Skip to main content

Advertisement

SpringerLink
Log in

Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Background

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Further studies are needed to reach concrete conclusion.

Objective

To study the effect of PRP injection in treatment of mild to moderate idiopathic CTS.

Methods

This is a randomized controlled trial in a cohort of Egyptian patients suffered from mild to moderate CTS. They were randomly divided into two groups. Group 1: patients received ultrasound guided PRP injection and group 2 patients received ultrasound guided corticosteroid injection. The outcome measures were assessed via Visual Analog Scale, the Boston Carpal Tunnel Syndrome Questionnaire, electrophysiological findings in sensory and motor functions of median nerve and morphological changes of median nerve detected by ultrasound.

Results

This study included 150 patients suffered from mild to moderate idiopathic CTS 15 did not provide the written consent and 37 participants were excluded from the study based on the exclusion criteria leaving only 98 patients to participate in the study they were divided into two groups PRP Injection Group (PRP-inj-G) — this group included 49 patients (40 females and 9 males) steroid injection Group (St-inj-G) — included 49 patients (41 females and 8 males). At the beginning of study there was no significant difference between both groups in all parameters. (a) PRP injection had significantly improved the clinical manifestations, the electrodiagnostic examination (EDX) parameters of the median nerve (MN), and the median nerve cross sectional area (m-CSA) at 1 month and 3 months post-injection evaluation in comparison to baseline recordings; (b) local steroid injection had significantly improved the clinical manifestations, the EDX parameters of the MN, and the m-CSA at 1 month and 3 months post-injection evaluation in comparison to baseline recordings and (c) PRP injection was superior to the local steroid injection in the improvement of clinical manifestations as well as the MN motor conduction velocity along the wrist-elbow segment, the sensory latency (SL) and the MN sensory conduction, this superiority was observed in third month follow-up suggesting better outcomes in long-term follow-up.

Conclusion

Platelet-rich plasma could be effective treatment of mild to moderate idiopathic CTS and superior to corticosteroid in improving pain, function, and distal sensory latency of median nerve.

Trial registration

Clinical Trials.gov Identifier: NCT03863873

Key Points:

• PRP is effective treatment of mild to moderate CTS.

• PRP is superior to corticosteroids in improving pain and function in CTS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Abbreviations

APBm:

Abductor pollicis brevis muscle

BCTQ:

Boston carpal tunnel questionnaire

BCTQ-FSS:

Boston carpal tunnel questionnaire functional status scale

BCTQ-SSS:

Boston carpal tunnel questionnaire symptom severity scale

CTS:

Carpal tunnel syndrome

CMAP:

Compound muscle action potential

DML:

Distal motor latency

EDX:

Electrodiagnosis

GFs:

Growth factors

ICTS:

Idiopathic carpal tunnel syndrome

Inj.G:

Injection group

m.CSA:

Median cross sectional area

MN:

Median nerve

PRP:

Platelet rich plasma

RCT:

Randomized controlled trial

SNAP:

Sensory nerve action potential

SNCV:

Sensory nerve conduction velocity

SL:

Sensory latency

VAS:

Visual analog scale

References

  1. Shiri R, Miranda H, Heliövaara M, Viikari-Juntura E (2009) Physical work load factors and carpal tunnel syndrome: a population-based study. Occup Environ Med 66(6):368–373

    Article  CAS  Google Scholar 

  2. O'Connor D, Marshall S, Massy-Westropp N.(2003) Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev;(1):CD003219. Review

  3. Katz JN, Keller RB, Simmons BP, Rogers WD, Bessette L, Fossel AH et al (1998) Maine carpal tunnel study: outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort. J Hand Surg [Am] 23(4):697–710

    Article  CAS  Google Scholar 

  4. Gerritsen AA, Korthals-de Bos IB, Laboyrie PM, de Vet HC, Scholten RJ, Bouter LM (2003) Splinting for carpal tunnel syndrome: prognostic indicators of success. J Neurol Neurosurg Psychiatry 74(9):1342–1344

    Article  CAS  Google Scholar 

  5. Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW (2010) Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments--a systematic review. Arch Phys Med Rehabil 91(7):981–1004

    Article  Google Scholar 

  6. Marshall S, Tardif G, Ashworth N(2007) "Local corticosteroid injection for carpal tunnel syndrome." Cochrane Database Syst Rev;(2):Cd001554

  7. Sampson S, Gerhardt M, Mandelbaum B (2008) Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 1(3–4):165–174

    Article  Google Scholar 

  8. Zheng C, Zhu Q, Liu X, Huang X, He C, etal JL (2016) Effect of platelet-rich plasma (PRP) concentration on proliferation, neurotrophic function and migration of Schwann cells in vitro. J Tissue Eng Regen Med 10(5):428–436

    Article  CAS  Google Scholar 

  9. Uzun H, Bitik O, Uzun Ö, Ersoy US, Aktaş E (2016) Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg 51(5):301–305 1–5

    Article  Google Scholar 

  10. You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH (1999) Relationships between clinical symptom severity scales and nerve conduction measures in CTS. Muscle Nerve 22:497–501

    Article  CAS  Google Scholar 

  11. Werner RA, Andary M (2011) Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 44(4):597–607

    Article  Google Scholar 

  12. Padua L, Lo Monaco M, Valente EM, Tonali PA (1996) A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome. Muscle Nerve 19(1):48–53

    Article  CAS  Google Scholar 

  13. Wong SM, Griffith JF, Hui AC, Tang A, Wong KS (2002) Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 46(7):1914–1921

