Marc Darrow MD,JD

We see many people at our practice with a long medical history of thumb pain and thumb pain treatments. These people would up seeing us because their long medical history of conservative  care treatments, possibly surgery or surgical recommendation did not help them and they are seeking stem cell therapy or PRP platelet rich plasma therapy as options. Perhaps as options and an alternative to some type of hand surgery.

Thumb pain is often confused with wrist pain and carpal tunnel pain. The confusion with Carpal Tunnel Syndrome is the belief that there is some type of tendon involvement. The confusion with the wrist pain can lead to the belief that there is a ligament or osteoarthritis involvement. As an added layer of confusion doctors may find it difficult to determine if the person’s pain is coming from the wrist or thumb.

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Marc Darrow MD,JD

I see many people with finger problems. This includes “trigger finger.” For some people they have been to other doctors and have been diagnosed with the more technical term, “stenosing tenosynovitis.” Whether a trigger finger or stenosing tenosynovitis diagnosis, you have been to the doctor because your finger is stuck or locked in a bent position and it is making a loud popping noise that you know is not right.

Over the course of time people try to manage trigger finger on their own. Many go online and look for quick remedies and suggestions.

Many people will:

• Rest their fingers or avoid activities that irritate the situation. This is particular tough on a musician or someone who does a lot of dexterity work with their hands. So these people look for other things that may help.
• They may alternate heat and ice therapy depending on whether they have inflammation or puffiness.
• Sometimes they walk around with their hand a container of warm water to try to get the finger to relax and loosen up.
• Add to this anti-inflammatories.
• Some may also purchase a finger splint at the pharmacy and try to keep their finger extended with the splint and tape.

For those who did not find relief with these remedies, they sought out a doctor. At the doctors they got:

• Stronger medications than the one they were taking: ibuprofen, naproxen or acetaminophen to help manage the pain.
• A better splint

The A1 pulley

Doctors tend to get more technical when the patient is progressing their way towards surgery. Here a doctor may explain to the patient that they have a problem with their A1 pulley and their  flexor tendon. The flexor tendon attaches the muscles of the forearm to the bones of the fingers. In its path from forearm to finger, the flexor tendons passes through a band of tissue that holds it is place along the finger bones called the A1 pulley. When this tendon does not slide properly within the A1 pulley and it becomes irritated and inflamed. If the flexor tendon becomes too enlarged and swells up to the point that it can no longer glide back and forth within the A1 pulley. It gets stuck and so does your finger.

Is there a connection between carpal tunnel syndrome and trigger finger?

A May 2020 study (1) reviewed the connection between Carpal tunnel release and trigger finger. They wrote: “Carpal tunnel release is acknowledged as a predisposing factor for the development of the trigger finger. However, the incidence of new-onset trigger finger after Carpal tunnel release surgery has been inconsistently reported. In this study, we aimed to evaluate the prevalence of Carpal tunnel release as a risk factor of the development of the trigger finger.”

• Post-Carpal tunnel release trigger finger was detected in 26.3% of the 57 patients of this study
• The trigger finger occurred approximately six months after Carpal tunnel release surgery. The thumb and ring fingers were the most commonly involved fingers.
• Ten out of 15 (66.7%) patients who developed a post-Carpal tunnel release trigger finger had mild-to-moderate Carpal tunnel syndrome, and five (33.3%) patients had severe Carpal tunnel syndrome. No significant difference was found between the patients who did and did not develop a trigger finger after Carpal tunnel release surgery.

“The rate of developing a post-Carpal tunnel syndrome trigger finger was remarkable in our study.” The authors of this study suggested that patients under going Carpal tunnel release be advised of the potential of developing trigger finger.

Non-Surgical options : Cortisone, PRP and Stem Cell Therapy

Since trigger finger is considered a problem of inflammation some will think that the obvious treatment should be a strong anti-inflammatory, such as a cortisone injection. Others would rather not go down the cortisone route because of the well known side-effects and the simple fact that cortisone is not a healing treatment, it is a symptom suppression treatment.

