas Prolotherapy has permanent effects. However, cortisone does have one permanent effect: Continual use will permanently weaken tissue. Anyone receiving long-term prednisone or cortisone shots will confirm this fact. 

The annular ligament's job is to attach the radius bone to the ulnar bone or in other words, to enable the hand to rotate, as in turning a key or a screwdriver. Because of the tremendous demands placed on the fingers and hands to perform repetitive tasks, the annular ligament is stressed every day. Eventually, this ligament becomes lax and a source of chronic pain. 

Unfortunately, many patients with elbow and hand pain have been also been misdiagnosed with Carpal Tunnel Syndrome. Carpal Tunnel Syndrome refers to the entrapment of the median nerve as it travels through the wrist into the hand. The nerve supplies sensation to the skin over the thumb, index, and middle fingers. A typical Carpal Tunnel Syndrome patient will experience pain and numbness in these areas of the hand. 

 Because most physicians do not know the referral pain patterns of ligaments, they do not realize that cervical vertebrae 4 and 5 and the annular ligament can refer pain to the thumb, index, and middle fingers. Ligament laxity can also cause numbness. Cervical and annular ligament laxity should always be evaluated prior to making the diagnosis of Carpal Tunnel Syndrome. Surgery for Carpal Tunnel Syndrome should not be done until an evaluation is performed by a physician who understands the referral patterns of ligaments and is experienced in Prolotherapy. 

 Seldom do patients find relief from the "Carpal Tunnel" complaints of pain in the hand and elbow with physical therapy and surgery because the diagnosis is wrong. The most common reason for pain in the elbow referring pain to the hand is weakness in the annular ligament, not from Carpal Tunnel Syndrome. Several sessions of Prolotherapy will easily strengthen the annular ligament and relieve chronic elbow pain.