Efficacy and safety of platelet-rich plasma in the treatment of carpal tunnel syndrome: A network meta-analysis of different injection treatments

Abstract

Purpose: Carpal tunnel syndrome (CTS) is a common form of median nerve compression in the wrist caused by focal peripheral neuropathy. Platelet-rich plasma (PRP) therapy could improve the healing ability by exposing the injured tissues to high concentrations of autologous growth factors. Our study aims to compare all injective treatments for CTS and assess the efficacy and priority of PRP therapy.Methods: We searched Medline, Embase, Web of Science, Cochrane databases, and Clinicaltrial.gov until 17 October 2022. We only included data from randomized controlled trials (RCTs) that evaluated PRP injection therapy or drug injection therapy. The included RCTs measured at least one of the following three outcomes with validated instruments: in the visual analog scale (VAS), symptom severity scale (SSS), and functional status scale (FSS).Results: Overall, 19 studies with 1,066 patients were included in this study. We used the SUCRA rankings to determine the merits of various therapies. In all, 5% dextrose injections were the best treatment strategy for the VAS (MD −1.22, 95% CI −2.66 to 0.23; SUCRA = 79.2%), followed by triamcinolone (high-dose) injections (MD −0.69, 95% CI −2.11 to 0.73; SUCRA = 62.7%) and PRP injections (MD −0.39, 95% CI −1.67 to 0.89; SUCRA = 60.0%). In the SSS, the most effective intervention was hydroxyprogesterone injections (MD −0.62, 95% CI −1.09 to −0.16; SUCRA = 91.0%). The SUCRA ranking of PRP was second only to steroids and estrogen (MD −0.39, 95% CI −0.60 to −0.18; SUCRA = 60.8%). In the FSS, the best regimen strategy was hydroxyprogesterone injections (MD 0.12, 95% CI −0.30 to 0.54; SUCRA = 99.5%), followed by triamcinolone (low-dose) injections (MD −0.02, 95% CI −0.54 to 0.49; SUCRA = 87.4%) and PRP injections (MD −0.26, 95% CI −0.43 to −0.09; SUCRA = 77.1%).Conclusion: PRP is an alternative choice for CTS treatment. PRP injection is second only to steroids and estrogen in the treatment efficacy of CTS, with a wide indication and safe outcome.

Upadacitinib Is a Better Choice than Abrocitinib for Patients with Moderate-to-Severe Atopic Dermatitis: An Updated Meta-Analysis

“…Another reviewer BL would make decision when YZ and RL met disagreements and failed consensus. Small-study efects that led to potential reporting or publication bias could be calculated by Egger's test [20]. Publication bias was evaluated by funnel plots and P ≤ 0.05 was considered a statistically signifcant risk of bias.…”

Local injection therapy for carpal tunnel syndrome: a network meta-analysis of randomized controlled trial

“…In a network meta-analysis comparing PRP, D5W, CS, splints, and saline, PRP and D5W were superior to CS in improving symptom severity and functional status (Lin C. P. et al, 2020). Pan et al further compared the efficacy of PRP, D5W, progesterone, ozone, and various types and doses of CS by using the same approach as that described by Lin et al, and the results of the former were consistent with those of the latter (Hong et al, 2022). However, the aforementioned studies are deficient.…”

“…The use of several emerging topical, injectable agents as options for treating CTS has been attempted. Of them, platelet-rich plasma (PRP) and 5% dextrose in water (D5W) are the most critical potential treatments ( Lin et al, 2020 ; Hong et al, 2022 ). Ozone O) and hyaluronidase (HA) have also shown potential ( Elawamy et al, 2020 ; Forogh et al, 2021 ).…”

Process Optimization and Efficacy Assessment of Standardized PRP for Tendinopathies in Sports Medicine: Retrospective Study of Clinical Files and GMP Manufacturing Records in a Swiss University Hospital

“…Delivery of supra-physiological concentrations of growth factors and cytokines found in PRP (i.e., following platelet breakdown) often stimulates an accelerated and physiological regenerative response at the site of the tissular injury. Currently, PRP is commonly used in surgery and regenerative medicine to improve the recovery potential of soft tissues (e.g., ligaments, tendons, cartilage, and nerves) and bones [ 32 , 33 , 34 , 35 , 36 , 37 ]. Its clinical use has also been extensively reported for cutaneous wounds, burns, and skin donor sites, as well as for esthetic applications (e.g., cutaneous and capillary) [ 28 , 38 , 39 , 40 , 41 , 42 , 43 ].…”