Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN

Platelet Rich Plasma therapy uses a patient’s blood to make a healing solution. From the blood, platelets and growth factors are separated and injected into a damaged joint. In our practice PRP is seldom given as a stand alone treatment. We also use Prolotherapy in a combined treatment. Prolotherapy is the injection of a simple dextrose or sugar to create a healing response. These treatments are further explained below.

A September 2025 study published in Belgium (1) compared surgical treatment, corticosteroid injection, and platelet-rich plasma (PRP) injection in mild and moderate carpal tunnel syndrome and assessed their superiority over each other. The study included 92 wrists from 68 participants with mild to moderate carpal tunnel syndrome. Following patient randomization, the first group underwent surgical treatment, the second group received steroid injections guided by ultrasonography, and the third group received PRP injections guided by ultrasonography. Prior to treatment, as well as one, three, and six months later, patients had evaluations.

The patients’ functional status and the severity of their symptoms were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), while the visual analog scale (VAS) was used to determine the patients’ pain levels. Patients also had electrodiagnostic examinations, and ultrasonography was used to measure the median nerve’s cross-sectional area (CSA) and flattening ratio (FR). In patients with mild to moderate CTS, injection procedures are useful, but surgical treatment has been shown to be more effective in terms of both clinical outcomes and electrophysiological parameters.

The use of Platelet Rich Plasma therapy for Carpal Tunnel Syndrome

• PRP treatment takes your blood, like going for a blood test, and re-introduces the concentrated blood platelets from your blood into areas of the carpal tunnel region.
• Your blood platelets contain growth and healing factors. When concentrated through simple centrifuging, your blood plasma becomes “rich” in healing factors, thus the name Platelet RICH plasma.
• The procedure and preparation of therapeutic doses of growth factors consist of autologous blood collection (blood from the patient), plasma separation (blood is centrifuged), and application of the plasma rich in growth factors (injecting the plasma into the area.) In our office, patients are generally seen every 4-6 weeks. Typically three to six visits are necessary per area.
• In much of the research surrounding PRP treatments you will see, that single injections are given and then monitored for months. This is not the way we perform these treatments. In our 30+ years of clinical experience, we have noted that degenerative damage requires a more comprehensive approach. Even so, improvements in single-shot treatments have been noted in the medical literature.

A May 2024 study in the journal PloS one. Public Library of Science one (2) reviewed data taken from 18 previously published studies on injection treatments for carpal tunnel patient-reported outcomes. They ranked effectiveness of treatments as:

First, platelet-rich plasma is effective in alleviating symptoms and pain associated with carpal tunnel syndrome and improving function over both the short and long term.

Second, dextrose (Prolotherapy) is effective in terms of symptom and pain relief and functional improvement in both the short and long term, except for pain relief in the short term.

Third, steroids are effective in terms of symptom and pain relief and functional improvement in the short term, but their long-term effects are not significant.

Platelet Rich Plasma could reduce swelling of the median nerve for a mid-long-term pain relief effect

In a capacity as an anti-inflammatory agent, in November 2020, researchers publishing in the medical journal BioMed Research International (3) evaluated the effectiveness of platelet-rich plasma injections in patients with carpal tunnel syndrome. What they found in their research was PRP could be effective for mild to moderate carpal tunnel syndrome and superior to traditional conservative treatments in improving pain and function and reducing the swelling of the median nerve for a mid-long-term effect. To some extent, the electrophysiological indexes (nerve function) also improved after PRP injection compared with other conservative treatments.

An October 2025 study in the journal Medicine (10) published results from a comprehensive meta-analysis, including seven studies with a total of 365 patients diagnosed with carpal tunnel syndrome (CTS). Among these, 183 patients received platelet-rich plasma (PRP) treatment, while 182 patients were assigned to the conventional treatment group.

The results demonstrated that patients in the PRP group experienced significant reductions in symptom severity scores at 1, 3, and 6 months post-treatment. Additionally, improvements in functional status scores were observed at 3 and 6 months in the PRP group compared to the conventional treatment group.

Regarding changes in the cross-sectional area of the median nerve, the PRP group showed an increase at 1 month; however, decreases were noted at 3 and 6 months. Despite these variations, the differences between the PRP and conventional treatment groups were not statistically significant.

Platelet-rich plasma is a safe and effective therapeutic option for patients with carpal tunnel syndrome. While PRP improves subjective outcomes such as symptom severity and functional status, it has minimal impact on median nerve cross-sectional area, sensory nerve conduction velocity, and distal motor latency.

“PRP represents a promising therapy for patients with mild to moderate carpal tunnel syndrome.” But:

A May 2020 study from the University of Toronto published in the Archives of Physical Medicine and Rehabilitation (4) reviewed the current research comparing Platelet Rich Plasma Therapy injections, cortisone, and saline injections. They concluded that “PRP represents a promising therapy for patients with mild to moderate carpal tunnel syndrome; however, included studies were limited as follow-up was short, the studies included patients that were heterogeneous (widespread to be able to isolate on a subgroup that may have had better or lesser success than another group), and the number of included studies was low. Further investigation is necessary to determine the true efficacy and effect of PRP and to better delineate the long-term results in patients with carpal tunnel syndrome.”

“Platelet-rich plasma could be an effective treatment of mild to moderate idiopathic carpal tunnel syndrome and superior to corticosteroid in improving pain, function, and distal sensory latency of median nerve.”

A December 2019 study published in the journal Clinical Rheumatology (5) looked at patients suffering from mild to moderate carpal tunnel syndrome. They were randomly divided into two groups. Group 1: patients received ultrasound-guided PRP injection and group 2: patients received ultrasound-guided corticosteroid injection. The researchers in this study closely examined the impact of treatments on the median nerve.

