Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Published:December 07, 2019DOI:


      • Platelet-rich plasma (PRP) is theorized to reduce inflammation and promote neuronal and axon regeneration.
      • Four randomized controlled trials assessed the effects of PRP on pain and function in carpal tunnel syndrome.
      • PRP results in significant improvement in the Boston Carpal Tunnel Questionnaire but no change in the visual analog scale.
      • PRP represents a promising intervention; however, studies were of short follow-up.
      • Further investigation is necessary to determine the true efficacy and effect of PRP.



      To systematically review and evaluate the efficacy and complication profile of platelet-rich plasma (PRP) injection into the carpal tunnel for management of carpal tunnel syndrome (CTS).

      Data Sources

      PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Sciences (from inception to January 1, 2019).

      Study Selection

      Controlled trials addressing PRP for CTS.

      Data Extraction

      Two reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. The outcomes of interest were the visual analog score (VAS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ), including the subscales of the symptom severity scale (SSS) and the Functional Status Scale (FSS). Other reported outcome measures and complications were analyzed descriptively.

      Data Synthesis

      Four randomized controlled studies satisfied the inclusion criteria and analyzed a total of 191 cases with a final follow-up of either 3 or 6 months. Control groups included splinting in 2 studies, corticosteroid injection in 1 study, and saline injection in 1 study. There was a statistically and clinically significant improvement in the BCTQ (standardized mean difference=-2.06; 95% confidence interval [CI], -3.41 to -0.70; P=.003) between groups. Subgroup analysis showed significant improvement in SSS (standardized mean difference=-1.95; 95% CI, -3.65 to -0.25; P=.02) but not for FSS (standardized mean difference=-2.19; 95% CI, -4.77 to 0.40; P=.10). There was a similar improvement in VAS and nerve conduction studies in those receiving PRP compared to controls. Complication rate in the included studies was low with 4 of 97 participants receiving PRP injections experiencing transient pruritis, burning, or tingling.


      PRP represents a promising therapy for patients with mild to moderate CTS; however, included studies were limited as follow-up was short, the studies included patients that were heterogeneous, and the number of included studies was low. Further investigation is necessary to determine the true efficacy and effect of PRP and to better delineate the long-term results in patients with CTS.


      List of abbreviations:

