The hand and wrist pack fifteen joints, two dozen tendons and three major nerves into a space smaller than a paperback. That density is why an accurate diagnosis matters more here than almost anywhere else — thumb-side wrist pain can be tendon, joint or nerve, and the three are treated very differently.
Where it hurts, and what brings it on, narrows things down quickly.
- Numbness in the thumb, index and middle fingers that wakes you at night. The median nerve — carpal tunnel.
- Sharp pain on the thumb side of the wrist with gripping, wringing or lifting a child. The thumb tendons — de Quervain's.
- Pain at the base of the thumb with pinching, and a squared-off look developing. The basal joint.
- Pain on the little-finger side with forearm rotation, often with clicking. The TFCC.
- Deep aching at the back of the wrist with loss of extension and grip, years after an injury. Wrist arthritis.
- A wrist that is visibly swollen rather than simply painful. That is a workup, not a treatment — see below.
Every patient here is examined by a board-certified orthopedic surgeon, and most are scanned with ultrasound in the same visit. Ultrasound shows tendons and nerves moving in real time, which a static image cannot.
Not every problem on this page is best treated with an injection. Where the evidence points to a splint, hand therapy, a corticosteroid injection or an operation, that is what you will be told.
Carpal tunnel syndrome
The median nerve is compressed as it passes under the transverse carpal ligament. The classic pattern is numbness in the thumb, index and middle fingers that wakes you at night and makes you shake the hand out, along with dropping things and losing fine dexterity.
Assessment is a clinical examination plus ultrasound measurement of the nerve where it enters the tunnel; nerve conduction studies are added when the picture is unclear or the severity needs grading.
Night splinting and activity modification come first and resolve a meaningful share of mild cases. A corticosteroid injection is well established and works quickly. Carpal tunnel is also the best-studied hand condition for PRP: symptom and function scores improve, though measurements of the nerve itself do not change, and PRP has not been shown to outperform a corticosteroid injection. Class IV laser may potentially help symptoms alongside splinting.
The one thing not to do is wait too long. Wasting at the base of the thumb, numbness that has become constant rather than intermittent, or nerve testing showing significant loss all mean the nerve is being damaged, and a release is the treatment. Injections in that setting trade a permanent result for a temporary one, and you will be referred.
de Quervain's tenosynovitis
The two tendons that lift and straighten the thumb become inflamed inside their sheath at the thumb side of the wrist. Pain is sharp with gripping, wringing and lifting a child, and is reproduced by tucking the thumb into a fist and bending the wrist toward the little finger.
A thumb spica splint plus a corticosteroid injection into the sheath remains the best-supported first treatment, and for most people it settles the problem. PRP is a reasonable second option when a steroid injection has failed, or for a patient who would rather avoid one — the skin over the thumb side of the wrist is thin, and steroid there can leave a pale patch or a dip in the fat that does not always recover. Class IV laser may potentially help. Expect more soreness in the first week from PRP than from steroid.
Wrist ligament injury and instability
The scapholunate ligament is the one that matters most. It is commonly injured in a fall onto an outstretched hand, frequently missed at the time because the X-ray looks normal, and it announces itself later as pain at the back of the wrist with loading — push-ups, pressing up out of a chair — sometimes with a clunk.
Assessment is examination for tenderness and shift at the specific interval, plain X-rays including a clenched-fist view that loads the ligament, and MRI or arthroscopy when the diagnosis is genuinely in question.
A partial injury with the bones still aligned is managed with splinting, activity modification and hand therapy that trains the muscles which stabilise the joint. There is no controlled evidence that an orthobiologic injection repairs a torn scapholunate ligament. A complete tear with the bones separating is a surgical problem and time matters — untreated, it is the injury that produces the wrist arthritis described below, years later. That is a referral.
Wrist synovitis
Synovitis is a finding, not a diagnosis. The lining of the joint is inflamed, and the question that matters is why: rheumatoid or psoriatic arthritis, crystal disease such as gout or CPPD, an old injury, or — rarely and urgently — infection.
This is the one condition on this page where the first step is a workup rather than a treatment. That means examination, imaging and, where indicated, blood work or aspirating the joint for analysis. If the cause turns out to be inflammatory arthritis, the treatment is a rheumatologist and disease-modifying medication, and you will be referred; an injection into that wrist treats the symptom while the disease keeps going.
There is no orthobiologic evidence for wrist synovitis, and no injection is given into a swollen wrist whose cause has not been established.
Wrist arthritis
Arthritis at the wrist is most often post-traumatic — the late consequence of a scaphoid fracture that did not heal, or of a scapholunate ligament injury, sometimes decades earlier. It produces deep, aching pain at the back of the wrist, loss of extension, and weakness of grip.
Assessment is examination plus X-rays, which show the pattern and how far it has progressed; CT is occasionally added.
Splinting, activity modification, hand therapy and a guided corticosteroid injection are the non-operative options. Orthobiologic injection for wrist arthritis has not been shown to work — the small amount of published work is uncontrolled, and the one study with a statistical comparison found no effect. Where wrist arthritis is advanced the durable answers are surgical, and that is a referral rather than something to postpone with injections.
TFCC tears
The triangular fibrocartilage complex is the cushion and ligament sling on the little-finger side of the wrist. Tears cause pain with forearm rotation — turning a key, a doorknob, a screwdriver — often with clicking and a sense of instability.
Assessment is examination, X-rays to check whether the ulna sits long relative to the radius, and MRI when a tear needs confirming.
Anatomy determines what is possible here. The outer rim of the TFCC has a blood supply and can heal; the central portion does not and will not, regardless of what is injected into it. Peripheral tears often settle with a period of immobilisation and activity change.
There is no controlled evidence that PRP or bone marrow concentrate helps a TFCC tear, either injected alone or added to surgery, and the only comparative study did not favour it. That is stated plainly because this is a diagnosis for which injections are frequently offered. Tears that stay symptomatic are an arthroscopic problem and a referral.
Thumb arthritis — CMC or basal joint
The joint at the base of the thumb wears out more often than any other joint in the hand. Pain sits in the web space and the base of the thumb, is worst with pinching — jar lids, keys, buttons — and eventually produces a visible squaring at the base.
Assessment is examination, including loading and rotating the joint, plus X-rays to stage it.
A well-fitted thumb orthosis and hand therapy are the foundation and are more effective than most patients expect. A guided corticosteroid injection into a joint this small — it holds about a teaspoon at most — often gives months of relief. Class IV laser may potentially help with pain.
On orthobiologics, the honest position: basal joint arthritis is one of the most heavily marketed uses of PRP, and the best-designed trial did not show it beating a saline injection. Some patients report benefit and it is safe. When the joint is worn to the point that pinch is failing, the reliable answer is surgical, and that is a referral.
Arthritis elsewhere in the hand
The knuckles and the small finger joints develop arthritis too — the bony bumps at the end joints and the middle joints that many people recognise from a parent's hands.
Splints for the individual joint, hand therapy, topical and oral anti-inflammatories and guided corticosteroid injection are the mainstays. These joints hold under a teaspoon of fluid, which is why injecting them without imaging guidance often places the medication in the tissue around the joint rather than in it.
There is no published trial of orthobiologics in the finger joints specifically. What you may read about PRP for “hand arthritis” comes from studies of the thumb base, and that is not the same joint.
All PRP is not the same
The trials on this page that found nothing have something in common: nearly all of them gave a single injection, and almost none reported how many platelets were in it. Across the whole published hand and wrist literature, only two studies state what was actually prepared.
That matters, because where dose has been measured it changes the answer. In knee osteoarthritis — where Dr. Buford was one of the authors of a systematic review covering 32 randomised trials and 3,589 patients — under-dosed PRP behaves like saline and adequately dosed PRP does not. Trials injecting a preparation barely richer in platelets than ordinary blood found nothing. The trial that drew more blood, spun it twice and delivered several times the platelet dose was still showing benefit five years later.
Most of the negative trials did not report the dose, so it is possible that they were not really studying an effective PRP dose at all. Whether the threshold established in the knee applies in the hand and wrist has not been tested, and that will not be claimed here. But “PRP did not work in that study” and “PRP does not work” are different statements.
If you are considering PRP anywhere, ask what platelet dose you are getting, and how they know. All PRP is not the same — what your dose actually was →
What is offered here
- Assessment by a board-certified orthopedic surgeon, with the nerve, the tendons and the joints considered separately rather than lumped together as “wrist pain”.
- Ultrasound in the room — the median nerve measured where it enters the tunnel, tendons examined in motion, and any injection placed under direct vision. In a region this crowded that is not a refinement; an injection a few millimetres off is a different treatment.
- Platelet-rich plasma and bone marrow concentrate where indicated, with the evidence for your particular problem described as it actually stands. Detail and cost on PRP and orthobiologics for the wrist.
- Class IV MLS laser, which may potentially help symptoms alongside splinting or therapy. Class IV MLS laser therapy.
- Referral, promptly and with your records, where an operation or a rheumatologist is the right answer.
What is not offered
- Hand and wrist surgery — this practice is orthobiologics, shoulder surgery and knee surgery. Hand and wrist operations are not performed here and you will be referred to a hand surgeon, with your imaging and workup handed over personally rather than left to you to arrange.
- Injection into a swollen wrist whose cause has not been established.
- Injectable allograft products — amniotic fluid, Wharton's jelly, exosomes and regenerative protein arrays. Why not, in full, below.
What we do not offer, and why
This field has a marketing problem, so rather than just listing exclusions it is worth stating the standard being applied.
We do not use any product that lacks a clear FDA regulatory pathway for use in humans and clear human clinical outcomes data showing that it is safe and that it works for the indication being treated. Both halves, not either one. That single sentence accounts for most of what is on the market and not on the menu here.
