Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial

Abstract

BackgroundCarpal tunnel syndrome is the most common peripheral entrapment neuropathy, for which conservative treatments are the first measures taken. However, these measures are not usually sufficient. Recently major attention has been drawn to platelet-rich plasma for its possible effects on axon regeneration and neurological recovery. Although few studies have evaluated the effects of this treatment in carpal tunnel syndrome, further investigation is required to reach concrete conclusion.MethodsIn this randomized controlled trial, women referring to the physical medicine and rehabilitation clinic at Shahid Modarres Hospital during 2016 with a diagnosis of mild and moderate idiopathic carpal tunnel syndrome were chosen. They were randomly assigned to two groups: (i) a control group using only a wrist splint, and (ii) a platelet-rich plasma group that received wrist splints along with a single local injection of platelet-rich plasma. The outcome measures were assessed via Visual Analogue Scale, the Boston Carpal Tunnel Syndrome Questionnaire and electrophysiological findings including the peak latency of sensory nerve action potential and the onset latency of the compound muscle action potential.ResultsA total of 41 women were included (20 wrists as control group) and (21 wrists as platelet-rich plasma group). Before treatment there were no significant differences between the two groups except for the median peak latency of sensory nerve action potential which was significantly higher among the patients in the platelet-rich plasma group (p = 0.03). All the measured variables significantly decreased in both groups after 10 weeks of treatment except for the median onset latency of the compound muscle action potential (p = 0.472). Finally, the changes in neither of the evaluated outcome measures were found to significantly differ between the two groups, even when the analyses were adjusted for age of the patients.ConclusionThe findings of this study showed that in a relatively short period of time after treatment, a single injection of platelet-rich plasma in the wrist does not significantly add to the effects of conservative treatment with wrist splints, in regards to the women pain and symptom severity, functional status and electrophysiological parameters.Trial registrationThe trial has been retrospectively registered with an ID: IRCT2017041513442N13 (Date of registration: 2017–06-19).

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

“…Regenerative injections may cause a rapid decrease of symptom severity; however, functional improvement still depends on the recovery of muscle endurance and strength, which requires adequate rest and proper wrist positioning, with the use of a splint. Further, although PRP injection ranked second in effectiveness in terms of functional improvement, the patients in the two included PRP studies [23,29] had additional splinting after the injection. An earlier randomized controlled trial has revealed that splinting combined with corticosteroid injection was superior to corticosteroid injection alone, in terms of functional recovery and symptom relief in CTS [48].…”

“…The maximal follow-up duration was 24 weeks in five trials [22,[31][32][33][34], 12 weeks in three trials [27,28,30], 10 weeks in one trial [29], and four weeks in one trial [23]. Only one study [29] reported some minor adverse effects after the injection.…”

“…Of the ten included studies, three compared PRP with corticosteroid injection [27,30,32], one compared PRP with saline injection [28], three compared PRP injection (with or without additional splinting) with splinting alone [23,29,33], one [34] compared D5W with saline injection, one [22] compared D5W with corticosteroid injection, and one [31] compared PRP with D5W injection. With respect to outcome assessment, the Boston Carpal Tunnel Questionnaire (BCTS) was used in nine [22,23,27,[29][30][31][32][33][34] of the ten enrolled studies. The visual analogue scale (VAS) for pain was used as a surrogate for the symptom severity scale (SSS) in one trial [28].…”

“…The visual analogue scale (VAS) for pain was used as a surrogate for the symptom severity scale (SSS) in one trial [28]. In terms of the injection technique, seven studies [22,23,28,30,31,33,34] used ultrasound guidance, whereas three [27,29,32] employed palpation guidance. The maximal follow-up duration was 24 weeks in five trials [22,[31][32][33][34], 12 weeks in three trials [27,28,30], 10 weeks in one trial [29], and four weeks in one trial [23].…”

“…Three studies were further discarded because one was a conference proceeding without retrievable data [24], one was a case report [25], and the other was a case series without a control group [26]. Therefore, ten studies were included in the final quantitative analysis (Figure 1) [22,23,[27][28][29][30][31][32][33][34].…”