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

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.

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Fig. 1

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

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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.

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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.

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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

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Keywords

  • Carpal tunnel syndrome
  • Corticosteroids
  • Platelet rich plasma