Amniotic fluid, Wharton's jelly, exosomes and regenerative protein arrays
These are marketed heavily, often as “stem cell” injections, and patients are frequently quoted a great deal of money for them. None of them is used here. There are two reasons, and the second matters more than the first.
The regulatory reason. The FDA regulates these products as biologic drugs. None of them currently holds an approved orthopedic indication. That is a description of their regulatory status rather than a matter of opinion, and it holds whatever a clinic's marketing says about it.
The evidence reason, which is the more significant one. Treatment here is based on evidence, and there is no published literature for any of these injectable allograft options in orthopedics showing that any of them works better than PRP or bone marrow concentrate. Not equivalent-but-cheaper, not better-in-a-subgroup — the comparison that would justify using them has not been made in their favour. PRP and bone marrow concentrate, by contrast, have a substantial published human literature behind them.
So even setting the regulatory question aside entirely, there is no evidence-based argument for choosing one of these over a treatment prepared from your own tissue.
Adipose (fat) based treatments, also called microfat
Texas Orthobiologics does not currently offer adipose-based orthobiologics. That is a practice decision, and it is worth separating from the regulatory picture, because the two kinds of adipose treatment are not in the same position.
Adipose preparations produced with a device carrying FDA clearance or approval are regulatory compliant. An adipose-based biologic is often called microfat, after the way clinicians in the United States must process the tissue. It is a legitimate orthobiologic option and some clinicians have success with it.
Treatments based on stromal vascular fraction — SVF — are not currently regulatory compliant. This is now settled, and it is worth being specific about how it got there, because clinics still advertise these injections.
In 2024 a federal appeals court held that SVF is a drug under federal law, and that it does not qualify for the same-surgical-procedure exception that same-day fat procedures had relied on. The Supreme Court declined to review that decision in 2025. On 28 August 2026 the district court entered a permanent injunction on remand in United States v. California Stem Cell Treatment Center, Inc., which also names Cell Surgical Network Corporation. That is not a warning letter or an opinion — it is a standing federal court order.
The practical meaning for a patient is simple. An SVF injection is an unapproved drug unless it goes through the drug approval pathway, whatever the clinic offering it advertises about same-day processing or minimal manipulation. That argument has been made, and it lost.
Every injection here is made from your own tissue
Every biologic injection performed at Texas Orthobiologics is autologous — prepared from the patient's own blood or bone marrow on the day of treatment.
That is deliberately a statement about injections rather than a blanket position on donor tissue. Donor cartilage used as a structural graft in cartilage transplantation surgery is a different proposition entirely: it is regulated under an established pathway, it is implanted rather than injected, and it carries decades of published human outcomes data. It meets the standard above. An injectable donor cell product does not.
Get seen urgently for these
A hot, swollen, exquisitely painful hand or wrist with fever — particularly after a bite, a puncture or a cut, because an infected hand loses function quickly. Numbness that has become constant, or weakness and wasting at the base of the thumb. A wrist injury you cannot use, since a scaphoid fracture is often missed on the first X-ray and does badly when it is. None of those is an injection problem.
Common questions
Can PRP fix my carpal tunnel without surgery?
For mild to moderate carpal tunnel it may reduce symptoms, and it is the best-studied orthobiologic use in the hand. But it has not been shown to work better than a corticosteroid injection, and while symptom scores improve, measurements of the nerve itself do not change. If you have constant numbness, weakness, or wasting at the base of the thumb, injections are the wrong treatment and a release is the right one.
Is PRP better than a cortisone shot for thumb arthritis?
Not on the current evidence. The best-designed study compared PRP against a saline injection in ninety patients and found no meaningful difference at six months. A guided corticosteroid injection remains a reasonable option, and a well-fitted thumb splint does more than most patients expect. PRP is safe and some patients report benefit, but it should not be sold to you as the proven choice.
My wrist is swollen. Should I just get it injected?
No. Swelling in a wrist is a finding, not a diagnosis, and the question that matters is why. Rheumatoid or psoriatic arthritis, gout or CPPD, an old injury and, rarely, infection all look similar from the outside and are treated completely differently. That gets worked up first. An injection into a wrist whose cause has not been established treats the symptom while the disease continues.
I have a TFCC tear. Will an injection heal it?
Anatomy decides that, and mostly the answer is no. The outer rim of the TFCC has a blood supply and can heal, so peripheral tears often settle with immobilisation and activity change. The central portion has no blood supply and will not heal regardless of what is injected into it. There is no controlled evidence that PRP or bone marrow concentrate helps a TFCC tear, either alone or added to surgery.
Do you do hand and wrist surgery yourself?
No. This practice is orthobiologics, shoulder surgery and knee surgery. Hand and wrist operations are not performed here, so if your problem needs one you will be told plainly and referred to a hand surgeon, with your imaging and workup handed over personally rather than left to you to arrange. Being told an injection will not help is part of the assessment, not a failure of it.
