Abstract
Objective
To assess the therapeutic effect of platelet-rich plasma (PRP) for moderate-to-severe
carpal tunnel syndrome (CTS).
Design
A prospective, randomized, double-blinded, controlled trial (1-year follow-up).
Setting
Outpatient of local medical center settings.
Participants
Patients (N=26) who were diagnosed with bilateral moderate-to-severe CTS (total 52
wrists) were included. For each patient, one wrist was randomized into either the
PRP or control group and the contralateral wrist of the same patient was allocated
to another group.
Twenty-four patients were included in the final data analysis.
Interventions
The wrists in the PRP group received a single ultrasound-guided dose of PRP injection
(3.5mL), and the control group received a single ultrasound-guided injection with
normal saline (3.5mL).
Main Outcome Measures
The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores were used as the primary
outcome. Secondary outcomes encompassed the cross-sectional area of the median nerve
and electrophysiological study. Assessments were conducted prior to injection and
1, 3, 6, and 12 months postinjection.
Results
Compared to the control group, the PRP group exhibited significant improvements in
BCTQ severity scores at all time points, BCTQ functional scores at the sixth month,
and cross-sectional area at the 12th month postinjection (P<.0125).
Conclusions
A single dose of ultrasound-guided perineural PRP injection can provide therapeutic
effect for 1 year postinjection.
Keywords
List of abbreviations:
BCTQ (Boston Carpal Tunnel Syndrome Questionnaire), CSA (cross-sectional area), CTS (carpal tunnel syndrome), DML (distal motor latency), FSS (functional status scale), MCID (minimal clinically important difference), NS (normal saline), PRP (platelet-rich plasma), SNCV (sensory nerve conduction velocity), SSCT (subsynovial connective tissue), SSS (symptom severity scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome.Cochrane Database Syst Rev. 2003; 2003: CD003219
- Clinical course and prognostic factors in conservatively managed carpal tunnel syndrome: a systematic review.Arch Phys Med Rehabil. 2016; 97: 836-852 e1
- Treatment of carpal tunnel syndrome.Muscle Nerve. 2007; 36: 167-171
- Platelet rich plasma injection grafts for musculoskeletal injuries: a review.Curr Rev Musculoskelet Med. 2008; 1: 165-174
- Effect of platelet rich plasma and fibrin sealant on facial nerve regeneration in a rat model.Laryngoscope. 2007; 117: 157-165
- Effect of platelet-rich plasma on peripheral nerve regeneration.J Reconstr Microsurg. 2008; 24: 159-167
- The effect of platelet-rich plasma on cavernous nerve regeneration in a rat model.Asian J Androl. 2009; 11: 215-221
- Effect of neural-induced mesenchymal stem cells and platelet-rich plasma on facial nerve regeneration in an acute nerve injury model.Laryngoscope. 2010; 120: 907-913
- An autologously generated platelet-rich plasma suturable membrane may enhance peripheral nerve regeneration after neurorraphy in an acute injury model of sciatic nerve neurotmesis.J Reconstr Microsurg. 2014; 30: 617-626
- Platelet-rich plasma limits the nerve injury caused by 10% dextrose in the rabbit median nerve.Muscle Nerve. 2014; 49: 56-60
- Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome.Neural Regen Res. 2015; 10: 1856-1859
- Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: a prospective randomized, single-blind controlled trial.Sci Rep. 2017; 7: 94
- Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome.J Plast Surg Hand Surg. 2017; 51: 301-305
- Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial.BMC Musculoskelet Disord. 2018; 19: 49
- Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: a placebo-controlled clinical study.J Tissue Eng Regen Med. 2018; 12: e1480-e1488
- Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: a controlled study.J Tissue Eng Regen Med. 2019; 13: 709-714
- Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients.Ann Neurol. 2018; 84: 601-610
- Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation.Neurology. 2002; 58: 1589-1592
- Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands.Acta Neurol Scand. 1997; 96: 211-217
- Functional recovery in osteoarthritic chondrocytes through hyaluronic acid and platelet-rich plasma-inhibited infrapatellar fat pad adipocytes.The Am J Sports Med. 2016; 44: 2696-2705
- Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial.Mayo Clin Proc. 2017; 92: 1179-1189
- A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.J Bone Joint Surg Am. 1993; 75: 1585-1592
- A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire.BMC Musculoskelet Disord. 2006; 7: 78
- Effect of radial shock wave therapy for carpal tunnel syndrome: a prospective randomized, double-blind, placebo-controlled trial.J Orthop Res. 2016; 34: 977-984
- Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome.Arthritis Rheum. 2002; 46: 1914-1921
- G∗Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behav Res Methods. 2007; 39: 175-191
- Effectiveness of platelet rich plasma injections for non-surgical management of carpal tunnel syndrome: a systematic review and meta-analysis of randomized controlled trials.Arch Phys Med Rehabil. 2020; 101: 897-907
- Platelet-rich plasma increases anti-inflammatory markers in a human coculture model for osteoarthritis.Am J Sports Med. 2015; 43: 1474-1484
- Nerve hydrodissection for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial.Muscle Nerve. 2019; 59: 174-180
- Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study.Neurology. 2001; 56: 1459-1466
- Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial.Am J Sports Med. 2016; 44: 884-891
- Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: a single-blind randomized prospective study.Am J Phys Med Rehabil. 2013; 92: 999-1004
- Effectiveness of ultrasound-guided compared to blind steroid injections in the treatment of carpal tunnel syndrome.Arthritis Care Res (Hoboken). 2017; 69: 1060-1065
- Altered median nerve deformation and transverse displacement during wrist movement in patients with carpal tunnel syndrome.Acad Radiol. 2014; 21: 472-480
- Transverse plane tendon and median nerve motion in the carpal tunnel: ultrasound comparison of carpal tunnel syndrome patients and healthy volunteers.PLoS One. 2012; 7e37081
- A prognostic model for the patient-reported outcome of surgical treatment of carpal tunnel syndrome.Muscle Nerve. 2018; 58: 784-789
Article Info
Publication History
Published online: February 03, 2021
Footnotes
Supported by the Ministry of Science and Technology, Taiwan , Republic of China (grant no. MOST 106-2314-B-016-009 ).
Disclosures: none.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine
