All too often degenerative changes on x-ray or MRI are identified as the source of pain. At the Centeno-Schultz Clinic we acknowledge that pain can arise from many sources and that abnormalities on x-ray or MRI do not localize the source of pain. There are patients with abnormal radiographic studies who have no pain and patients who have normal studies with debilitating pain.
This concept was validated in a recent study which examined the relationship between age/gender and prevalence of wrist arthritis. The authors found the same variability that we see in the Centeno-Schultz Clinic: “Patients with little radiographic evidence of arthritis may have many complaints while others with severe arthritis have very few if any.”
Therapy based on radiographic abnormalities alone does not make sense. The authors conclude: “a recommendation to operate on trapeziometacarpal (wrist) arthritis based upon radiographic criteria when the patient has adapted well to their illness would be questionable.” This makes particular sense given that arthritis is an inevitable part of aging.
After a complete evaluation potential pain generators are identified through ultrasound or x-ray guided diagnostic injections. Therapies at the Centeno-Schultz Clinic include platelet rich plasma, low dose cortisone, prolotherapy and autologous stem cell injections.