Abstract
Carpal tunnel syndrome (CTS) accounts for approximately 90% of peripheral entrapment neuropathy cases. Treatments of CTS as splinting, corticosteroid injection, and surgery are not 100% effective, and alternative treatments are worth exploring. Surgery indicated in patients with persistent numbness, pain, and motor dysfunction. Empirical evidence indicates that many patients with CTS respond to anti-inflammatory medications. Recently, major attention has been drawn to platelet-rich plasma (PRP) for its possible effects on axon regeneration and neurological recovery.ObjectivesTo evaluate the therapeutic efficacy of single ultrasound guided PRP injection of CTS versus surgical procedures and medical treatment in patients with mild-moderate CTS regarding pain relief and function improvement.MethodsThirty patients were injected in the carpal tunnel with single ultrasound-guided PRP (1–2 ml) injections; 30 patients went to surgical procedure, and 30 patients received conventional medical treatment and hand support. They were followed by using VAS (visual analogue scale), Boston questionnaire for CTS, and nerve conduction study for clinical improvement.ResultsBoth groups of patients who had received PRP injection and who underwent to surgery showed improvements in their scores of evaluation parameters at 6 months post intervention, while the third group that received medical treatment shows insignificant improvement at 6 months post treatment.ConclusionPRP can be considered as a safe, less invasive, and long-lasting alternative to surgery and effective with one shot session compared to medical treatment in management of mild-moderate CTS.Trial registrationClinical trial.govID: NCT04235426.Unique protocol ID:1472.Verification date: January 2020.
Highlights
IntroductionCarpal tunnel syndrome (CTS) accounts for approximately 90% of peripheral entrapment neuropathy cases [1]
Platelet-rich plasma (PRP) can be considered as a safe, less invasive, and long-lasting alternative to surgery and effective with one shot session compared to medical treatment in management of mild-moderate Carpal tunnel syndrome (CTS)
Mild CTS was defined as sensory latency of longer than 3.6 ms with or without reduced amplitude of sensory nerve action potential; moderate CTS was defined as sensory latency of longer than 3.6 ms plus a prolonged motor latency (4.3– 6 ms) with normal motor amplitude, so we selected for the present study mild-moderate CTS patients with sensory latency of longer than 3.6 ms plus a prolonged motor latency (4.3–6 ms) with normal motor and sensory amplitude
Summary
Carpal tunnel syndrome (CTS) accounts for approximately 90% of peripheral entrapment neuropathy cases [1]. Existing evidence-based treatments for carpal tunnel syndrome, splinting, corticosteroid injection, and surgery are not 100% effective, and alternative treatments are worth exploring [2, 3]. Empirical evidence indicates that many patients with CTS have self-limiting symptoms and respond to nonoperative conservative treatments, including rest, modification of physical behaviors, splinting, nerve-gliding exercises, manual therapy techniques, and anti-inflammatory medications [5]. We aim in this study to evaluate the therapeutic efficacy of single ultrasound-guided platelet-rich plasma injection of the carpal tunnel versus surgical procedures and medical treatment and hand support in patients with mildmoderate carpal tunnel regarding pain relief and function improvement during a follow-up period of 6 months Platelet-rich plasma (PRP) is a biological product of condensed platelet that contains multiple growth factors and has anti-inflammatory and regenerating effect with subsequently positive impacts on neuronal healing and axon regeneration [6,7,8].
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