      BCTQ (Boston Carpal Tunnel Questionnaire), CTS (carpal tunnel syndrome), FSS (Functional Status Scale), MCID (minimal clinically important difference), NCS (nerve conduction studies), PRP (platelet-rich plasma), VAS (visual analog scale), SSS (symptom severity scale)
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        • Louie D.
        • Earp B.
        • Blazar P.
        Long-term outcomes of carpal tunnel release: a critical review of the literature.
        Hand. 2012; 7: 242-246
        • Ng A.W.H.
        • Griffith J.F.
        • Lee R.K.L.
        • Tse W.L.
        • Wong C.W.Y.
        • Ho P.C.
        Ultrasound carpal tunnel syndrome: additional criteria for diagnosis.
        Clin Radiol. 2018; 73 (214.e11-8)
        • Oh W.T.
        • Kang H.J.
        • Koh I.H.
        • Jang J.Y.
        • Choi Y.R.
        Morphologic change of nerve and symptom relief are similar after mini-incision and endoscopic carpal tunnel release: a randomized trial.
        BMC Musculoskelet Disord. 2017; 18: 1-8
        • Werner R.A.
        • Andary M.
        Carpal tunnel syndrome: pathophysiology and clinical neurophysiology.
        Clin Neurophysiol. 2002; 113: 1373-1381
        • Marshall S.
        • Tardif G.
        • Ashworth N.
        Local corticosteroid injection for carpal tunnel syndrome.
        Cochrane Database Syst Rev. 2007; (CD001554)
        • Chesterton L.S.
        • Blagojevic-Bucknall M.
        • Burton C.
        • et al.
        The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial.
        Lancet. 2018; 392: 1423-1433
        • Wu Y.T.
        • Ke M.J.
        • Ho T.Y.
        • Li T.Y.
        • Shen Y.P.
        • Chen L.C.
        Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients.
        Ann Neurol. 2018; 84: 601-610
        • Roghani R.S.
        • Holisaz M.T.
        • Tarkashvand M.
        • et al.
        Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial.
        Clin Interv Aging. 2018; 13: 117-124
        • Inui A.
        • Nishimoto H.
        • Mifune Y.
        • Kokubu T.
        • Sakata R.
        • Kurosaka M.
        Ultrasound measurement of median nerve cross-sectional area at the inlet and outlet of carpal tunnel after carpal tunnel release compared to electrodiagnostic findings.
        Arch Orthop Trauma Surg. 2016; 136: 1325-1330
        • Tang C.Q.Y.
        • Lai S.W.H.
        • Tay S.C.
        Patient-reported outcomes of carpal tunnel release surgery in patients with bilateral severe carpal tunnel syndrome.
        J Hand Surg Eur. 2017; 42: 932-936
        • Boya H.
        • Özcan Ö.
        • Özteki N.H.H.
        Long-term complications of open carpal tunnel release.
        Muscle Nerve. 2008; 38: 1443-1446
        • Sonoo M.
        • Menkes D.L.
        • Bland J.D.P.
        • Burke D.
        Nerve conduction studies and EMG in carpal tunnel syndrome: do they add value?.
        Clin Neurophysiol Pract. 2018; 3: 78-88
        • Muiños-López E.
        • Delgado D.
        • Sánchez P.
        • et al.
        Modulation of synovial fluid-derived mesenchymal stem cells by intra-articular and intraosseous platelet rich plasma administration.
        Stem Cells Int. 2016; 2016: 1247950
        • Wang A.
        • McCann P.
        • Colliver J.
        • et al.
        Do postoperative platelet-rich plasma injections accelerate early tendon healing and functional recovery after arthroscopic supraspinatus repair?: a randomized controlled trial.
        Am J Sports Med. 2015; 43: 1430-1437
        • Le A.
        • Enweze L.
        • DeBaun M.R.
        • Dragoo J.L.
        Current clinical recommendations for use of platelet-rich plasma.
        Curr Rev Musculoskelet Med. 2018; 11: 624-634
        • Zheng C.
        • Zhu Q.
        • Liu X.
        • et al.
        Effect of platelet-rich plasma (PRP) concentration on proliferation, neurotrophic function and migration of Schwann cells in vitro.
        J Tissue Eng Regen Med. 2016; 10: 428-436
        • Malavolta E.A.
        • Assunção J.H.
        • Gracitelli M.E.C.
        • Ferreira Neto A.A.
        Comments on: Evaluation of platelet-rich plasma and fibrin matrix to assist in healing and repair of rotator cuff injuries: a systematic review and meta-analysis.
        Clin Rehabil. 2016; 30: 726-727
        • Fiz N.
        • Pérez J.C.
        • Guadilla J.
        • et al.
        Intraosseous infiltration of platelet-rich plasma for severe hip osteoarthritis.
        Arthrosc Tech. 2017; 6: e821-e825
        • Park G.Y.
        • Kwon D.R.
        Platelet-rich plasma limits the nerve injury caused by 10% dextrose in the rabbit median nerve.
        Muscle Nerve. 2014; 49: 56-60
        • Farrag T.Y.
        • Lehar M.
        • Verhaegen P.
        • Carson K.A.
        • Byrne P.J.
        Effect of platelet rich plasma and fibrin sealant on facial nerve regeneration in a rat model.
        Laryngoscope. 2007; 117: 157-165
        • Ding X.
        • Li S.W.
        • Zheng X.M.
        • Hu L.Q.
        • Hu W.L.
        • Luo Y.
