Biologics in Hand & Wrist Surgery

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) causes pain, numbness, and weakness that limit hand function. Conservative treatments provide only temporary relief and do not address the root cause, while surgery helps severe cases but does not support nerve regeneration.

Biologic Adjuncts for Hand Procedures

Biologics offer a regenerative approach that can address the underlying cause of CTS, delay or avoid surgery, or support surgical release.

PRP injection therapy is superior to corticosteroid injections and conservative treatment.^3-11,14

There is strong evidence for conservative PRP injection therapy in mild to moderate CTS.

Biologic Adjuncts for Hand Procedures

Scientific Insights

High-level evidence supports PRP as an effective conservative treatment for mild-to-moderate CTS. Randomized controlled trials show PRP provides greater improvements in pain, symptom severity, and function than corticosteroid injections or splinting.

Clinical data confirm PRP consistently outperforms conventional treatments and shows added value in surgery.

Conservative PRP Injection Therapy

Superior to corticosteroid injection^4,9,10,14
Superior to conservative treatment (splint^3,6,8,11; placebo control^5,7)
PRP injection therapy is safe and effective for mild to moderate CTS^1-15

Surgical Release + PRP

PRP might contribute to resolution of patient-reported numbness¹⁶
Adding PRP can improve functional recovery (hand grip strength)¹

References

chevron_right

Key Takeaways

Strong evidence for conservative PRP injection therapy in mild to moderate CTS
Adjunctive PRP in carpal tunnel release surgery might improve functional recovery

Study Limitations

Short follow-up period in most studies
Heterogeneity in PRP preparation and application protocols

Biologic Adjuncts for Hand Procedures

References

Eltabl M, Saif D, Alemam S. Platelet-rich plasma injection versus surgical and medical treatment of mild-moderate carpal tunnel syndrome [published online August 24, 2020]. Egypt J Neurol Psychiatry Neurosurg. 2020;56(88). doi: 10.1186/s41983-020-00186-z
Lai CY, Li TY, Lam KHS, et al. The long-term analgesic effectiveness of Platelet-Rich plasma injection for carpal tunnel syndrome: A cross-sectional cohort study. Pain Med. 2022;23(7):1249-1258. doi:10.1093/pm/pnac011
Chen SR, Shen YP, Ho TY, et al. One-Year efficacy of platelet-rich plasma for moderate-to-severe carpal tunnel syndrome: A prospective, randomized, double-blind, controlled trial. Arch Phys Med Rehabil. 2021;102(5):951-958. doi:10.1016/j.apmr.2020.12.025
Senna MK, Shaat RM, Ali AAA. Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome. Clin Rheumatol. 2019;38(12):3643-3654. doi:10.1007/s10067-019-04719-7
Shen YP, Li TY, Chou YC, et al. 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;13(11):2009-2017. doi:10.1002/term.2950
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;13(5):709-714. doi:10.1002/term.2815
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;12(3):e1480-e1488. doi:10.1002/term.2566
Wu YT, Ho TY, Chou YC, et al. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial. Sci Rep. 2017;7(1):94. doi:10.1038/s41598-017-00224-6
Atwa TA, Esh AM, Abd El Al IT, Awad, YM. Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome: Clinical and electrophysiological study. Egypt Rheumatol. 2019;41(3):237-241. doi:10.1016/j.ejr.2018.07.008
Hashim NA, Fathy HA, Esawy MM, et al. Comparison of efficiency between platelet rich plasma and corticosteroid injection therapies in patients with carpal tunnel syndrome: A prospective randomized controlled study. Egypt J Neurol Psychiatry Neurosurg. 2020;56(59). doi:/ab 10.1186/s41983-020-00184-1
Gado SE, El Banna HS. Efficacy of platelet-rich plasma injection in mild and moderate carpal tunnel syndrome: Randomized control study. Egypt Rheumatol Rehabil 47, 4 (2020). 2020;47(4). doi: 10.1186/s43166-020-00008-3
Zaki EM, Ebied AA, Morgan MFI. Platelet-Rich plasma in treatment of idiopathic carpal tunnel syndrome. The Egyptian Journal of Hospital Medicine. 2025;100(1):3747-3753. doi: 10.21608/ejhm.2025.448753
Du Y, Jiang X, Fu K, Cui C. Efficacy and safety of platelet-rich plasma in the treatment of carpal tunnel syndrome: A meta-analysis. Medicine (Baltimore). 2025;104(44):e45010. doi:10.1097/MD.0000000000045010
Uzun H, Bitik O, Uzun Ö, Ersoy US, Aktaş E. Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg. 2017;51(5):301-305. doi:10.1080/2000656X.2016.1260025
Jiang J, Xing F, Luo R, Liu M. Effectiveness of Platelet-Rich plasma for patients with carpal tunnel syndrome: A systematic review and meta-analysis of current evidence in randomized controlled trials. Front Pharmacol. 2022;13:834213. doi:10.3389/fphar.2022.834213
Mekariya K, Monteerarat Y, Chotiyarnwong C, Limthongthang R, Vathana T, Laohaprasitiporn P. Effectiveness of adjuvant leukocyte-poor platelet-rich plasma in carpal tunnel release: A randomized controlled trial. J Hand Surg Eur Vol. 2025;50(7):907-913. doi:10.1177/17531934241312322
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;10(1):2085. doi:10.1038/s41598-020-59113-0