PRP vs cortisone

A research team in November 2020 (2) announced that they would conduct a study to compare PRP injections to cortisone injections for trigger finger. There is limited research on PRP effectiveness for trigger finger outside of research that suggests “Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease (painful thumb tendons).”

Further they write:

“PRP has been shown to reduce symptoms in different tendon pathologies with the rationale to potentially accelerate the healing process. PRP has positive effects on both short-term and long-term pain on tendon and ligament healing. PRP contains various growth factors that have potential tendon-healing properties. PRP has been previously used in hand pathologies such as osteoarthrosis.

Injection of corticosteroids in the vicinity of the A1 pulley is generally accepted as a first-line therapy, although recurrence rates up to 33% have been reported. Moreover, up to 5.8% of major adverse events have been reported in soft-tissue injections of cortisone (defined as those needing intervention or not disappearing). As some authors have stated superiority of PRP compared to cortisone in select musculoskeletal disorders,, investigating the clinical efficacy of PRP in treating trigger finger is warranted.”

We have seen many people with problems of trigger finger. We have helped many with PRP treatments. Equally we have helped a lot of people with stem cell therapy for their trigger finger problems.

Stem Cell therapy

In our practice, Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. We offer stem cells drawn from patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.

There is no direct study on the effect of stem cell therapy on trigger finger. Like PRP above there is an expectation that the treatment would be beneficial based on successful treatments documented in the medical literature on other types of tendinopathies.

More recently a January 2020 study (3) suggested: “there have been over 100 studies using MSCs for tendon healing, and the majority of these studies has been published in the last 5 years. These studies have used the traditional bone marrow derived stromal cells (BMSCs), adipose derived stem cells (ASCs), endogenous ligament derived stem cells (LDSCs) or tendon derived stem cells (TDSCs), and MSCs from other sources, such as synovial fluid. MSC-based therapies have been applied to augment tendon and ligament healing in several different ways.” What we see is an explosion in research based on the concept that stem cell therapy may be very beneficial for tendon injuries such as those found in a trigger finger.

Doctors writing in the medical journal Hand Surgery suggested that bone-marrow derived stem cells accelerate tendon healing in animal studies.(4) Doctors know that chronic tendon injuries present unique management challenges because of the long-held belief that they result from ongoing inflammation. This thinking has caused physicians to rely on treatments demonstrated to be ineffective in the long term—e.g., anti-inflammatory medications and cortisone shots.

Published in the Journal of Muscles Ligaments Tendons, researchers from Italy wrote: “Tendon injuries represent, even today, a challenge, as repair may be exceedingly slow and incomplete. Regenerative medicine and stem cell technology have shown to be of great promise.” (5)

Most recently, a study from the Feinstein Institute for Medical Research indicated the potential effectiveness of bone marrow (stem cells) for Achilles tendon healing, particularly during the early phases.(6)

Do you have questions? Ask Dr. Darrow

Over the years we have seen many people with various finger and hand problems and we have helped many people.

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

1 Aspinen S, Nordback PH, Anttila T, Stjernberg-Salmela S, Ryhänen J, Kosola J. Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial. Trials. 2020 Dec;21(1):1-9.
2 Shafaee-Khanghah Y, Akbari H, Bagheri N. Prevalence of Carpal Tunnel Release as a Risk Factor of Trigger Finger. World Journal of Plastic Surgery. 2020 May;9(2):174.
3 Leong NL, Kator JL, Clemens TL, James A, Enamoto‐Iwamoto M, Jiang J. Tendon and ligament healing and current approaches to tendon and ligament regeneration. Journal of Orthopaedic Research®. 2020 Jan;38(1):7-12.
4 He M, Gan AW, Lim AY, Goh JC, Hui JH, Chong AK. Bone marrow derived mesenchymal stem cell augmentation of rabbit flexor tendon healing. Hand Surg. 2015 Oct;20(3):421-9. doi: 10.1142/S0218810415500343.
5 Tetta C, Consiglio AL, Bruno S, Tetta E, Gatti E, Dobreva M, Cremonesi F, Camussi G. Muscles: the role of microvesicles derived from mesenchymal stem cells in tissue regeneration; a dream for tendon repair? Ligaments Tendons J. 2012 Oct 16;2(3):212-21. Print 2012 Jul.
6 Shapiro E, Grande D, Drakos M. Biologics in Achilles tendon healing and  repair: a review. Curr Rev Musculoskelet Med. 2015 Feb 6. PubMed. 1376

Marc Darrow MD,JD

Systemic and local side-effects of corticosteroid injections including joint destruction

A patient will often come into our office with conflicting ideas about cortisone injections. The patient will tell us that his/her other doctors told them that cortisone injections are safe, effective, and will help their pain, if used sparingly. But, intuitively, the patient had doubts and concerns.

But as this patient continued to wait for a surgery, decisions had to be made as to how much pain management would be needed to “hold them over,” until the surgical date.

Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation, which in turn can lessen a patient’s level of discomfort. Numerous studies over the years have shown that prolonged use of cortisone will eventually cause degenerative joint disease in the joints they are injected into.

Understanding the possible complications of corticosteroid injections

Here are some of the most recent papers reminding doctors about the possible side effects of corticosteroids:

A January 2021 (1) study issued this statement:

“The current evidence would suggest that the use of corticosteroids provides moderate short-term benefit for reducing pain and improving functioning. These benefits generally last several weeks without long-term effectiveness. In addition to its limited short-term effectiveness, there are multiple potential adverse effects including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections.”

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Marc Darrow MD,JD

Most of the people that contact our office looking for treatment for their thumb pain have already had a long history of treatments with limited success. In fact, many will confess that their doctors are now recommending pain management (anti-inflammatories and painkillers) as their primary treatments now that splints, physical therapy, and a generous amount of ice are no longer helping. These people will receive pain management until the decision is made to go to surgery or “live with it.” For many, the benchmark of when to proceed to surgery is when cortisone injections fail to offer relief and is in fact giving the person more pain.

So what do we do for these bone on bone thumb people who have basically lost the use of the hands because they have no grip strength and are being pain managed? We offer a physical examination, and assessment of their pain and functional challenges, and when appropriate a recommendation for stem cell therapy into the thumb joint.

Can stem cell therapy help avoid surgery?

Surgery should always be considered the last option. For some people, damage in the joint is so severe and significant that surgery may be the only way. For many others, surgery can realistically be avoided and the thumb joint rebuilt with regenerative medicine injections.

Why should you avoid surgery? Let’s let the surgeons tell us.

Concerns surrounding trapeziometacarpal surgery.

Trapeziometacarpal joint osteoarthritis or rhizarthrosis is degeneration at the trapezium bone at the wrist and the first metacarpal bone of the thumb. The Trapeziometacarpal joint is a tricky joint to repair with surgery. This according to surgeons publishing research in the American Journal of hand surgery (June 2019). The surgeons expressed concerns that failure rates of trapeziometacarpal implants were considered high because of aseptic loosening, dislocation, and persisting pain.(1) This followed an April 2018 study (2) that also questioned whether thumb joint replacement surgery at the trapeziometacarpal joint provided significant benefits for the patient.

A brief look at this study reveals that doctors looked at four women diagnosed with stage III osteoarthritis at the Trapeziometacarpal who underwent total joint replacement surgery.

• What the surgeons found was the surgery was able to restore some thumb function but did not fully replicate the movements of a healthy trapeziometacarpal joint.

The irony is is that people have this surgery because they have limited range of motion and functionality of the thumb. Many came out of the surgery the same way. Now the goal of surgery differs for many patients. For some, it is pain relief, but for many it is a return to normal thumb motion so that they can return to work or increase the quality of life in retirement. Pain relief while a successful benefit of surgery, is not for many, the goal of restoring functionality to their thumb. Pain relief and restoration of movement is.

Trapeziectomy concerns

Trapeziectomy is the removal of the trapezium bone at the thumb’s base. Why remove a bone, even a small one? Because the bone is thought to be the primary cause of pain as it has become misshapen by osteoarthritis. In the trapeziectomy with LRTI surgery, a ligament reconstruction procedure is also performed to help the thumb function better anatomically. To someone who uses their hands a lot, as in physically demanding work, the recover time of this procedure is 4 to 6 months. If successful.

Why say, if successful? A study in the medical journal Hand.(3)

Here we have a study from doctors at the University of Massachusetts Medical School. In this study the patient charts of 179 patients who had a thumb surgery were examined. Noted is that 21 patients had both thumbs undergo surgery.

The patients in this study had:

• simple trapeziectomy with or without LRTI and with or without Kirschner wire stabilization, or a Weilby procedure. (Tendon reconstruction replaces the void left by the bone removal).
• The average follow-up was 11.6 months
• Seventy hands had a postoperative complication. (That is 70 out of 200 or 35%).
• Ten of these complications were considered major, defined as requiring antibiotics, reoperation, or other aggressive interventions. (That is 5% of all patients).

CONCLUSIONS: Patients undergoing trapeziectomy with LRTI or Weilby had a greater incidence of reported complications when compared with trapeziectomy alone. These results suggest an advantage of simple trapeziectomy.

Why is there a risk that total joint replacement of the Trapeziometacarpal will not reduce pain?

A study from March 2020 (4) suggests that total joint replacement of the trapeziometacarpal joint provides good restoration of the thumb motion and pain relief in most patients. But there is also a risk of no improvement following the operation. The purpose of this study was to identify patients at risk of no clinically important improvement following operative treatment of osteoarthritis of the TMC joint.

• The researchers included 287 consecutive patients (225 women, 62 men) treated with total joint replacement of the trapeziometacarpal joint due to osteoarthritis with an average age of 58.9 years (range 41-80) in a prospective cohort study.
• Looking for who would have the greatest risk for no improvement following the surgery, the researchers found there was an increased risk of no clinically important improvement in hand function for patients with high preoperative grip strength. Also, we found an increased risk of no clinically important improvement in female patients.

But I am young, I need the surgery to get back to work or sport activities

Above we spoke about the realistic 3 – 6 month recovery time that will include splints, medications, therapies. Some doctors believe that the surgical repair of Trapeziometacarpal osteoarthritis is too aggressively recommended and this can lead to unwanted complication.

A study in the journal Hand Surgery and Rehabilitation, (5) they suggests:

“The demand for surgical treatment is growing and the patients are becoming younger, adding to the challenge. Surgery can only be proposed after failure of well-conducted conservative treatment and requires a complete X-ray assessment. . . The ideal arthroplasty (joint replacement) technique has yet to be defined but nevertheless, the chosen technique must be well-suited to the patient’s condition. Although many studies have been published on this topic, they do not help us define the treatment indications.

Prospective studies focusing on the patient rather than evaluating a certain surgical technique are needed. Trapeziectomy with or without ligament reconstruction is still considered the gold standard, but the challenges associated with treating its complications limit its indications. Arthrodesis, interposition or arthroplasty are also viable therapeutic options. The patient must be sufficiently informed to be able to contribute to choosing the indication.”

PRP injection can help rebuild the thumb joint. A comparison of PRP to cortisone

Above I presented the studies from the surgeons above the challenges they face providing thumb surgery. In this section I will present the options that include Platelet Rich Plasma injections and stem cell therapy injections.

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected into the thumb/wrist area to stimulate healing and regeneration. PRP puts specific components in the blood to work. Blood is made up of four main components; plasma, red blood cells, white blood cells, and platelets. Each part plays a role in keeping your body functioning properly. Platelets act as wound and injury healers. They are first on the scene at an injury, clotting to stop any bleeding and immediately helping to regenerate new tissue in the wounded area.

