PRP for Carpal Tunnel Syndrome

Posted on the 24 March 2021 by Centeno-Schultz Clinic

Do you have wrist or hand pain? Numbness or that sensation of your hand and fingers falling asleep? Have you been told you have carpal tunnel syndrome? We can help you diagnose and treat this issue. We shall cover the following questions:

What is carpal tunnel syndrome? What causes this? How do you diagnosis it? What are treatment options? What evidence is there that PRP can help?

What Is Carpal Tunnel Syndrome and Its Symptoms?

Carpal tunnel syndrome is the condition when a nerve in your wrist called the median nerve is compressed or inflamed causing pain, numbness, tingling, and or hand weakness. Usually, the pain or numbness is in the wrist, thumb and first 3 fingers of the hand and it may feel as these fingers “fall asleep.” When more severe the pain can be very intense and may cause sharp or burning sensations up the arm and keep you from sleeping.  When severe, the muscles in the thumb pad (thenar muscles) can get weak and then shrink or atrophy. It is usually caused by excessive wrist flexion activities, such as computer work, texting, working with the hands or sleeping with the wrist curled.

Anatomy

The median nerve provides sensation to the palm of the thumb, index, middle, and half of the ring fingers. It also gives motor function to the thumb muscles.  Thus when the nerve is irritated it causes the above symptoms. This nerve travels in a space called the carpal tunnel. This space has a roof, the transverse carpal ligament (flexor retinaculum), floor carpal bones (wrist bones), and 8 finger and wrist flexor tendons (4 tendons of the flexor digitorum superficialis and flexor digitorum profundis) and the thumb flexor tendon (flexor policis longus) travel in it.

How Do You Diagnose Carpal Tunnel Syndrome?

The diagnosis can be made by a musculoskeletal trained physician such as a physical medicine and rehab physician, pain medicine specialist, sport specialist, or neurologist by taking a good history and performing a thorough physical examine. An ultrasound can also show thickening or inflammation of the median nerve. Also, a nerve conduction study and Electromyography (NSC/EMG) can diagnose the problem and provide information to the nerve function and severity. At the Centeno Schultz clinic we fully examine the hand, wrist, elbow and neck as issues in either or combination of these areas can cause similar symptoms. WE also perform a live ultrasound examination.

What Can I Do to Treat Carpal Tunnel Syndrome?

There a few measures you can take on your own to help the symptoms of carpal tunnel. If possible, you can better ergonomically set up your desk to support the wrist and limit wrist flexion.  Also, relative rest of the wrist can help. There are over the counter “carpal tunnel braces” you can wear at nighttime for at least 6 weeks to open up the carpal tunnel when you may curl at night. If needed this can be worn in the day as well. Over the counter anti-inflammatory medications such as Ibuprofen, Alleve, etc can help with pain, swelling and some of the symptoms. We do not encourage regular or long term use of these meds however, because they do not address the underlying problems, and can have negative effects on healing. They inhibit platelets and PRP as well so they don’t’ work well with our treatments. They also have many potential negative side effects such as stomach bleeds, liver or kidney damage, increasing the risk for heart attacks and strokes, etc.  Going to an occupational or physical therapist can also help a lot. These conservative measures usually help enough when the nerve irritation is mild.

If these measures do not help enough, then traditional pain doctors may offer an injection of steroids to reduce the swelling and help with the pain around the median nerve. In the past these injections were performed “blind” meaning no image (ultrasound) guidance. However, now the standard should be any injections should be performed under some type of image guidance such as  ultrasound.  Steroids do not address the problem but may help one be able to continue therapy to help it get better. If this fails or only helps temporarily then it is not advised to do these many times as again, they can inhibit healing and can have many negative side effects like weakening the immune system, damaging the nearby tendons, causing bone loss, raising blood sugars, etc. Lastly if all else fails, then surgery is an option. With surgery, the roof of the carpal tunnel, the transverse carpal ligament is cut. This opens space around the nerve relieving the compression. Recovery can take 2-3 weeks. The surgery can help 2/3rds to ¾ of patients. However, that ligament helps to stabilize the wrist so cutting it can cause future wrist and thumb pain and arthritis. The surgery also has higher risks of nerve, vein or tendon injury, infection, and compartment syndrome. There are newer techniques that use a needle to cut the ligament which may reduce these risks but still predisposes one to arthritis from cutting the ligament.