• The PRP group included 40 females and 9 males. The cortisone group included 41 females and 8 males.
• PRP injection had significantly improved the clinical manifestations, the electrodiagnostic examination  parameters of the median nerve, and the median nerve cross-sectional area at 1 month and 3 months post-injection evaluation in comparison to baseline recordings;
• Local steroid injection (cortisone) had significantly improved the clinical manifestations, the electrodiagnostic examination  parameters of the median nerve, and the median nerve cross-sectional area at 1 month and 3 months post-injection evaluation in comparison to baseline recordings
• PRP injection was superior to the local steroid injection in the improvement of clinical manifestations as well as the median nerve motor conduction velocity along the wrist-elbow segment, the sensory latency (how long your nerves take to respond to stimulation), and the median nerve sensory conduction (demonstrated by nerve conduction studies), this superiority was observed in the third-month follow-up suggesting better outcomes in long-term follow-up.
• CONCLUSION: “Platelet Rich Plasma could be an effective treatment of mild to moderate idiopathic carpal tunnel syndrome and superior to corticosteroids in improving pain, function, and distal sensory latency of the median nerve.”

Let’s point out here that this is a single PRP injection versus a single cortisone injection. A more comprehensive approach to PRP would likely produce superior results as we have seen in our clinical observations and outcomes.

A March 2026 study in the journal Injury (6) compared the effectiveness of platelet-rich plasma (PRP) injection, corticosteroid injection, and wrist splinting—in patients diagnosed with bilateral moderate CTS.

In this randomized controlled trial, 45 patients with bilateral moderate carpal tunnel syndrome were enrolled and equally assigned to one of three groups: PRP combined with splinting, corticosteroid injection combined with splinting, and splinting alone (serving as the control group). Assessments were performed prior to treatment, as well as at one month and six months after treatment initiation.

All groups demonstrated significant improvements in pain scores at both follow-up points. Notably, reductions in night pain and numbness were more pronounced in the PRP and corticosteroid groups compared to the control group. Strength measurements revealed improvement in all groups at the one-month mark; however, by six months, sustained enhancement in grip strength was observed exclusively in the PRP group, while pinch strength improvements persisted in both the PRP and corticosteroid groups.

PRP, in particular, showed indications of more sustained benefits, especially at the six-month follow-up, suggesting it may offer longer-lasting improvements.

The single PRP injection for carpal tunnel syndrome

Typically we do not find that we can help a patient achieve long-lasting healing with a single injection of PRP. Some people do achieve this result.

Doctors at Greece’s Athens University published their findings in the journal Neural Regeneration Research (7) in which they investigated whether a single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome.

• Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study.
• Under ultrasound guidance, platelet-rich plasma was injected into the region around the median nerve
• At one month after a single injection of platelet-rich plasma, pain (as measured by a standard visual analog scale) almost disappeared in eight patients and it was obviously alleviated in three patients. At the same time, upper limb function was obviously improved.
• In addition, no ultrasonographic manifestation of carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During the 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding the use of platelet-rich plasma for the treatment of carpal tunnel syndrome.

A later paper from these same researchers (8) published in 2018 in the Journal of Tissue Engineering and Regenerative Medicine found similar findings regarding the effectiveness of a single injection of platelet-rich plasma (PRP).

• In this latter study, 50 patients diagnosed with mild to moderate carpal tunnel syndrome and who had symptoms 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.
  • Group B (24 patients) were injected with a placebo (normal saline).
• Group A – the PRP injection patients showed a 76.9% success in treatment whereas Group B – the placebo group – patients demonstrated 33.3% success. This is considered statistically significant.

When will a single PRP injection fail?

We take great strides in our articles to give a realistic assessment of treatments based on nearly three decades of helping people with conditions related to wrist pain, elbow pain, thumb pain, and Carpal Tunnel Syndrome. We have seen people respond to one treatment of PRP, however, we do not use PRP as a stand-alone treatment. In our opinion, maximum results can be achieved if we combine PRP treatment with dextrose Prolotherapy injections and sometimes non-surgical nerve release. In our clinical experience, while one injection of PRP may help some people, it is usually not the long-term relief the people seek. This is also borne out by the number of people who contact us seeking to continue a more comprehensive PRP Carpal Tunnel Syndrome treatment following a failed healing program. However, it is not just the number or type of treatment a patient receives that may lead to treatment failure. There can be other factors.

A June 2021 study published in the International Journal of Clinical Practice (9) tried to offer guidelines to help doctors predict who would have successful PRP treatments for their Carpal Tunnel Syndrome and those who would have less of a chance to have successful PRP treatment for their Carpal Tunnel Syndrome.

• In this study, the doctors followed seventy-one patients with moderate carpal tunnel syndrome who received a single PRP injection. The patient’s progress was assessed at three months and at six months post-injection using the standard 0-10 visual analog scale (VAS) score.
  • Patients who showed improvement in pain scores of MORE than 50% were deemed “patients with good outcomes.”
  • Patients who showed improvement in pain scores of LESS than 50% were deemed “patients with poor outcomes.”

What were the factors that may have caused some of the patients to have poor outcomes?

• Weight, patients with more body weight had less than good results
• Distal motor latency problems. Many of you have had Distal motor latency testing, many after the initial surgery. This is a motor nerve conduction test. The test is seen as a collaboration of nerve conduction improvement following successful carpal tunnel surgery. In the patients who did not have good PRP results, distal motor latency did not improve.
• Too much inflammation. The cross-sectional area of the median nerve was “thicker.” People who suffer from Carpal Tunnel Syndrome have significant swelling, thickening, and irritation in the tendons and surrounding wrist area. These swelled-up tendons can then compress the median nerve.

More articles

Carpal tunnel syndrome: Non-surgical injections and nerve release treatments

References

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