Hyaluronic Acid Injections – Gel Injections – Rooster Comb Injections
Here in my newest episode of ‘Ask Dr. Hacker’, I address a question from a man recently diagnosed with bone on bone arthritis in the wrist joint. He had questions regarding the use of hyaluronic acid injections for the wrist.
G. B. asks:
Hello – I have osteoarthritis in both of my wrists, I am 66 years old and very active (especially fishing) most of the rooster comb therapy is for knee problems. I have a friend that had the wrist injections at his doctor up in the valley with success. I have been diagnosed with bone on bone, all my doctor could do was prescribe hydrocodone – not the choice I like. He mentioned the rooster comb therapy, but the clinic does not do this procedure and I cannot find anyone in San Diego that does the therapy to the wrist.
Dear G.:
Great question. First, what are these injections? I’ve written about this before in the knee. Read it here. Originally derived from the combs of roosters (truthfully!) hyaluronic acid is a naturally occurring compound found in cartilage. It is a building block for joint tissue. When injected into the joint, it has an effect on inflammation, and perhaps on the cartilage itself. The result, we hope, is pain relief.
These injections can be successful in relieving the pain from osteoarthritis for up to six months. Typically, they are given in the knee joint in a series of either 3 or 5 injections. There are several brands with names like Hyalgan, Supartz, Synvisc, Euflexxa and more. Some surgeons use ultrasound or x-ray to help place the needle in the right place.
Do hyaluronic acid injections work?
I think we realistically see mixed results from these injections with a 50/50 success rate for all comers. The success rates are promising, however may not be helpful in severe arthritis. Be careful of promises of success. I have not seen a big difference in success with any of the brands available.
Other names for hyaluronic acid injections
These injections often go many different names. They are also called ‘rooster comb’ injections, ‘gel’ injections, and visco-supplementation injections. There are all the same.
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Gel Injections in the shoulder and the wrist
The use of these injections has been approved for the knee joint only at this point. This is because all the studies designed to bring it to market were knee injection studies, and thus the FDA has approved it for the knee. It does make sense, however, that the shoulder and wrist are similar in their design and function. Cartilage in these joints is no different in its makeup than the knee. It is, however, considered ‘off-label’ in these joints and is often not covered by insurance. This is because the FDA has not permitted its use in other joints. Ethically, it is my opinion that it may be of benefit, however your insurance will likely not cover its use.
Options for joint osteoarthritis
There are many options for osteoarthritis to consider in addition to hyaluronic acid. Hyaluronic acid injections are one of the most common options to try. Other injection options include steroids, PRP, and stem cells. Beyond this, we start talking about surgical options like arthroscopy (outpatient surgery), partial resurfacing and complete joint resurfacing. My goal is always to try the least invasive first. If interested, I am happy to discuss it with you.
If you have questions about arthritis, visco-supplementation, or gel injections, please feel free to contact me.
If you found this useful, please write a comment or review! I can’t give you personal advice over the internet but would love to hear your thoughts. For personal advice, I am happy to see you in the office.
I have recently been diagnosed with wrist arthritis and fusion has been suggested. Having had the Orthovisc injections in the knee and finding them helpful i was curious if there was a similar treatment for a wrist. So It may be in my interest to explore such therapy with my Dr. I have found this article to be informative. Thank you. Ronald G. De Luco
Hyaluronic injections have been FDA approved for use in the knee. Its use in other joints have not been well studied, and it’s a great conversation to have with your orthopedic surgeon about the risks and benefits of this. It is often not covered by insurance as it is considered ‘off label’ usage of the injection. Definitely something to think about. We just don’t know if it works in the wrist based on scientific evidence.