Hand, Wrist and Elbow Orthobiologics

Hand, wrist and elbow problems are hard to rest. You can stay off an injured knee for a few weeks, but you cannot stop using your hands to open a door, wash dishes, type, button a shirt or hold a golf club. That is why pain in these joints tends to get reported late. This page collects what Don Buford, MD has written about orthobiologic treatment of the upper extremity, from tennis elbow and partial ulnar collateral ligament tears to thumb arthritis, carpal tunnel syndrome, De Quervain's tenosynovitis and wrist instability. It is written for patients weighing their options and for physicians who want to know what the published evidence actually supports.

Tennis elbow and golfer's elbow

Lateral elbow tendinopathy, usually called tennis elbow, and its inner-elbow counterpart, golfer's elbow, are the most common reasons people come in with elbow pain. The comparative evidence for platelet rich plasma in these conditions has improved considerably. A 2023 level 1 study followed 64 patients with lateral elbow tendinopathy for two years and found the PRP injection outperformed the steroid injection. A more recent level 2 study compared PRP to dry needling and concluded PRP was better at the six month mark and beyond.

The honest caveat is that the dry needling comparison report leaves out key details about the PRP dose that was used, which makes it hard to reproduce or to compare against other trials. Allan Mishra published the benchmark article on PRP for tennis elbow in the American Journal of Sports Medicine in 2013, and the field has been arguing about dosing ever since. When you read a study on elbow tendinopathy, the platelet dose and the number of injections matter as much as the headline conclusion.

Elbow ligament injuries and the throwing athlete

Partial thickness tears of the ulnar collateral ligament, the ligament on the inner elbow that takes the strain of throwing, have become far more frequent and in a far younger population. Single sport specialization at a young age carries consequences, and the throwing elbow is where many of them show up. In Dr. Buford's experience, 85 to 90 percent of symptomatic partial thickness UCL tears heal within three months after one or two high dose PRP injections. That is his own clinical experience rather than a published trial result, and individual response varies.

Some cases are treated with a combination approach. One young baseball athlete had a bone marrow concentrate injection for a partial UCL tear, followed two weeks later by a PRP injection to push the healing response further along. Every injection is placed with ultrasound guidance, which lets the ligament be imaged and the needle tracked into the exact area of the tear.

Arthritis in the thumb, hand and wrist

Thumb base arthritis and wrist osteoarthritis are typically managed with medication, bracing, therapy and steroid injections. PRP is the option in that list that works from the patient's own blood and its healing and anti-inflammatory signals rather than by suppressing inflammation from outside. One patient reported about 80 percent pain relief that lasted a year after a single in-office PRP injection at a point when steroid shots had stopped helping his hand. Results differ from patient to patient.

A common question is whether bone marrow concentrate adds anything over PRP in joints as small as the hand and wrist, where injection volumes are tiny. One patient, himself a surgeon with hand and wrist arthritis, reported that his bone marrow concentrate injection lasted roughly three times longer than the PRP injection he had received previously. That is a single reported experience, not a controlled comparison, and it is offered as an observation rather than a rule.

Carpal tunnel, De Quervain's and wrist instability

Numbness and pain in the hands, a grip that has weakened over time, trouble with buttons and small tasks, and waking at night with numb painful hands are the classic signs of carpal tunnel syndrome. Published research supports PRP injection for carpal tunnel syndrome and for De Quervain's tenosynovitis, and both are treated in the office with ultrasound guidance so the median nerve or the first dorsal compartment can be targeted directly.

Wrist instability is a different problem and a harder one. One patient had chronic left distal radioulnar joint instability that persisted through five months of nonoperative treatment. Surgery was on the table, and the patient elected a bone marrow derived stem cell injection instead. Cases like that are the reason it is worth asking about orthobiologics before committing to an operation for a ligament problem in the wrist.

Why dose and documentation matter

Every PRP injection given in this office is analyzed and documented so that dosing criteria can be developed for specific orthopedic applications. PRP is a biologic, and like any drug the amount delivered changes the result. Much of the published literature reports a treatment simply as PRP without saying how many platelets were in it, which is a large part of why trial results conflict. Where the evidence is mixed, we say so.