Carpal Tunnel Demystified: A Comprehensive Guide to Causes, Care, and PRP Solutions
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity and is due to compression of the median nerve at the level of the wrist. It is typically characterized by sensory symptoms, including pain, numbness, and paresthesias (tingling or “pins and needles”) radiating from the wrist into the first three digits.
If left untreated, CTS can progress to motor symptoms, including muscle atrophy (wasting) of the thenar eminence (the mound at the base of the thumb), reduced grip strength, and decreased hand dexterity, which can adversely affect all activities of daily living.1
Pathophysiology of Carpal Tunnel Syndrome
The “carpal tunnel” comprises the carpal (wrist) bones that make up the floor and walls of the tunnel, with a thick connective tissue called the flexor retinaculum forming the roof. The contents of the carpal tunnel include nine tendons, surrounded by their associated synovial sheaths and the median nerve. Proposed mechanisms for median nerve injury include increased pressure within the tunnel, injury to the microvasculature that supplies the median nerve, median nerve connective tissue compression, and synovial tissue hypertrophy.2
Diagnosis and Treatment of Carpal Tunnel Syndrome
A thorough history and physical exam will raise clinical suspicion of CTS. Symptoms are often provoked by activities that involve sustained flexion or extension of the wrist, such as driving, reading, typing, and holding a cell phone.
Symptoms may typically be noted initially at night, with individuals complaining of paresthesias that wake them from sleep. If a clinician suspects CTS, patients are often referred for electrodiagnostic testing (EMG/nerve conduction studies) to confirm and assess the severity of the condition. Based on electrodiagnostic testing results, CTS is classified into mild, moderate, and severe types.
Initial treatment of mild and moderate cases of CTS includes conservative measures, such as splinting the wrist in a neutral position, corticosteroid injections, and physical or occupational therapy. Severe cases, on the other hand, are typically referred to a hand surgeon for consideration of a surgical release procedure.
Treatment and Relief: Neurodynamic Modulation (NM)
Physical and occupational therapy to treat CTS involves nerve gliding using various methods, including soft tissue, joint mobilization, and neurodynamic techniques.
Neurodynamic modulation (NM) is a specific technique for CTS that involves functional massage of the upper trapezius muscle, wrist opening and closing, and active gliding and tensioning mobilization of the median nerve. The theory behind NMT is that it promotes regular physiologic and mechanical movements of the median nerve within the carpal tunnel as the nerve moves within the upper limb during specific movements.
A recently published systematic review3 evaluated the therapeutic effectiveness of NM on symptom severity and functional status in patients with mild to moderate CTS. This study found that patients after NM treatment showed significant improvements in the Boston Carpal Tunnel Questionnaire (BCTQ, a patient-reported questionnaire that assesses symptom severity and functional status) and pain scores, as well as improved sensory and motor conduction velocities and motor latencies on electrodiagnostic studies.
Ultimately, while additional high-quality randomized controlled trials are needed to establish its effectiveness, NM shows promise in decreasing pain and improving hand function in individuals with mild to moderate CTS.
Treatment and Relief: Platelet-Rich Plasma (PRP) Therapy
Platelet-rich plasma (PRP) is a biological therapy that uses concentrated platelets to treat various tendon, ligament, and joint pathologies because of the abundant growth factors involved in tissue repair and regeneration. PRP is also postulated as a neurogenic, neuroprotective, and neuroinflammatory modulator that can enhance nerve regeneration. Favorable outcomes for PRP on nerve regeneration have been demonstrated in several animals and in vitro studies.
A recent prospective, double-blind controlled trial assessed the one-year efficacy of PRP for moderate-to-severe CTS4 and found significant reduction in the symptom severity scale (part of the BCTQ) and statistically significant improvements in sensory nerve conduction velocities and motor distal latencies when PRP was compared to saline.
Other notable studies include Uzun et al. 5, who reported that PRP was associated with a more significant reduction in BCTQ scores at three months post-intervention, and Malahias et al. 6, who demonstrated promising results at three-month follow-up for patients treated with PRP compared to those injected with saline. While additional studies are required to help better understand PRP’s utility in treating CTS, the current literature demonstrates that PRP is a promising novel treatment in patients with mild to moderate CTS with therapeutic effects seen as long as one year post-injection.
Get Relief from Carpal Tunnel Syndrome Today
If you’re suffering from CTS, relief from its discomfort and limitations is within reach. Whether through innovative treatments like PRP therapy or targeted approaches such as neurodynamic modulation, practical solutions exist to help you heal and regain full function.
At Desert Spine and Sports Physicians, our board-certified specialists are dedicated to providing personalized care tailored to your unique needs. Request an appointment today to explore the best treatment options for your journey to recovery. Your hands deserve expert care—let us help you get back to living pain-free.
1. Zaheer SA, Ahmed Z. Neurodynamic Techniques in the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Jul 25;12(15):4888. doi: 10.3390/jcm12154888.
2. Joshi A, Patel K, Mohamed A, Oak S, Zhang MH, Hsiung H, Zhang A, Patel UK. Carpal Tunnel Syndrome: Pathophysiology and Comprehensive Guidelines for Clinical Evaluation and Treatment. Cureus. 2022 Jul 20;14(7):e27053. doi: 10.7759/cureus.27053.
3. Zaheer SA, Ahmed Z. Neurodynamic Techniques in the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Jul 25;12(15):4888. doi: 10.3390/jcm12154888. PMID: 37568290; PMCID: PMC10419623.
4. Chen SR, Shen YP, Ho TY, Li TY, Su YC, Chou YC, Chen LC, Wu YT. 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 May;102(5):951-958. doi: 10.1016/j.apmr.2020.12.025.
5. Uzun, Hakan, et al. “Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome.” Journal of Plastic Surgery and Hand Surgery 51.5 (2017): 301-305.
6. Malahias, Michael‐Alexander, et al. “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 12.3 (2018): e1480-e1488.