Effect of Platelet-Rich Plasma Injection on Mild or Moderate Carpal Tunnel Syndrome: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Chunke Dong,Hongyu Wei,Yuting Zhu,Chungen Li,Di Wu,Yingna Qi,Yan Sun,Fabiano Bini

doi:10.1155/2020/5089378

Abstract

Objective To evaluate efficacy of platelet-rich plasma (PRP) injection in carpal tunnel syndrome (CTS), we conducted this meta-analysis, as well as proposed a protocol for its application in curative processes. Methods All randomized controlled trials (RCTs) of PRP for the management of mild or moderate CTS were included in this study. Database search was conducted from study inception to July 2020, including PubMed, Embase, Web of Science, and Cochrane Library. We used visual analogue scores (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) as evaluation tools for primary outcomes. Second outcomes comprised cross-sectional area (ΔCSA) and electrophysiological indexes including distal motor latency (DML), sensory peak latency (SPL), motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), compound muscle action potential (CMAP), and sensory nerve action potential (SNAP). The pooled data were analyzed using RevMan 5.3. Subgroup and sensitivity analyses were conducted with the evidence of heterogeneity. Egger' test was used to investigate publication bias. Results 9 RCTs were finally screened out with 434 patients included. Control groups comprised corticosteroid injection in 5 trials, saline injection in 1 trial, and splint in 3 trials. At the 1st month after follow-up, only ΔCSA between the PRP group and the control group showed significant difference (P < 0.05). In the 3rd month, there were statistically significant differences in VAS, BCTQ, SPL, SNCV, and ΔCSA between two groups (P < 0.05), while no statistically significant differences were found in the remaining outcomes. In the 6th month, there were statistically significant differences at BCTQ (P < 0.05) in primary outcomes and ΔCSA (P < 0.05) in secondary outcomes between two groups. As to adverse events in PRP injection, only one study reported increased pain sensation within 48 h after injections. Conclusion This systematic review and meta-analysis demonstrates that the PRP could be effective for mild to moderate CTS and superior to traditional conservative treatments in improving pain and function and reducing the swelling of the median nerve for a mid-long-term effect. To some extent, the electrophysiological indexes also improved after PRP injection compared with others conservative treatments.

Highlights

Carpal tunnel syndrome (CTS) is one of the most disturbing entrapment neuropathy in upper limbs [1] affecting up to 5% of the adult population [2]
Due to the pathogenesis of the median nerve (MN) compression, which passes through the carpal tunnel, CTS is characterized by representative symptoms such as paresthesia and pain in areas innervated by the MN
Afterwards, we reviewed abstracts and titles of included studies, selected the relevant information, and removed duplication independently, and 20 studies were selected

Summary

Introduction

Carpal tunnel syndrome (CTS) is one of the most disturbing entrapment neuropathy in upper limbs [1] affecting up to 5% of the adult population [2]. Due to the pathogenesis of the median nerve (MN) compression, which passes through the carpal tunnel, CTS is characterized by representative symptoms such as paresthesia and pain in areas innervated by the MN. Motor deficit or atrophy of the innervated muscles emerges in severe CTS [3] which strikes a huge impact on quality of life. CTS therapies usually include conservative and surgical management. Surgical therapy is best documented scientifically, but it is not without flaws; in mild and moderate CTS, conservative therapy is often preferred [4, 5]. Wolny and Linek [6, 7] assessed the effective-

Methods

Results

Conclusion