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Comparison of the short-term clinical effectiveness of 5% dextrose water, platelet rich plasma and corticosteroid injections for carpal tunnel syndrome: a systematic review and network meta-analysis of randomized controlled trials

Published:December 16, 2022DOI:https://doi.org/10.1016/j.apmr.2022.11.009

      Abstract

      Objective

      To compare the short-term effectiveness of corticosteroids, 5% dextrose(D5W), and platelet-rich plasma (PRP) injections for treating carpal tunnel syndrome (CTS).

      Data sources

      Four databases (MEDLINE (PubMed), Embase, the Cochrane Controlled Trials Register, and Web of Science (WOS)) were researched from inception to the 1st of April 2022.

      Study selection

      Two authors independently screened the literature to identify the RCTs meeting the included criteria, which involved comparing corticosteroid, 5% dextrose water (D5W), and platelet-rich plasma (PRP) injection with each other or placebo-controlled for treating CTS.

      Data extraction

      The two reviewers independently conducted information extraction, the outcomes included were the changes in Symptom Severity Scale (SSS), Function Status Scale (FSS), and Visual Analogue Scale (VAS) at short-term follow-up after drug injection treatment and any adverse events reported.

      Data synthesis

      Twelve randomized controlled trials with 749patients (817 hands) were included. The results of this study suggested that PRP injection was the most likely to relieve symptoms, improve functions and alleviate pain, with the SUCRA being 91.5%, 92.7%, and 80.8%, respectively, followed by D5W injection (74.4%, 72.2%, 72.1%), and corticosteroid injection (33.7%, 31.9%, 46.2%). The injection of three drugs was significantly better than that of a placebo.

      Conclusion

      From the results of the network meta-analysis, PRP injection is the most recommended treatment among the injection of corticosteroid, D5W, and PRP.
      The protocol of this network meta-analysis has been registered in PROSPERO with registration number CRD42022325228.

      Keywords

      List of abbreviations:

      CTS (Carpal tunnel syndrome, SSS, Symptom Severity Scale, FSS, Function Status Scale), VAS (Visual Analogue Scale), D5W (5% dextrose water), PRP (Platelet-rich plasma), NMA (Network Meta-analysis), SMD (Standardized mean difference), 95% CI (95% confidence interval), IF (Inconsistency factor), SUCRA (Surface under the cumulative ranking curve)
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