A 2018 study in the journal Cartilage (6) offered this comparison between PRP injections and cortisone injections. Before I start with this study I would like to point out that many people reach out to me and tell me how painful the actual cortisone injection was for them. The problem is the size of the needle and the size of the joint space. When we inject into this area we typically use a freeze spray and very fine needles. This provides the patient with a lot of comfort during the procedure. Also we do not offer a single injection of PRP. We inject into various areas of the wrist and thumb area to maximize the healing effect of the PRP injection.

To the research – the summary learning points:

• Various systematic reviews have recently shown that intra-articular platelet-rich plasma can lead to symptomatic relief of knee osteoarthritis for up to 12 months. There exist limited data on its use in small joints, such as the trapeziometacarpal joint (TMJ) or carpometacarpal joint (CMCJ) of the thumb.
• A prospective, randomized, blind, controlled, clinical trial of 33 patients with clinical and radiographic osteoarthritis of the trapeziometacarpal joint (grades: I-III) was conducted.
• Group A patients (16 patients) received 2 ultrasound-guided IA-PRP injections, while group B patients (17 patients) received 2 ultrasound-guided intra-articular methylprednisolone and lidocaine injections at a 2-week interval.
  • Patients were evaluated prior to and at 3 and 12 months after the second injection.
  • After 12 months’ follow-up, the IA-PRP treatment has yielded significantly better results in comparison with the corticosteroids, in terms of pain relief, better function, and patients’ satisfaction.

A study published in January 2021 compared PRP to cortisone in patients with trapeziometacarpal joint arthritis

A prospective, randomized, blind, controlled, clinical trial of 33 patients with clinical and radiographic osteoarthritis of the TMJ (grades: I-III) was conducted.(7)

• Group A patients (16 patients) received 2 ultrasound-guided intra-articular PRP injections, while group B patients (17 patients) received 2 ultrasound-guided intra-articular methylprednisolone and lidocaine injections at a 2-week interval.
• Patients were evaluated prior to and at 3 and 12 months after the second injection using the visual analogue scale (VAS) 100/100, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), and patient’s subjective satisfaction.
• After 12 months’ follow-up, the intra-articular PRP treatment has yielded significantly better results in comparison with the corticosteroids, in terms of VAS score, Q-DASH score , and patients’ satisfaction. Corticosteroids offer short-term relief of symptoms, but intra-articular PRP might achieve a lasting effect of up to 12 months in the treatment of early to moderate symptomatic trapeziometacarpal joint arthritis.

Doctors at the University of Malaga in Spain presented this case study of a concert pianist helped by PRP

This case review (8) was published in October 2019:

“Thumb carpometacarpal osteoarthritis is a progressively disabling, debilitating condition presenting with thumb base pain and hand functional impairment. Platelet-rich plasma has been used widely for the management of musculoskeletal pathologies, osteoarthritis being among them.

• A 59-year-old male professional pianist presented with chronic, mild onset of right thumb base pain involving a progressive lack of pinch strength in his right hand, and severe difficulties with playing.
• Three PRP injections were administered to the Thumb carpometacarpal joint on a 1-week interval regime.
• Clinical outcomes were assessed by using standard scoring scales including those for pain, grip and pinch strength
• Functional outcome was excellent according to patient’s capability with daily living activities and specific playing demands.
• At 12 months follow-up, no recurrences or complications were identified, with the musician returning to his previous level of performance 2 weeks before the end of this period.

“Patient self-reported satisfaction was high and he reported to return to his routine piano activity with no limitations. This case-based review study documents the clinical efficacy of PRP treatment from both functional and perceived-pain perspectives in a professional pianist. Presenting this case, our aim is to draw attention of healthcare providers dealing with Thumb carpometacarpal osteoarthritis to PRP as a safe, beneficial therapy for this condition which needs further assessment in randomized controlled trials.”