PRP for Carpal Tunnel Syndrome

At the Centeno-Schultz Clinic | Orthopedic Regenerative Medicine – Denver & Broomfield, CO we specialize in treating musculoskeletal and orthopedic problems trying to stimulate the body’s own innate healing system via precise injections. This typically provides, better and longer lasting results, is safer than drugs and steroids, can prevent many invasive and dangerous surgeries, have much quicker recovery times than surgery. PRP can be used to treat carpal tunnel syndrome. We perform a procedure called hydrodissection. We use ultrasound to guide a very small needle around the median nerve and inject local anesthetic and our specialized PRP called platelet lysate. At the Centeno Schultz clinic we have a specialized lab to process patient’s blood and bone marrow to customize PRP and bone marrow (containing stem cells) to treat different patients and different problems instead of a one size fits all approach used by most all physicians doing regenerative medicine procedures. Injecting the fluid releases the nerve from surrounding tight or scarred tissue then the platelet lysate has growth factors shown to heal and repair nerves. This reduces inflammation naturally, releases the nerve compression, and heals the nerve so that pain is reduced and muscle function restored. Usually, 1-2 two of these procedures are needed to fully treat this problem. See video below. Recovery is quick, as there may just be some mild soreness and stiffness for a day or two after the procedure. If PRP for Carpal Tunnel Syndrome treatment is used when the disease is mild or moderate success rates are very high. If the nerve damage is too severe  so that the muscles are very atrophied, then this procedure is less likely to help and surgery may be needed. So, if you suspect you have this problem you should have it evaluated as soon as possible to increase the chances of success.

Evidence for PRP to Treat Carpal Tunnel

Despite a common misconception that there is no evidence for regenerative medicine spread by health care providers who are not familiar with regenerative medicine or have conflicts of interest, that is false. There are tons of studies showing that PRP and bone marrow (containing stem cells) can help patients with a variety of orthopedic problems and the research grows every month.

At Regenexx we also track all patients in a registry and that data is updated monthly and freely available. Here is a link to all our hand and wrist outcome data.  Specifically, for carpal tunnel there are several studies (I have 13 referenced at the end of this post) that show PRP works for carpal tunnel syndrome. For example, There was a good 2018 review article on PRP for Carpal tunnel syndrome. This review looked at 4 studies using various PRP products. The review concluded that PRP was safe (no serious complications), effective for improving symptoms and function, and worked best for mild to moderate carpal tunnel syndrome.  A recent 2019 single blinded randomized controlled trial compared PRP to bracing for carpal tunnel. It showed the  PRP did significantly better for pain, function and improvement in nerve conduction tests which is a great objective measure.

Bottom Line

Carpal tunnel syndrome is a common cause of wrist and hand pain, numbness, weakness, and can significantly impair your quality of life. Being evaluated early to see if this is the cause of your problems is critical to having more and less invasive treatment options and better chances of long term success in alleviating this problem. When conservative treatments like rest, medications, braces, and therapy are not enough, PRP for Carpal Tunnel is a great treatment option. It can replace steroids that have negative side effects and help avoid more risky surgery options. Here at the Centeno Schultz Clinic we are experts in diagnosing and treating wrist problems including carpal tunnel syndrome and specialize in regenerative treatments that help you heal yourself.

