The Effectiveness of Plasma Rich in Growth Factors (PRGF) in the Treatment of Nerve Compression Syndromes of the Upper Extremity: A Retrospective Observational Clinical Study

Abstract

Background: Nerve compression syndromes of the upper extremity are a common cause of neuropathic pain and functional impairment. Recently, platelet-rich plasma (PRP) infiltrations have emerged as an effective biological approach to the treatment of this type of injury. The objectives of this retrospective observational study were to assess clinical improvement in patients with median and ulnar nerve entrapment syndrome after undergoing biologically-assisted nerve release surgery with plasma-rich-in-growth-factors (PRGF) technology. Methods: Participants (n = 39) with moderate-to-severe nerve compression syndrome of the upper limb diagnosed by both electromyography and clinical examination, and who were treated with PRGF, were identified from the center’s medical records. The evaluation was based on patient-reported outcomes. Pre- and post-treatment differences in the Visual analog scale (VAS), the Boston carpal tunnel questionnaire (BCTQ), and the Quick-DASH score were assessed. Results: Three study groups were conducted: patients with carpal tunnel syndrome (n = 16), with recurrent carpal tunnel syndrome (n = 8), and with ulnar nerve entrapment (n = 15). The median follow-up was 12 months (interquartile range (IQR), 9–16). In comparison to pre-treatment values, all three study groups obtained statistically significant improvements for the three analyzed scales at the end of the follow-up, with p < 0.001 for all scales in the carpal tunnel syndrome and ulnar nerve entrapment groups and p < 0.01 for all scales in the recurrent carpal tunnel syndrome group. There were no serious adverse effects in the analyzed patients. Conclusion: PRGF-assisted open surgical nerve release treatment (intraneural and perineural liquid PRGF infiltrations and nerve wrapping with PRGF membrane) exerts long-term beneficial effects on pain reduction and functional improvement in the nerve and nerve–muscle unit in patients with upper extremity compression syndromes.

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

“…An alternative technical approach to PRP final product standardization would be individual growth factor or cytokine content-based standardization, which presents both advantages and disadvantages [ 36 , 44 ]. On the one hand, selection of a single quality control marker (i.e., or a small panel of markers) to be used for PRP product standardization is technically feasible, with the use of specific and sensitive analytical tools, and may be considered advantageous over the current controls performed using iterative platelet enumeration from an analytical viewpoint.…”

“…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 ].…”

Surgical Treatment of Saphenous Nerve Injury Assisted by Plasma Rich in Growth Factors (PRGF): Lessons from a Case Report

“…Conservative management of neuropathic pain includes several types of treatment, such as oral or topical analgesics, the modification of activities of daily living, transcutaneous electrical stimulation, nerve blocks with corticosteroids and local anaesthetics, cryoneuroablation, pulsed and continuous radiofrequency [28,29], the application of particulate amniotic umbilical cord [30], and the use of platelet-rich plasma (PRP) [31][32][33][34], among others. The PRP we used was PRGF, which has a moderate concentration of platelets and is free of leucocytes and erythrocytes, and so it can be classified as a pure P-PRP [35].…”

“…The aim of wrapping the nerve with the PRGF membrane was two-fold. On the one hand, it helped to avoid surgical adhesions, and on the other hand, it helped to stimulate regen-eration with an extra supply of growth factors and other bioactive molecules involved in nerve regeneration, such as NGF, BDNF, IGF-1, PDGF, VEGF, HGF, TGF-β, fibronectin and vitronectin [32,34,36].…”

Current Status of PRP Manufacturing Requirements & European Regulatory Frameworks: Practical Tools for the Appropriate Implementation of PRP Therapies in Musculoskeletal Regenerative Medicine

“…Platelets then express adhesion factors in order to adhere to the injured endothelium ( Figure 1 B). In the context of regenerative medicine, the platelet growth factors are of particular interest [ 54 , 57 , 58 ]. Platelets notably synthesize epidermal growth factor (EGF), hepatocyte growth factor (HGF), insulin-like growth factor, and transforming growth factor (TGF) ( Figure 1 B) [ 54 , 57 ].…”