        The effect of platelet-rich plasma on cavernous nerve regeneration in a rat model.
        Asian J Androl. 2009; 11: 215-221
        • Sánchez M.
        • Anitua E.
        • Delgado D.
        • et al.
        Ultrasound-guided plasma rich in growth factors injections and scaffolds hasten motor nerve functional recovery in an ovine model of nerve crush injury.
        J Tissue Eng Regen Med. 2017; 11: 1619-1629
        • Anjayani S.
        • Wirohadidjojo Y.W.
        • Adam A.M.
        • Suwandi D.
        • Seweng A.
        • Amiruddin M.D.
        Sensory improvement of leprosy peripheral neuropathy in patients treated with perineural injection of platelet-rich plasma.
        Int J Dermatol. 2014; 53: 109-113
        • Sánchez M.
        • Yoshioka T.
        • Ortega M.
        • Delgado D.
        • Anitua E.
        Ultrasound-guided platelet-rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 1084-1089
        • Wu Y.T.
        • Ho T.Y.
        • Chou Y.C.
        • et al.
        Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: a prospective randomized, single-blind controlled trial.
        Sci Rep. 2017; 7: 1-11
        • Uzun H.
        • Bitik O.
        • Uzun Ö.
        • Ersoy U.S.
        • Aktaş E.
        Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome.
        J Plast Surg Hand Surg. 2017; 51: 301-305
        • Malahias M.A.
        • et al.
        Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: a placebo-controlled clinical study.
        J Tissue Eng Regen Med. 2018; 12e14808
        • Raeissadat S.A.
        • Karimzadeh A.
        • Hashemi M.
        • Bagherzadeh L.
        Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial.
        BMC Musculoskelet Disord. 2018; 19: 1-6
        • McGinn T.
        • Wyer P.C.
        • Newman T.B.
        • et al.
        Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic).
        CMAJ. 2004; 171: 1369-1373
        • Dumitru D.
        • Amato A.
        • Zwarts M.
        Focal peripheral neuropathies.
        Electrodiagnostic medicine. 2nd ed. Hanley and Belfus, Philadelphia2002
        • Padua L.
        • LoMonaco M.
        • Gregori B.
        • Valente E.M.
        • Padua R.
        • Tonali P.
        Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands.
        Acta Neurol Scand. 1997; 96: 211-217
        • American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation
        Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement.
        Muscle Nerve. 2002; 25: 918-922
        • Alexander M.
        • Chytas D.
        • Mavrogenis A.F.
        • Nikolaou V.S.
        • Johnson E.O.
        • Babis G.C.
        Platelet - rich plasma injections for carpal tunnel syndrome : a systematic and comprehensive review.
        Eur J Orthop Surg Traumatol. 2019; 29: 1-8
        • Sánchez M.
        • Anitua E.
        • Delgado D.
        • et al.
        Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration.
        Expert Opin Biol Ther. 2017; 17: 197-212
        • Karaahmet Ö.Z.
        • Gürçay E.
        • Kara M.
        • Serçe A.
        • Kıraç Ünal Z.
        • Çakcı A.
        Comparing the effectiveness of ultrasound-guided versus blind steroid injection in the treatment of severe carpal tunnel syndrome.
        Turkish J Med Sci. 2017; 47: 1785-1790
        • Cellocco P.
        • Rossi C.
        • Bizzarri F.
        • Patrizio L.
        • Costanzo G.
        Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study.
        J Hand Surg Am. 2005; 30: 493-499
        • Niedermeier S.R.
        • Pettit R.J.
        • Frantz T.L.
        • Colvell K.
        • M Awan H.
        Early postoperative improvement in sleep and pain after carpal tunnel release.
        Hand. 2018; (1558944718793984)
        • Siegmeth A.W.
        • Hopkinson-Woolley J.A.
        Standard open decompression in carpal tunnel syndrome compared with a modified open technique preserving the superficial skin nerves: a prospective randomized study.
        J Hand Surg Am. 2006; 31: 1483-1489
        • Merolla G.
        • Dellabiancia F.
        • Ricci A.
        • et al.
        Arthroscopic debridement versus platelet-rich plasma injection: a prospective, randomized, comparative study of chronic lateral epicondylitis with a nearly 2-year follow-up.
        Arthroscopy. 2017; 33: 1320-1329
        • Murray D.J.
        • Javed S.
        • Jain N.
        • Kemp S.
        • Watts A.C.
        Platelet—rich—plasma injections in treating lateral epicondylosis: a review of the recent evidence.
        J Hand Microsurg. 2016; 7: 320-325
        • Lue Y.J.
        • Wu Y.Y.
        • Liu Y.F.
        • Lin G.T.
        • Lu Y.M.
        Confirmatory factor analysis of the Boston Carpal Tunnel Questionnaire.
        J Occup Rehabil. 2015; 25: 717-724
        • Leite J.C.
        • Jerosch-Herold C.
        • Song F.
        A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire.
        BMC Musculoskelet Disord. 2006; 7: 78
        • Padua L.
        • Padua R.
        • Aprile I.
        • Caliandro P.
