Hand pain from thumb arthritis and carpal tunnel syndrome often come together. At our office in St. Louis we check both: PRP into the worn thumb base joint, and ultrasound-guided hydrodissection with PRP to free the squeezed median nerve. When the nerve is already losing muscle, carpal tunnel release is the right call, and we perform it here, in-house.
The thumb does half the work of the hand. Every pinch, twist and grip runs through one small joint at its base, where the thumb meets the wrist. Right next to it, the median nerve runs through a tight tunnel under a band of ligament. Wear out the joint and squeeze the nerve, and you get a hand that aches at the base of the thumb, tingles at night and drops the coffee cup.
Most patients arrive having been treated for one of the two. The numbness got a wrist splint. The aching got a cortisone shot. Nobody looked at both.
The two feel different once you know what to ask:
Numbness can also come from the neck. We check whether hand numbness starts in the wrist or the neck before treating anything.
Medicine bills one diagnosis per visit, and each diagnosis gets its own fix. Release the carpal tunnel and the thumb base still grinds. Remove the arthritic thumb bone and the fingers still go numb. The patient who had surgery and still hurts is often the patient who had two problems and one operation.
We look at the whole hand in one visit: an exam of the thumb base and the nerve, ultrasound of the joint and the median nerve in the room, and nerve testing when the numbness is constant.
The same three forces drive both:
Platelets are the repair workers. In PRP injections we draw your blood, concentrate the platelets in an FDA-cleared device and place them into the thumb base joint under ultrasound. The joint is the size of a pea, and blind needles miss.
In a randomized trial of 33 patients with thumb base arthritis, ultrasound-guided PRP beat steroid at 12 months on pain, hand function and satisfaction. A 2025 review of 17 trials covering 1,166 thumbs found no surgery clearly better than another, and PRP outperforming steroid shots. In a blinded trial of 95 patients, a mix of the patient’s own fat and PRP was the only injection that clearly beat saltwater for pain and function. That is the logic behind adding microfragmented fat for a more worn joint.
The median nerve gets stuck to the tissue around it, like a wire glued to the inside of a pipe. In hydrodissection we watch the nerve on ultrasound and use fluid to peel it free from the ligament and the tendons beside it. Then we can place PRP around the nerve to calm the irritated tissue. Hydrodissection is done in our own office.
A 2024 network analysis of 18 trials found PRP helped carpal tunnel symptoms and function in both the short and long term, while steroid helped only in the short term. A 2025 analysis of nine hydrodissection studies (458 patients) ranked PRP highest for symptom relief at 12 and 24 weeks.
Some nerves are past the point of an injection. Surgery is the right answer when you have:
A squeezed nerve that has started to lose muscle needs room, and fast. When we see that, we tell you the same day, and we perform the carpal tunnel release in-house, so you are not sent back to the start of someone else’s waiting list. The same goes for a thumb base that has collapsed: joint surgery is the better tool.
Procedures are done under local anesthetic. You are awake, there is no sedation, and most patients drive themselves home. Expect soreness for about 48 hours after PRP. Protect the hand for the first few days and follow the rehab plan.
The number of treatments follows clinical need. Some feel better in three weeks; others need a second or third treatment, decided by how the tissue responds. Lifestyle and behavior are 40 to 50 percent of our protocol: hand therapy, night splinting, laser therapy and metabolic optimization. You can’t make a carrot grow faster than it grows.
More on this condition from Dr. Padda on YouTube:
Yes, and it is common. The joint and the nerve sit side by side and share the same risk factors.
Mild to moderate carpal tunnel often responds to hydrodissection, PRP, splinting and metabolic repair. Constant numbness or thumb muscle wasting needs a release, which we perform in-house.
Steroid works faster. In a randomized trial, PRP held its benefit at 12 months while steroid did not.
Wrists bend while you sleep, which squeezes the median nerve. Night numbness is a classic carpal tunnel sign.
No. We use local anesthetic, you stay awake, and most patients drive themselves home.
PRP is not billed to insurance. HSA and FSA funds are generally eligible.
If you had a splint for the numbness and a shot for the thumb and the hand still fails you, have both problems looked at in one visit. Every option is laid out on our orthobiologics in St. Louis page. Over 90% of our accepted case-study patients see significant improvement. These are practice-reported figures from our own population, not trial outcomes, and individual results vary. Request the orthobiologics guide above, or call our office at 4477 Woodson Rd in St. Louis at (314) 481-5000.
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