References

  1. Raeissadat SA, Karimzadeh A, Hashemi M, Bagherzadeh L. Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial. BMC Musculoskelet Disord. 2018 Feb 13;19(1):49. doi: 10.1186/s12891-018-1963-4. PMID: 29433485; PMCID: PMC5810049. https://pubmed.ncbi.nlm.nih.gov/29433485/
  2. Senna MK, Shaat RM, Ali AAA. Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome. Clin Rheumatol. 2019 Dec;38(12):3643-3654. doi: 10.1007/s10067-019-04719-7. Epub 2019 Aug 16. PMID: 31420812. https://pubmed.ncbi.nlm.nih.gov/31420812/
  3. Güven SC, Özçakar L, Kaymak B, Kara M, Akıncı A. Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: A controlled study. J Tissue Eng Regen Med. 2019 May;13(5):709-714. doi: 10.1002/term.2815. Epub 2019 Apr 8. PMID: 30707787. https://pubmed.ncbi.nlm.nih.gov/30707787/
  4. Kuo YC, Lee CC, Hsieh LF. Ultrasound-guided perineural injection with platelet-rich plasma improved the neurophysiological parameters of carpal tunnel syndrome: A case report. J Clin Neurosci. 2017 Oct;44:234-236. doi: 10.1016/j.jocn.2017.06.053. Epub 2017 Jul 5. PMID: 28688621. https://pubmed.ncbi.nlm.nih.gov/28688621/
  5. Malahias MA, Chytas D, Mavrogenis AF, Nikolaou VS, Johnson EO, Babis GC. Platelet-rich plasma injections for carpal tunnel syndrome: a systematic and comprehensive review. Eur J Orthop Surg Traumatol. 2019 Jan;29(1):1-8. doi: 10.1007/s00590-018-2278-8. Epub 2018 Jul 18. PMID: 30022241. https://pubmed.ncbi.nlm.nih.gov/30022241/
  6. Catapano M, Catapano J, Borschel G, Alavinia SM, Robinson LR, Mittal N. Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2020 May;101(5):897-906. doi: 10.1016/j.apmr.2019.10.193. Epub 2019 Dec 7. PMID: 31821797. https://pubmed.ncbi.nlm.nih.gov/31821797/
  7. Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Huang GS, Chen LC. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial. Sci Rep. 2017 Dec;7(1):94. doi: 10.1038/s41598-017-00224-6. Epub 2017 Mar 7. PMID: 28273894; PMCID: PMC5427966. https://pubmed.ncbi.nlm.nih.gov/28273894/
  8. Shen YP, Li TY, Chou YC, Ho TY, Ke MJ, Chen LC, Wu YT. Comparison of perineural platelet-rich plasma and dextrose injections for moderate carpal tunnel syndrome: A prospective randomized, single-blind, head-to-head comparative trial. J Tissue Eng Regen Med. 2019 Nov;13(11):2009-2017. doi: 10.1002/term.2950. Epub 2019 Aug 20. PMID: 31368191. https://pubmed.ncbi.nlm.nih.gov/31368191/
  9. Lin CP, Chang KV, Huang YK, Wu WT, Özçakar L. Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis. Pharmaceuticals (Basel). 2020 Mar 18;13(3):49. doi: 10.3390/ph13030049. PMID: 32197544; PMCID: PMC7151714. https://pubmed.ncbi.nlm.nih.gov/32197544/
  10. Trull-Ahuir C, Sala D, Chismol-Abad J, Vila-Caballer M, Lisón JF. Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial. Sci Rep. 2020 Feb 7;10(1):2085. doi: 10.1038/s41598-020-59113-0. PMID: 32034241; PMCID: PMC7005701. https://pubmed.ncbi.nlm.nih.gov/32034241/
  11. Chang CY, Chen LC, Chou YC, Li TY, Ho TY, Wu YT. The Effectiveness of Platelet-Rich Plasma and Radial Extracorporeal Shock Wave Compared with Platelet-Rich Plasma in the Treatment of Moderate Carpal Tunnel Syndrome. Pain Med. 2020 Aug 1;21(8):1668-1675. doi: 10.1093/pm/pnz309. PMID: 31774510. https://pubmed.ncbi.nlm.nih.gov/31774510/
  12. Malahias MA, Nikolaou VS, Johnson EO, Kaseta MK, Kazas ST, Babis GC. Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: A placebo-controlled clinical study. J Tissue Eng Regen Med. 2018 Mar;12(3):e1480-e1488. doi: 10.1002/term.2566. Epub 2017 Dec 17. PMID: 28873284. https://pubmed.ncbi.nlm.nih.gov/28873284/
  13. Malahias MA, Nikolaou VS, Johnson EO, Kaseta MK, Kazas ST, Babis GC. Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: A placebo-controlled clinical study. J Tissue Eng Regen Med. 2018 Mar;12(3):e1480-e1488. doi: 10.1002/term.2566. Epub 2017 Dec 17. PMID: 28873284. https://pubmed.ncbi.nlm.nih.gov/28873284/