Platelet-Rich Plasma Versus 5% Dextrose for Mild-to-Moderate Carpal Tunnel Syndrome

Abstract

Although current conservative treatments are helpful for most patients with mild-to-moderate carpal tunnel syndrome (CTS), the cochrane review and large population-based study only concluded their short-term or limited efficacy. Hence, it is critical to develop a novel approach for mild-to-moderate CTS. In 2017, we have demonstrated that ultrasound-guided perineural injection with PRP or D5W is an effective and worthwhile intervention for patients with mid-to-moderate CTS. However, the comparsion of perineural PRP and D5W injection has not been investigated in a single study. This is a prospective, randomized, double-blind, head-to head comparative study. Forty-three patients with bilateral CTS were randomized into PRP and D5W groups. PRP group received one-dose 3cc PRP injection and one-dose 3cc D5W injection to another wrist of the same patient as D5W group. The primary outcome is visual analog scale (VAS) and secondary outcomes include Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, electrophysiological study of the median nerve, and finger pinch strength. The evaluation was performed pretreatment as well as on the 1st, 3th, and 6th after the injection. A total of 43 patients (43 wrists in each group) completed the study. The PRP group had a significantly noticeable reduction of VAS score, BCTQ and CSA of median nerve than the D5W group (P<0.05). Moreover the improved trend between two groups seem more significant in moderate CTS. This study shows PRP is more effective than D5W for patients with mild-to moderate CTS.