Stem Cell Therapy for thumb osteoarthritis

In our experience of over 23 years seeing patients with thumb osteoarthritis we have seen positive results with PRP and with bone marrow derived stem cell. There is research coming suggesting that the positive effects of stem cell therapy studied and documented in the large joints, the hips and knees for example, can be demonstrated in the small joints, those of the thumb for example. This was suggested and shown by research in the journal Plastic and reconstructive surgery. Global open. (9)

Stem cells offered in the thumb region act in the same manner as those injected into the knee. In our observations we have noted:

• We found that in the short-term, receiving multiple injections into a painful joint is more effective than receiving a single stem cell injection.
• Functionality score increased after first treatment, illustrating that patients experienced an immediate benefit in performing everyday activities with less difficulty.
• By the second injection, patients began to report improvement with pain at rest. Patients then experienced additional decreases in resting pain with each treatment thereafter.
• The increase in mean functionality score with successive stem cell treatments shows that increasing the number of BMC treatments improves patient performance in daily activities.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References:
1 Ganhewa AD, Wu R, Chae MP, Tobin V, Miller GS, Smith JA, Rozen WM, Hunter-Smith DJ. Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review. The Journal of hand surgery. 2019 Jun 28.
2 D’Agostino P, Dourthe B, Kerkhof F, Vereecke EE, Stockmans F. Impact of Osteoarthritis and Total Joint Arthroplasty on the Kinematics of the Trapeziometacarpal Joint: A Pilot Study. The Journal of hand surgery. 2018 Apr 1;43(4):382-e1.
3 Brandt KD, Radin P, Dieppe P, Putte L. Yet more evidence that osteoarthritis is not a cartilage disease. Ann Rheum Dis. 2006;65(10):1261-1264.
4 Mosegaard SB, Stilling M, Hansen TB. Risk factors for limited improvement after total trapeziometacarpal joint arthroplasty. Health and Quality of Life Outcomes. 2020 Dec;18:1-8.
5 Gay AM, Cerlier A, Iniesta A, Legré R. Surgery for trapeziometacarpal osteoarthritis. Hand Surgery and Rehabilitation. 2016 Sep 30;35(4):238-49.
6 Malahias MA, Roumeliotis L, Nikolaou VS, Chronopoulos E, Sourlas I, Babis GC. Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial. Cartilage. 2018 Oct 20:1947603518805230.
7 Malahias MA, Roumeliotis L, Nikolaou VS, Chronopoulos E, Sourlas I, Babis GC. Platelet-rich plasma versus corticosteroid intra-articular injections for the treatment of trapeziometacarpal arthritis: a prospective randomized controlled clinical trial. Cartilage. 2018 Oct 20:1947603518805230.
8 Medina-Porqueres I, Martin-Garcia P, Sanz-De Diego S, Reyes-Eldblom M, Cantero-Tellez R. Platelet-rich plasma for thumb carpometacarpal joint osteoarthritis in a professional pianist: case-based review. Rheumatology international. 2019 Oct 14:1-9.
9 Murphy MP, Buckley C, Sugrue C, Carr E, O’Reilly A, O’Neill S, Carroll SM. ASCOT: Autologous Bone Marrow Stem Cell Use for Osteoarthritis of the Thumb-First Carpometacarpal Joint. Plast Reconstr Surg Glob Open. 2017 Sep 19;5(9):e1486. doi: 10.1097/GOX.0000000000001486. PubMed PMID: 29062653; PubMed Central PMCID: PMC5640358.

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Marc Darrow MD,JD

Traditional methods of treating Carpal Tunnel Syndrome include wearing a splint at night or injections of cortisone to reduce swelling. If these measures are not successful, carpal tunnel release surgery, which sections the tough transverse carpal ligament and relieves pressure on the median nerve, may be performed. Despite some people having good success with surgery, there have been many patients who have presented to my office with worse symptoms after they had the carpal tunnel surgery.
Study: Surgeons confident Carpal Tunnel Surgery is a good option for patients, but not for them.

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