Stem cells and PRP injections for Carpal Tunnel Syndrome

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about carpal tunnel syndrome using the contact form below. 

Traditional methods of treating Carpal Tunnel Syndrome include wearing a splint at night or injections of cortisone to reduce swelling. If these measures are not successful, carpal tunnel release surgery, which sections the tough transverse carpal ligament and relieves pressure on the median nerve, may be performed. But surgery should be the last treatment a patient should ever consider. Many patients have presented to my office with worse symptoms after they had the carpal tunnel surgery.

Study: Surgeons confident Carpal Tunnel Surgery is a good option for patients, but not for them.


Surgeons less confident in the surgery if they, the surgeon, were the patient being recommended to the surgery.

Here is an amazing study from hand surgeons and post-surgical therapists.

Published in the Journal of plastic surgery and hand surgery, one of the objectives of this survey was to see if a surgeons’ eagerness to convince a patient of the benefit of six surgical procedures differed if they, the surgeons themselves were recommended to get one of the six surgeries as a patient with hand/wrist pain. One of the 6 procedures was Carpal Tunnel Release.

  • The surgeons in the study were divided into two groups.
    • Group 1: Surgeons who were told to “pretend to be a patient being recommended to Carpal Tunnel surgery.”
    • Group 2: Surgeons who were told to continue on being surgeons and make recommendations for Carpal Tunnel Syndrome treatments.
  • Surgeons who considered themselves as patients had less confident perception on the benefit of carpal tunnel release compared with surgeons, who considered treating patients.”(1)

At our Institute we find ourselves in agreement with these surgeons, we too have little confidence in the carpal tunnel release surgery.

Here is another problem with surgical intervention. Many people with carpal tunnel syndrome have it because of repetitive work related movements. So the question many of these people present to their surgeon is, “when can i go back to work?”

When can I return to work after carpal tunnel release surgery? Conflicting opinion causes problems for patients

October 2018: The Journal of hand surgery, European volume.

  • In this study, over 300 surgeons and therapists responded to a request for what each one of them would recommend to a patient who asked: “When can I go back to work?,” following carpal tunnel release surgery
  • The average recommendations were:
    • 7 days for desk-based duties,
    • 15 days for repetitive light manual duties and
    • 30 days for heavy manual duties.
  • However, the responses these patient received from their health care provider were wide-ranging:
    • 0-30 days for desk-based;
    • 1-56 days for repetitive light manual; and
    • 1-90 days for heavy manual.
  • The study authors suggested these variations were a problem: “Variation in the recommended timescales for return to work and other functional activities after carpal tunnel release suggests that patients are receiving different and possibly even conflicting advice.”
  • The study’s conclusion: “There is a limited evidence base from which to derive recommendations for safe and effective return to different types of occupation after carpal tunnel release surgery.”(2)

When can you return to work after carpal tunnel surgery? No one is quite sure.

Over the years we have seen many patients with Carpal Tunnel Syndrome.

Injection of simple dextrose more effective than cortisone

Cortisone is not considered a good long-term solution to Carpal Tunnel Syndrome. Studies show that any pain relief cortisone provides is short-lived.

In September 2018, doctors compared cortisone injections against that of simple dextrose (Prolotherapy) and published their findings in the Annals of Neurology.

  • Fifty-four people with mild-to-moderate carpal tunnel syndrome were randomly divided into a dextrose injection group and steroid injection group.
  • The patients were administered one session of perineural injection with 5 cc of dextrose or 3 cc triamcinolone acetonide mixed with 2 cc normal saline (steroid group), under ultrasound guidance.
  • Using various scoring tools, patients were assessed for response to treatment at 1, 3, 4, and 6 months post-injection.

RESULTS:

  • All patients (27 wrists per group) completed the study. Compared with the steroid group, the dextrose group exhibited a significant reduction in pain and disability through 4th to 6th month.
  • This study demonstrates that perineural injection of 5 cc of dextrose is more beneficial than that of corticosteroid in patients with mid-to-moderate carpal tunnel syndrome , 4 to 6 months post-injection.(3)

Platelet Rich Plasma PRP injections and hydrodissection

  • Nerve hydrodissection for carpal tunnel syndrome is a technique used when median nerve gets compressed in the wrist . It involves using an anesthetic or saline solution to separate the nerve from the surrounding tissue, specifically the tendon and fascia.We use a tiny needle under ultrasound guidance

A study from Athens University in Greece published in the journal Neural regeneration research investigated whether a single injection of platelet-rich plasma would improve the clinical symptoms of carpal tunnel syndrome.

  • Fourteen patients with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study.
  • Under ultrasound guidance, 1–2 mL of platelet-rich plasma was injected into the region around the median nerve at the near edge of the carpal tunnel.
  • At 1 month after single injection of platelet-rich plasma, results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients.
  • Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved.
  • In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve.
  • During 3-month follow-up, the pain was not greatly alleviated in three patients of the 14 patients.
  • These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.(4)

Earlier in 2018, the same researchers released similar findings in which they tested whether a single injection of platelet-rich plasma (PRP), under ultrasound guidance, can improve the clinical symptoms of patients with a mild to moderate carpal tunnel syndrome.

  • In this study 50 patients suffering from mild to moderate carpal tunnel syndrome for a minimum of 3 months were randomly divided into 2 groups:
    • Group A (26 patients) received an ultrasound-guided PRP injection into the carpal tunnel, whereas
    • Group B (24 patients) was injected with placebo (0.9% normal saline). T
  • Group A patients demonstrated a 76.9% success in treatment whereas Group B patients demonstrated 33.3% success, which was significantly less than Group A
  • The findings of this study suggest that a single PRP ultrasound-guided injection has positive effects in patients with carpal tunnel syndrome(5).

Stem Cells for Carpal Tunnel Syndrome

Stem cell therapy is a more advanced treatment for degenerative conditions. Often a patient with Carpal Tunnel Syndrome will also exhibit mild to advancing osteoarthritis of the wrist and thumb.

  • In a study from March 2018 researchers found that degenerative osteoarthritis of the wrist was strongly associated with carpal tunnel syndrome.(6)
  • In some instances surgeons will perform a thumb joint replacement and carpal tunnel release in the same procedure.(7)

When a patient comes into our office with wrist pain, thumb or hand pain, and carpal tunnel, we may recommend the use of stem cell treatments to treat the entire area. We have found this treatment to be effective and reliable in degenerative conditions of the wrists and hands. Our findings will be published in our paper “Treatment of Hand and Wrist Osteoarthritis with Bone Marrow Concentrate: A Case Series”

Are you a candidate for treatment? Ask Dr. Darrow


A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300

1 Leppänen OV, Jokihaara J, Jämsen E, Karjalainen T. Survey of hand surgeons’ and therapists’ perceptions of the benefit of common surgical procedures of the hand. Journal of plastic surgery and hand surgery. 2018 Jan 2;52(1):1-6.
2 Newington L, Francis K, Ntani G, Warwick D, Adams J, Walker-Bone K. Return to work recommendations after carpal tunnel release: a survey of UK hand surgeons and hand therapists. The Journal of Hand Surgery (European Volume). 2018 Jun 10.
3 Wu YT, Ke MJ, Ho TY, Li TY, Shen YP, Chen LC. Randomized double‐blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Annals of neurology. 2018 Sep 5.
4 Malahias MA, Johnson EO, Babis GC, Nikolaou VS. Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome. Neural Regeneration Research. 2015;10(11):1856-1859. doi:10.4103/1673-5374.165322.
5 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. Journal of tissue engineering and regenerative medicine. 2018 Mar;12(3):e1480-8.
6 Bacle G, Marteau E, Corcia P, Garaud P, Laulan J. Are Carpal Tunnel Syndrome and Regional Degenerative Osteoarthritis Linked? Results of a Case-Control Study. The Journal of Hand Surgery (Asian-Pacific Volume). 2018 Mar;23(01):41-6.
7. Ingari JV, Romeo N. Basal Joint Arthroplasty and Radial-sided Carpal Tunnel Release Using a Single Incision. Techniques in hand & upper extremity surgery. 2015 Dec 1;19(4):157-60. (1461)

There is controversy in the medical community about umbilical cord blood stem cells. Some insist that the injectable solution contains abundant live umbilical cord blood stem cells. Some suggest that the stem cells are not alive. I have seen the flow cytometry showing live stem cells. The research shows that these stem cells release cytokines and growth factors that awaken native stem cells. I have tried this treatment on myself for both shoulders and knees. After great success, I started using this treatment on patients. I still use PRP and bone marrow depending on the patient’s pathology and requirements. To date the results are excellent for all of these treatments. We are in the process of doing a study on cord blood stem cells (we have done others on bone marrow and PRP) to see which treatments are the most successful. We are awaiting more long term results.

Platelet-Rich Plasma Therapy for Unresolved Wrist Pain | New Research from the Darrow Stem Cell Institute

Our research on the effects of Platelet Rich Plasma Therapy on unresolved chronic wrist pain has now been published in the journal Orthopedic & Muscular System: Current Research (March 2019).

The objective of our study, was to share with the medical community our observations on pain and function in 6 patients who had their wrists (one patient had both wrists treated), who underwent PRP injections to the ligaments and joints of the wrist. We hypothesize that by strengthening the ligaments and regrowing tissue within the wrist joints, we may provide patients improved quality of life and pain relief.

You can download the entire study

These findings have been summarized here:

  • Platelet-Rich Plasma (PRP) is a minimally invasive surgical alternative that uses components from a patient’s own blood to regrow tissue and relieve pain. This study investigated the clinical effect of PRP on unresolved wrist pain.
  • Six patients and seven wrists underwent a series of two to four PRP injections for unresolved wrist pain.
  • Outcomes of resting pain, active pain, upper functionality scale, and overall improvement percentage were measured and compared to baseline.
  • The final follow-up was performed an average of 6.57 months after injection.
  • All patients included in the study experienced decreases in pain and improvement in functionality score at final follow-up.

Here are the six patient cases we presented:

Patient case: 1 – 28 year old female:

  • The first patient was a 28-year-old Caucasian female with 2 years of left wrist pain, most prominent when in flexion. The injury occurred when the patient fractured her left humerus in a snowboarding
    accident.
  • She had tried pain medications and heat to relieve pain which provided minimal relief.
  • The patient’s baseline characteristics were:
    • a resting pain of 3/10,
    • an active pain of 7/10,
    • and a functionality score of 4/20.
  • The patient received 4 PRP treatments over the course of four months.
  • During the course of treatment, the patient steadily improved feeling 50% overall improvement after the third treatment.
  • At  her final treatment, she reported an 80% overall improvement with a 0/10 resting pain, a 0/10 active pain, and a functionality score of 32/40. The patient stated that the pain was not as frequent nor as
    intense as it was prior to treatment.

Patient case: 2 – 42 year old male:

  • The second patient was a 42-year-old Caucasian male with four months of right wrist pain.
  • He described the pain he was suffering from as an achy feeling on the lateral aspect (the outer side) of his right wrist, typically aggravated during his daily activities.
  • The patient had previously received a Celestone (steroid)  injection three months prior to his first PRP treatment. The Steroid injection provided no relief.
  • The patient also reported that he had tried dry needling treatment, NSAIDs, ice, and stretching with no relief of symptoms.
  • An MRI displayed right wrist tendonitis and ulnar sided right wrist pain that may represent Extensor Carpi Ulnaris (ECU) tendonitis and a lunate triquetral ligament tear.
  • The patient’s baseline characteristics were:
    • a resting pain of 0/10,
    • an active pain of 3/10,
    • and a functionality score of 33/40.

Нe patient was treated with two PRP treatments within four days of each other. Shortly after the first treatment, the patient stated that the wrist continued to be tender but feeling significant better compared to prior to treatment. He then felt 100% improvement at a short follow-up aіer the second PRP treatment.

  • A year aіer the second PRP treatment, the patient stated that he had sustained:
    • 100% improvement,
    • and reported 0/10 resting pain,
    • 0/10 active pain,
    • and a 40/40 functionality score.

Patient case 3: 31 year old female

  • The third patient was a 31-year-old Caucasian female with two years of left wrist pain. The patient had felt a “pop” when she fell when lifting a heavy box.
  • The patient saw a hand specialist who prescribed a splint and recommended arthroscopic surgery.
  • She reported wrist edema and had a sharp pain when lifting heavy objects or doing bicep curls.
  • She had undergone heat, massage, and Arnica gel to relieve pain in addition to wearing a wrist brace.
  • An MRI showed findings consistent with partial tears of the ulnar attachment of the triangular fibrocartilage.
  • Her baseline characteristics were:
    • 7/10 resting pain,
    • 9/10 active pain,
    • and a 16/40 functionality score.

The patient received a series of two PRP treatments approximately two weeks apart.

  • After her first PRP treatment, she noticed her resting pain had improved compared to prior to treatment. She continued to use heat four times a day, which momentarily helped to relieve pain.
  • Five months after her last treatment, she reported a
    • 20% improvement,
    • a 5/10 resting pain,
    • a 7/10 active pain
    • and a functionality score of 21/40.

Patient case 4: 45 year old female

  • The fourth patient was a 45-year-old Hispanic female with suffered with bilateral wrist pain for nine years.
  • The patient had treated her wrist with deep tissue massage, acupuncture, ice, heat, and numbing cream, however, she felt only temporary relief.
  • An X-ray of the right wrist showed advanced arthritis of the radiocarpal joint. It also showed possible erosions involving the triquetral bone, and a probable zone of subchondral cystic change involving the distal radius.
  • Her baseline characteristics for both wrists were
    • 3/10 resting pain,
    • 7/10 active pain,
    • and 20/40 functionality score.

The patient received two PRP treatments a month apart.

  • After treatment, she stated a 25% improvement to both wrists.
  • The patient’s final outcome scores for her right wrist were:
    • a 2/10 resting pain,
    • a 3/10 active pain,
    • and a 24/40 functionality score.

The patient’s final outcomes for her left wrist were:

  • a 2/10 resting pain,
  • a 5/10 active pain
  • and functionality score was a 23/40.

Patient case 5: 38 year old male

  • The fifth patient was a 38-year-old Hispanic male with one year of left wrist pain.
  • The patient stated that he heard his wrist “pop” while moving an object at work.
  • He described the pain as sharp with numbness that was progressively worsening.
  • He also stated that his primary doctor recommended surgery. An MRI on the left wrist showed a sprain of the dorsal intercarpal ligament and degenerative changes in the intercarpal joint between the distal scaphoid and trapezium.
  • His baseline characteristics were
    • a 0/10 resting pain,
    • 4/10 active pain,
    • and 31/40 functionality score.

The patient received 2 PRP treatments over a 3 week period.

  • After the first treatment, he noticed an 80% improvement and stated that he was able to drive without as much discomfort compared to prior to treatment. He also noticed a decrease in the amount of clicking in his left wrist.
  • Nine months after the second PRP treatment, he experienced additional benefit, including
    • a 95% overall improvement,
    • with a 0/10 resting pain,
    • a 1/10 active pain,
    • and a 40/40 functionality score.

Patient case 6: 59 year old female

  • The sixth patient was a 59-year-old female with right wrist pain lasting the course of one year.
  • A radiograph of his right wrist showed a Scapholunate Advanced Collapse (SLAC) wrist with radioscaphoid osteoarthritis.
  • The patient had a limited range of motion and felt achy pain when supinating (hand with palm up) her wrist. She had previously received five cortisone injections, which had no improvement of pain and caused her to wear a brace daily. The pain had been so severe that it had prevented her from sleeping.
  • Her baseline characteristics were
    • 3/10 resting pain,
    • 8/10 active pain,
    • and 22/40 functionality score.

The patient received a series of 3 PRP treatments over a two month period.

  • After the first treatment, the patient noticed a decrease in pain and a slight increase in the range of motion. She continued to have difficulties opening jars and performing daily tasks.
  • Six months aіer her third PRP treatment, she reported a 50% overall improvement and noticed a substantial decrease in active pain and was able to perform her daily activities with less difficulties.
  • Her final pain outcomes were:
    • a 2/10 resting pain,
    • a 4/10 active pain,
    • and a 33/40 functionality score.

Summary

We found that all patients included in this study experienced improvements in resting pain, active pain, improvement percentage, and functionality score compared to baseline outcomes. It is also encouraging that none of these patients reported any adverse effects.

  • On average, patients reported a 11% decrease in resting pain,
  • a 53.33% decrease in active pain,
  • a 55.64% total overall improvement
  • and a 45.89% increase in functionality score.

Our results indicated improvement in all measurable outcomes for wrist pain and function aіer a minimum of two PRP treatments and continued improvement aіer a series of three or more treatments. To that end, patients in Cases 2 and 5 experienced the most notable results, with 100% and 95% overall improvement respectively following two rounds of PRP treatment. However, patients in Cases 3 and 4 experienced milder total improvements, at 20% and 25% respectively, under the same protocol of two PRP treatments.

Are you a candidate for treatment? Ask Dr. Darrow


A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300