    Article  CAS  Google Scholar 

  14. Miyamoto H, Halpern EJ, Kastlunger M, Gabl M, Arora R, Bellmann-Weiler R, Feuchtner GM, Jaschke WR, Klauser AS (2014) Carpal tunnel syndrome: diagnosis by means of median nerve elasticity--improved diagnostic accuracy of US with sonoelastography. Radiology. 270(2):481–486

    Article  Google Scholar 

  15. Dhurat R, Sukesh M (2014) Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesthet Surg 7(4):189–197

    Article  Google Scholar 

  16. Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Huang GS, Chen LC (2017) Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: a prospective randomized, single-blind controlled trial. Sci Rep 7(1):94

    Article  Google Scholar 

  17. Lee JY, Park Y, Park KD, Lee JK, Lim OK (2014) Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study. Medicine (Baltimore) 93(29):e350

    Article  Google Scholar 

  18. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain. 27:117–126

    Article  CAS  Google Scholar 

  19. Leite JC, Jerosch-Herold C, Song F (2006) A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord 7:78

    Article  Google Scholar 

  20. Simovic D, Weinberg DH (1999) The median nerve terminal latency index in carpal tunnel syndrome: a clinical case selection study. Muscle Nerve 22:573–577

    Article  CAS  Google Scholar 

  21. Macdonell RA, Schwartz MS, Swash M (1990) Carpal tunnel syndrome: which finger should be tested? An analysis of sensory conduction in digital branches of the median nerve. Muscle Nerve 13:601–606

    Article  CAS  Google Scholar 

  22. Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C (1992) Carpal tunnel syndrome: diagnosis with high-resolution sonography. AJR Am J Roentgenol 159:793–798

    Article  CAS  Google Scholar 

  23. Sánchez M, Anitua E, Delgado D, Prado R, Sánchez P, Fiz N et al (2017) 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 11(5):1619–1629

    Article  Google Scholar 

  24. Piskin A, Kaplan S, Aktaş A, Ayyildiz M, Raimondo S, Aliç T (2009) Platelet gel does not improve peripheral nerve regeneration: an electrophysiological, stereological, and electron microscopic study. Microsurgery 29(2):144–153

    Article  Google Scholar 

  25. Malahias MA, Johnson EO, Babis GC, Nikolaou VS (2015) Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome. Neural Regen Res 10(11):1856–1859

    Article  Google Scholar 

  26. Atwaa ET, Esh AM, Abd El Al IT, Awad YM (2018) Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome: clinical and electrophysiological study. Egypt Rheumatolt 41(3):237–241

    Article  Google Scholar 

  27. Uzun H, Bitik O, Uzun Ö, Ersoy US, Aktaş E (2017) Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg 51(5):301–305

    Article  Google Scholar 

  28. Raeissadat SA, Karimzadeh A, Hashemi M, Bagherzadeh L (2018) Safety. Efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial. BMC Musculoskelet Disord 19(1):49

    Article  Google Scholar 

  29. Agarwal V, Singh R, Sachdev A, Wiclaff, Shekhar S, Goel DA (2005) Prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rheumatology (Oxford) 44(5):647–650

    Article  CAS  Google Scholar 

  30. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B (2010) Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract 29(11):54

    Article  Google Scholar 

  31. El-Badawy M (2015) Electrophysiological and clinical comparison of local steroid injection by means of proximal versus distal approach in patients with mild and moderate carpal tunnel syndrome. Egypt Rheumatol Rehabil 42(3):120–127

    Article  Google Scholar 

  32. Soyupek F, Yesildag A, Kutluhan S, Askin A, Ozden A, etal UGA (2012) Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes. Rheumatol Int 32(10):3229–3234

    Article  Google Scholar 

  33. Wu YT, Ke MJ, Chou YC, Chang CY, Lin CY, Li TY (2016) Effect of radial shock wave therapy for carpal tunnel syndrome: a prospective randomized, double-blind, placebo-controlled trial. J Orthop Res 34(6):977–984

    Article  Google Scholar 

  34. Sánchez M, Garate A, Delgado D, Padilla S (2017) Platelet-rich plasma, an adjuvant biological therapy to assist peripheral nerve repair. Neural Regen Res 12(1):47–52

    Article  Google Scholar 

Download references

Acknowledgments

All authors wish to express deep appreciation and gratitude to professor Mohammad K. for his support in statistical analysis of this work and great appreciation to all cooperative patients participated in this study.

Funding

This study was totally funded by all authors. All authors are responsible for payment of publications fees. All authors declare that they did not receive any financial support.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Rheumatology and Rehabilitation, Mansoura University, Elgomhoria St., Mansoura, Egypt

    Mohammad K. Senna, Reham M. Shaat & Alaa Ali Awad Ali

Authors
  1. Mohammad K. Senna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reham M. Shaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alaa Ali Awad Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have contributed to the concept and design of the study, interpretation of the data and revising the manuscript, and have approved the final draft.

Dr. Mohammad k. Senna assessed EDX outcomes, Dr. Reham M. assessed US outcome and Dr. Alaa assessed clinical outcomes.

Corresponding author

Correspondence to Reham M. Shaat.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Senna, M.K., Shaat, R.M. & Ali, A.A.A. Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome. Clin Rheumatol 38, 3643–3654 (2019). https://doi.org/10.1007/s10067-019-04719-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-019-04719-7

Keywords

Search

Navigation