Platelet-rich plasma nerve hydrodissection is an exciting new possibility for treating carpal tunnel syndrome.
Carpal tunnel syndrome can be a very challenging and frustrating condition for many patients. It is caused by compression of the median nerve as it passes through the bony carpal tunnel, at the wrist, beneath the transverse carpal ligament. It affects up to 6% of the adults in the general population targeting those between 45 to 64 years of age. Carpal tunnel syndrome can be caused by obesity, pregnancy, diabetes, degenerative arthritis, repeated use of vibrating tools and hypothyroidism. It has not been found to be caused by computer usage. Carpal tunnel syndrome initially develops as tingling and numbness in the first three fingers of the hand (thumb, index finger, middle finger). As the syndrome progresses the simple tingling and numbness can progress to a very uncomfortable pins and needles sensation as well as a burning sensation. If the condition continues to progress patients report difficulty with picking up small objects, buttoning buttons, and opening a door knob. Conventional treatments for carpal tunnel syndrome include resting wrist splints, physical therapy to stretch the finger flexors, cortisone injections into the carpal tunnel, and modifications to home or work environment to decrease wrist and finger flexion. In is patients who find significant lasting improvement with these types of conventional treatments there is no need to consider more invasive procedures or surgery.
An exciting new treatment option appears to be in platelet-rich plasma nerve hydrodissection. It uses the power of platelet-rich plasma which is known to contain growth factors such as platelet-derived growth factor (PDGF), insulin-like growth factor 1 (IGF-1), fibroblast growth factors (FGF-II), transforming growth factor-b (TGF-b), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These growth factors support regeneration and repair of damaged nerves. This is combined with ultrasound-guided nerve hydrodissection also known as percutaneous neuroplasty to mechanically decrease the pressure on the median nerve by the surrounding ligaments and tendons within the carpal tunnel.
There have been an increasing number of articles in pubmed.com reviewing the use of platelet-rich plasma in the treatment of nerve damage. Two articles that peaked my interest in regards to the use of platelet rich plasma in the treatment of nerve damage described improvement in patients with leprosy [1] as well as a patient with severe nerve damage after an injury that greatly limited his ability to walk [2].
Patients with leprosy often develop significant peripheral neuropathies. Treating these peripheral neuropathies can be quite challenging and any sign of improvement is quite encouraging. This paper demonstrated statistical improvement in sensation following a small unguided platelet-rich plasma injection [1].
The second paper describes the plight of a young man who suffered a severe peroneal nerve injury and foot drop after sustaining multiple ligament injuries of his knee. His injury was significant enough that he had difficulty walking without an assistive device. For the first year following his injury he had very little improvement. Treatment was started approximately one year after the injury and within nine months after his first injection and following a total of seven platelet-rich plasma injections he is able to walk without assistance. He could even run up to 7 km which is quite surprising [2].
Nerve hydrodissection has been successfully used to treat lateral femoral cutaneous nerve compression (also known as meralgia parasthetica) [3]. It is an injection of fluid under ultrasound-guidance around a compressed nerve with the goal of stretching the underlying tissues to decrease pressure on the nerve. When done correctly it can be very safe, but there is always the possibility of injuring the nerve if not done by an experienced physician.
Although there is no perfect cure for carpal tunnel syndrome I’ve noticed that environmental modifications along with targeted treatment provides the best chance of improvement. Only time will tell if platelet-rich plasma nerve hydrodissection becomes a standard treatment in the future, but right now it’s exciting new option to try for patients who have failed traditional conservative therapy.
1. Anjayani S, Wirohadidjojo YW, Adam AM, Suwandi D, Seweng A, Amiruddin MD.Sensory improvement of leprosy peripheral neuropathy in patients treated with perineural injection of platelet-rich plasma. Int J Dermatol. 2013 Oct 29.
2. Sánchez M, Yoshioka T, Ortega M, Delgado D, Anitua E. Ultrasound-guided platelet-rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc. 2013 Mar 22.
3. Mulvaney SW. Ultrasound-guided percutaneous neuroplasty of the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica: a case report and description of a new ultrasound-guided technique. Curr Sports Med Rep. 2011 Mar-Apr;10(2):99-104.