        • Tonali P.
        Boston Carpal Tunnel Questionnaire: the influence of diagnosis on patient-oriented results.
        Neurol Res. 2005; 27: 522-524
        • De Kleermaeker F.
        • Boogaarts H.
        • Meulstee J.
        • Verhagen W.
        Minimal clinically important difference for the Boston Carpal Tunnel Questionnaire: new insights and review of literature.
        J Hand Surg Eur. 2019; 44: 283-289
        • Lew H.L.
        • Wang L.
        • Robinson L.R.
        Test-retest reliability of combined sensory index: implications for diagnosing carpal tunnel syndrome.
        Muscle Nerve. 2000; 23: 1261-1264
        • Robinson L.R.
        • Strakowski J.
        • Kennedy D.J.
        Is the Combined Sensory (Robinson) Index routinely indicated for all cases of suspected carpal tunnel syndrome undergoing electrodiagnostic evaluation?.
        PM R. 2013; 5: 433-437
        • Zeidman L.A.
        • Singh S.K.
        • Pandey D.K.
        Higher diagnostic yield with the combined sensory index in mild carpal tunnel syndrome.
        J Clin Neuromuscul Dis. 2014; 15: 143-146
        • Zeidman L.A.
        • Pandey D.K.
        A carpal tunnel grading system including combined sensory index-diagnosed mild cases: relation to presenting features and outcomes.
        Muscle Nerve. 2018; 57: 45-48
        • Atan T.
        • Günendi Z.
        Diagnostic utility of the sonographic median to ulnar nerve cross-sectional area ratio in carpal tunnel syndrome.
        Turkish J Med Sci. 2018; 48: 110-116
        • Tas S.
        • Staub F.
        • Dombert T.
        • et al.
        Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study.
        Neurosurg Focus. 2015; 39: E6
        • Kim J.K.
        • Koh Y.D.
        • Kim J.O.
        • Choi S.W.
        Changes in clinical symptoms, functions, and the median nerve cross-sectional area at the carpal tunnel inlet after open carpal tunnel release.
        Clin Orthop Surg. 2016; 8: 298-302
        • Phongamwong C.
        • Soponprapakorn N.
        • Kumnerddee W.
        Determination of electrophysiologically moderate and severe carpal tunnel syndrome: ultrasonographic measurement of median nerve at the wrist.
        Ann Rehabil Med. 2017; 41: 604-609
        • Asadov R.
        • Erdal A.
        • Buğdaycı O.
        • Gündüz O.H.
        • Ekinci G.
        The effectiveness of ultrasonography and ultrasonographic elastography in the diagnosis of carpal tunnel syndrome and evaluation of treatment response after steroid injection.
        Eur J Radiol. 2018; 108: 172-176
        • Kaile E.
        • Bland J.D.P.
        Safety of corticosteroid injection for carpal tunnel syndrome.
        J Hand Surg Eur. 2018; 43: 296-302
        • Cigna E.
        • Özkan Ö.
        • Mardini S.
        • Chiang P.T.
        • Yang C.H.
        • Chen H.C.
        Late spontaneous rupture of the extensor pollicis longus tendon after corticosteroid injection for flexor tenosynovitis.
        Eur Rev Med Pharmacol Sci. 2013; 17: 845-848
        • Lu H.
        • Yang H.
        • Shen H.
        • Ye G.
        • Lin X.J.
        The clinical effect of tendon repair for tendon spontaneous rupture after corticosteroid injection in hands.
        Medicine (Baltimore). 2016; 95: e5145
        • Boussakri H.
        • Bouali A.
        Subcutaneous rupture of the extensor pollicis longus tendon after corticosteroid injections for DeQuervain’s stenosing tenovaginitis.
        Case Rep Orthop. 2014; 2014: 934384
        • Saffarini M.
        Editorial commentary: “Doctor, are you sure the steroid injection won’t harm my shoulder?” Perhaps we should stop injecting corticosteroids and just repair those rotator cuffs.
        Arthroscopy. 2019; 35: 51-53
        • Kim C.
        • Cashdollar M.R.
        • Mendicino R.W.
        • Catanzariti A.R.
        • Fuge L.
        Incidence of plantar fascia ruptures following corticosteroid injection.
        Foot Ankle Spec. 2010; 3: 335-337
        • Turmo-Garuz A.
        • Rodas G.
        • Balius R.
        • et al.
        Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?.
        Musculoskelet Surg. 2014; 98: 121-126
        • Desai V.S.
        • Camp C.L.
        • Boddapati V.
        • Dines J.S.
        • Brockmeier S.F.
        • Werner B.C.
        Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery.
        Arthroscopy. 2018; 35: 45-50
        • Ramírez J.P.
        • Bonati-Richardson F.
        • García M.P.
        • et al.
        Intra-articular treatment with corticosteroids increases apoptosis in human rotator cuff tears.
        Connect Tissue Res. 2019; 60: 283-290
        • Skedros J.G.
        • Henrie M.K.
        • Finlinson E.D.
        • Trachtenberg J.D.
        Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection.
        BMJ Case Rep. 2018; 11e226598
        • Guo J.J.
        • Wu K.
        • Guan H.
        • et al.
        Three-year follow-up of conservative treatments of shoulder osteoarthritis in older patients.
        Orthopedics. 2016; 39: e634-e641