P-067 - Dextrose Prolotherapy as a Treatment for Thumb Pain: A Case of a Hobby Video Gamer

Abstract Title: Dextrose Prolotherapy as a Treatment for Thumb Pain: A Case of a Hobby Video Gamer


Background: Electronic sports (esports) represent a unique and rising aspect of sports medicine^1,2. This unique sport encompasses athletes who use a variety of electronic platforms to compete in several video games. However, gamers may include individuals playing casually for entertainment, streaming for hobby, or esports athletes on formal teams competing in tournaments. The nature of esports and gaming leads to a wide variety of injuries and medical considerations ranging from ophthalmologic strains, metabolic considerations, mental health and an array of musculoskeletal injuries^1,2. Gamers are particularly prone to injuries of the neck and upper extremity given the requirements of prolonged sitting and repetitive use of the shoulder, forearm, wrist and fingers to navigate gaming platforms^1,2. Wrist and hand injuries specifically are prevalent among gamers³. Common injuries may be acute or a result of more chronic overuse and could include various sprains, strains, degenerative disease, and specific diagnosis like Gamer’s thumb and Gamekeeper’s thumb. Gamer’s thumb, also known as de Quervain's tenosynovitis, is caused by overuse and results in inflammation on tendons in the first extensor compartment. Gamekeeper’s thumb, also known as Skier's thumb, is caused by injury to the ulnar collateral ligament.

Purpose/Objectives: A variety of treatment options can be used for musculoskeletal injuries including those of the wrist and hand. Conservative management is often conducted using various options including oral and topical medications, rest, ice, heat, home exercises, bracing or occupational and physical therapy. Another area of treatment is injection therapies including steroids for symptomatic relief and agents such as platelet-rich plasma (PRP) or prolotherapy that offer potential regeneration. Dextrose prolotherapy specifically has been shown to be effective in various musculoskeletal conditions, most notably osteoarthritis (OA)⁴. It's proposed mechanism is that increasing irritation and inflammation prompts a proliferative response, resulting in increased strength and stability at the injection site⁴. This led to considering the potential for using dextrose prolotherapy in treating musculoskeletal injuries in gamers. In this case study an amateur gamer who presented with pain of the first carpometacarpal (CMC) joint was evaluated and treated.

Methods: A 34-year-old female presented to the clinic with pain at the base of her right thumb. She described a constant pain for one month that was exacerbated by movement. She worked at a desk on a computer and streamed video games in the evenings. Since the pain began she was unable to perform her job and gaming normally. Past medical history was significant for a previous skier's thumb injury on the right several years prior. Physical exam showed full active to passive range of motion in the bilateral wrist and fingers. No erythema, edema, increased temperature or skin changes in the bilateral upper extremities were observed. Radial pulses were 2+ bilaterally with normal capillary refill. Tinel’s and Finkelstein’s tests were both negative. Tenderness to palpation was found at the right first CMC joint. The patient was diagnosed with a sprain of the first CMC joint and 1cc of 15% dextrose solution was injected under palpatory guidance into the joint space. The patient was advised to avoid anti-inflammatory medication and vigorous use of the thumb as well as to return in one month. At the next appointment, a second dextrose prolotherapy injection was performed.


Results: The patient returned five weeks later, following an initial 15% dextrose prolotherapy injection, and reported a 75% improvement in her pain. At this follow-up, when the second prolotherapy injection was performed, 25% dextrose solution was used. Four weeks after the second prolotherapy injection, the patient reported a 95% improvement in her pain and was able to return to her normal activities.

The incidence of musculoskeletal injuries in gamers and esports athletes is not uncommon and will likely continue to increase. Hand and wrist injuries among gamers cover a range from mild to severe, with notable cases of tendon rupture associated with excessive gaming^1,2,5,6. Studies have shown that injury, specifically de Quervain’s tenosynovitis, is associated with more frequent and prolonged duration of gaming^7–9. In an analysis of college varsity electronic sports athletes, injury to the wrist was the most common, and injuries of the finger or hand were included in the top five most common injuries¹⁰.

Dextrose prolotherapy has been used for a wide variety of musculoskeletal conditions^4,11. Many studies have investigated dextrose prolotherapy as treatment for chronic pain, tendinopathies, and OA^4,11,12. Overall, dextrose prolotherapy seems to be a safe, cost effective, and promising alternative treatment option for many individuals especially those with OA¹³. However, there is a lack of robust data to support its widespread use for various conditions or understand the mechanism in detail^14,15. In OA of the CMC joint specifically, dextrose prolotherapy injections seemed to be more advantageous than steroids and resulted in satisfactory pain relief and restoration of function^16,17. Previous cases have shown treatment and improvement of de Quervain's tenosynovitis with dextrose prolotherapy^18,19. This case specifically may have had a combination of components, including inflammation and possible chronic degenerative changes which sets it apart from the previous case reports on de Quervain’s tenosynovitis. This proposes that dextrose prolotherapy may be advantageous in a variety of conditions, ranging from acute to chronic, that could benefit from pain relief and improved function. In this patient case, dextrose prolotherapy injections provided symptomatic relief resulting in a restoration of previous function in a subacute sprain injury from gaming.

Conclusions/Implications for future research and/or clinical care: This case highlights the potential use of dextrose prolotherapy for musculoskeletal injuries in a more acute setting and in the population of video gamers. This represents an area of potential further research into efficacy and mechanism. Specifically in the context of esports, there is a great need for standardization and protocols on how to approach prevention and management of injury in athletes. There are only a few methods and resources describing how to best prevent and most efficiently and effectively treat injuries^1,5. Most current resources provide recommendations for reduced time spent gaming as a method to prevent or treat injury. This represents a unique problem given that gaming is increasing as a method of income and employment². This further draws attention to the significant need for more studies investigating regenerative medicine and treatments like dextrose prolotherapy for acute musculoskeletal injuries like those seen in esports.


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