Can PRP Be Used to Treat Carpal Tunnel Syndrome?

As you may know, as my job as the CMO of Regenexx, I often perform literature reviews on the latest evidence behind Orthobiologic injections. Two years ago I ran a quick search on treating Carpal Tunnel with Platelet-Rich Plasma and frankly didn’t expect to find much. What surprised me was that there were several Randomized Controlled Trials. I’ve been wanting to dig a bit deeper into that topic for a while, so here’s my Infographic on that treatment combo.

What Is Carpal Tunnel Syndrome?

Credit: Shutterstock

The Median nerve runs under a ligament in the wrist called the Transverse Carpal Ligament (1). Due to wear and tear, arthritis in the wrist Carpal bones, or instability in these small bones, the Median nerve can get beat up and become swollen. With enough time the nerve can become dysfunctional leading to nerve damage. Given that this nerve supplies an important thumb muscle, the patient can lose grip strength and dexterity, and power in the thumb.

The most common early symptom is pain or numbness in the thumb with use of the hand. The diagnosis can be made on a physical exam, nerve conduction study, or ultrasound imaging. The most common treatment is a high-dose steroid injection, but this can cause side effects (2,3). Surgery can be performed to cut the ligament, but this destabilizes the Carpal bones and may lead to bigger problems down the road (4,5).

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What Is PRP?

PRP stands for Platelet-Rich Plasma. This is made by centrifuging whole blood and concentrating platelets (6). These platelets release growth factors which can aid in healing. One of those growth factors is NGF (Nerve Growth Factor) and it’s believed that through this growth factor as well as others like VEGF (which builds new blood vessels), PRP may be able to help nerves repair (7-11).

Is There Evidence that PRP helps Carpal Tunnel Syndrome?

Two years ago when I performed a general literature search on PRP I was astounded to find high-quality RCTs (Randomized Controlled Trials) on using PRP to treat Carpal Tunnel Syndrome. At that point, I put a deeper dive into this topic on my list of things to do.

Using the US National Library of Medicine I ran searches on PRP and Carpal Tunnel Syndrome and only included RCTs. I found 8 to date, which are listed on the Infographic above (12-19). If you click on the image you’ll be taken to the PDF which has active links to these studies. Each circle represents a different study and a link back to PubMed.

PRP has been compared to steroid shots, dextrose injections, versus bracing, saline, PPP, shock wave therapy (ESWT) and used with surgery. 7 of 8 studies showed positive results. Hence, at this point, we have good evidence that PRP injections help Carpal Tunnel Syndrome. We even have a small Randomized Controlled Trial that shows that adding it to surgery improves outcomes.

What You Should Look for When Trying PRP to Treat Your Carpal Tunnel?

If this is something you want to try to avoid Carpal Tunnel Release Surgery, then there are a few pointers to keep in mind. First, you want amber PRP (leukocyte poor) as that will cause less flare-up. Second, the provider should be experienced with using ultrasound guidance to inject around nerves. Given that it’s critical that the nerve not be injected directly, DO NOT allow anyone who doesn’t have extensive ultrasound experience to inject your Carpal Tunnel with PRP. It should also go without saying that nobody should stick a needle into the area blind.

Finally, and perhaps most importantly, you want to find an experienced provider who can use Ultrasound-Guided Hydrodissection (20). This is the very careful and precise injection of PRP around the nerve to break up scar tissue. The video I have above shows one of my patients during a Median Nerve Hydrodissection used to treat Carpal Tunnel Syndrome.

The upshot? We have a surprising amount of research showing that PRP injections work when used to treat Carpal Tunnel Syndrome. If you want to try this, please find a provider with the experience and training to perform this procedure with precision!

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(1) Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal Tunnel Syndrome: A Review of Literature. Cureus. 2020;12(3):e7333. Published 2020 Mar 19. doi:10.7759/cureus.7333

(2) Kirby D, Donnelly M, Buchalter D, Gonzalez M, Catalano L, Hacquebord J. Influence of Corticosteroid Injections on Postoperative Infections in Carpal Tunnel Release. J Hand Surg Am. 2021 Dec;46(12):1088-1093. doi: 10.1016/j.jhsa.2021.06.022. Epub 2021 Aug 31. PMID: 34474948.

(3) Freire V, Bureau NJ. Injectable Corticosteroids: Take Precautions and Use Caution. Semin Musculoskelet Radiol. 2016 Nov;20(5):401-408. doi: 10.1055/s-0036-1594286. Epub 2016 Dec 21. PMID: 28002861.

(4) Garcia-Elias M, An KN, Cooney WP 3rd, Linscheid RL, Chao EY. Stability of the transverse carpal arch: an experimental study. J Hand Surg Am. 1989 Mar;14(2 Pt 1):277-82. doi: 10.1016/0363-5023(89)90021-x. PMID: 2703675.

(5) Fuss FK, Wagner TF. Biomechanical alterations in the carpal arch and hand muscles after carpal tunnel release: a further approach toward understanding the function of the flexor retinaculum and the cause of postoperative grip weakness. Clin Anat. 1996;9(2):100-8. doi: 10.1002/(SICI)1098-2353(1996)9:2<100::AID-CA2>3.0.CO;2-L. PMID: 8720784.

(6) Everts PA, Knape JT, Weibrich G, et al. Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol. 2006;38(2):174-187.

(7) Monje PV, Rendon S, Athauda G, Bates M, Wood PM, Bunge MB. Non-antagonistic relationship between mitogenic factors and cAMP in adult Schwann cell re-differentiation. Glia. 2009 Jul;57(9):947-61. doi: 10.1002/glia.20819. PMID: 19053056; PMCID: PMC2829776.

(8) Oudega M, Xu XM, Guénard V, Kleitman N, Bunge MB. A combination of insulin-like growth factor-I and platelet-derived growth factor enhances myelination but diminishes axonal regeneration into Schwann cell grafts in the adult rat spinal cord. Glia. 1997 Mar;19(3):247-58. doi: 10.1002/(sici)1098-1136(199703)19:3<247::aid-glia7>3.0.co;2-w. PMID: 9063731.

(9) Höke A, Sun HS, Gordon T, Zochodne DW. Do denervated peripheral nerve trunks become ischemic? The impact of chronic denervation on vasa nervorum. Exp Neurol. 2001 Dec;172(2):398-406. doi: 10.1006/exnr.2001.7808. PMID: 11716563.

(10) Kuffler DP, Reyes O, Sosa IJ, Santiago-Figueroa J. Neurological recovery across a 12-cm-long ulnar nerve gap repaired 3.25 years post trauma: case report. Neurosurgery. 2011 Dec;69(6):E1321-6. doi: 10.1227/NEU.0b013e31822a9fd2. PMID: 21712738.

(11) Zhu Y, Jin Z, Wang J, Chen S, Hu Y, Ren L, Wang Y, Song Q, Tian X, Xie F, Peng J, Peng N, Luo Y, Wang Y. Ultrasound-guided platelet-rich plasma injection and multimodality ultrasound examination of peripheral nerve crush injury. NPJ Regen Med. 2020 Nov 20;5(1):21. doi: 10.1038/s41536-020-00101-3. PMID: 33298932; PMCID: PMC7680141.

(12) 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.

(13) 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.

(14) 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.

(15) 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.

(16) 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.

(17) 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.

(18) 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.

(19) 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.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile