PRP for Carpal tunnel syndrome

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I want to talk about the use of platelet-rich plasma for carpal tunnel syndrome. A recent article came out that showed there’s superiority in using platelet-rich plasma over steroid injections for carpal tunnel syndrome in mild-to-moderate cases. It showed that there was a benefit with both treatments, but at the three-month mark, there was a greater improvement in terms of pain relief as well as in electrodiagnostic studies in the platelet-rich plasma treatment group. As a initial proof-of-concept study, there’s value to this, and it’s helpful to encourage additional evaluation and study.

On a clinical standpoint regarding a regenerative medicine practice, we would do things slightly differently, and it’s worthwhile discussing that. It’s always important to remember that in the actual clinical practice of regenerative medicine, there are layers to this process that can add additional value. So number one, what’s the orthobiologic we’d want to be treating with? So to begin with, for nerve-related issues, you would prefer to use platelet lysate rather than platelet-rich plasma. Platelet lysate is essentially taking platelet-rich plasma, cracking open the platelets, and just using the growth factors from that. And that’s preferable for nerve-related issues.

Number two, you would still use platelet-rich plasma in this case, but you would apply it to more than just a nerve. So what structures do you wanna treat in this sort of case, for a compressive neuropathy, which is what carpal tunnel syndrome is? Besides the platelet lysate for the median nerve sheath, you’d also want to be using platelet-rich plasma to treat a number of other structures. To begin with, any of the other soft tissue structures that help to prop open the carpal tunnel will be helpful in terms of functional improvement as well as reducing stress on the nerve as well. So to begin with, you also want to inject platelet-rich plasma into the ligaments around the carpal tunnel to help support that.

Number three, I’ll always look to see if there’s any other structures that may be involved as well. That includes tendons that may be chronically swollen, or tendinopathic, or inflamed. And in addition, also if there is an effusion or inflammation in any of the joints in the wrist area, treating that as well. In those cases, you may be using varying concentrations of platelet-rich plasma. If there’s chronic inflammation, you may also be using alpha-2-Macroglobulin which has a much more anti-inflammatory effect, so there’s a little bit more nuance to that than just regular platelet-rich plasma.

And then lastly, all of these structures need to be injected, of course, with ultrasound guidance. The difference between hitting a median nerve sheath and missing it is at a sub-millimeter level, and of course, when you’re starting to inject deeper structures in the wrist as well, you want to avoid hitting the nerve by using ultrasound guidance as well. So from a regenerative medicine standpoint, a lot of value to this study. Again, there’s layers involved to this that go beyond just that initial study, but definitely a worthwhile treatment option for carpal tunnel syndrome patients.

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