Rehab Log: AC Joint, Radial Collateral Ligament (Thumb)

Hello folks,

I’m a 27-year old orthopedic physical therapist. Over the past year I’ve picked up some nagging upper extremity issues, including a right AC joint injury in February 2016 while mis-racking a 5RM bench press, and a thumb injury sustained in March 2017 when I got my left thumb pinned under the bar while using an open grip for front squats.

Right now it’s hard for me to pick up plates with my left hand, and bench pressing has been out of the picture since the AC joint injury 16-17 months ago (I can, however, do weighted dips and weighted push ups without too much trouble). However, the biggest factor for me is the fact that these injuries make my job more difficult. As a result, I’ve been considering a plan to address both of these issues.

My plan will involve diagnostic musculoskeletal ultrasound to the AC ligaments, coracoclavicular ligaments, and possibly SC joint (to rule out any issues there), as well as both the radial and ulnar collateral ligaments of my thumb (I suspect the radial is the primary culprit, but both have some degree of laxity). Once I’ve quantified what I’m starting out with, I plan to proceed as such:

  1. Prolotherapy injections to stimulate a healing response (probably dextrose to start with, but this provider also offers PRP) in the ligaments of the AC joint, as well as the radial and ulnar collateral ligaments
  2. Taping to keep the AC joint in an approximated position, to allow any new healing to occur in a position where the ligaments are in a shortened state. (Side note: immobilize, splint, or tape your AC joint injuries immediately and aggressively, folks. I regret not doing this sufficiently when the injury first occurred.) I will also either tape (figure 8) or splint (thumb spica) the thumb.
  3. I plan on running TB-500 and BPC-157 in conjunction with the prolotherapy injections. I’ve just ordered 20mg of both from Blue Sky Peptides. I’m playing around with the idea of 2x/day injections (daily), in the neighborhood of 350-500mcg. I also may “taper” my doses such that I give myself large boluses of both compounds around the time of prolotherapy injections, and then taper down for a while until receiving the next injection.

To break it down more simply, my approach is this:

  1. Irritate ligamentous tissue in order to induce a healing response
  2. Facilitate/optimize that healing response with peptides (TB-500 and BPC-157).
  3. Ensure that the healing occurs with optimal joint approximation for optimal joint stability

The purpose of this post is so that I can ensure that I follow through. I’ve suffered many difficult injuries, but due to a combination of extreme lack of financial resources as well as a tendency toward self-reliance and resourcefulness, I have never sought help from another medical professional. I know it will be all too easy for me to not pursue the prolotherapy unless I hold myself to an extra level of accountability.

Feel free to read along or post questions.