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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:https://doi.org/10.1016/j.apmr.2019.10.193

      Highlights

      • 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.

      Abstract

      Objective

      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.

      Conclusions

      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.

      Keywords

      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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