One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial

Chen, Siru; Shen, Yu-Ping; Ho, Tsung-Yen; Li, Tsung-Ying; Su, Yu-Chi; Chou, Yu‐Ching; Chen, Liang‐Cheng; Wu, Yung-Tsan

doi:10.1016/j.apmr.2020.12.025

Cited by 23 publications

(32 citation statements)

References 35 publications

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“…Moreover, in several patients with initially long DMLs, the outcome improved from poor to good on comparing sixth-to third-month post-treatment data. This finding was consistent with the prolonged effect of neural regeneration TA B L E 1 The baseline characteristics and comparison of demographic data of the study population (3 month) post-PRP injection, 17 and it could imply that prolonged DML corresponds with poorer outcomes because it takes more time for neural regeneration.…”

Section: Discussionsupporting

confidence: 80%

“…The onset and peak of the TA B L E 3 The baseline characteristics and comparison of demographic data of the study population (6 month) regenerative effect of PRP may occur after the anti-inflammatory effect, and it may not be obvious in the early stages. 17 In addition, we observed more patients with good outcomes in the sixth month of follow-up as compared with the third month. These findings conflict with those of a previous study that showed symptoms recurred from the fourth to sixth month after steroid injection.…”

Section: Discussionmentioning

confidence: 64%

“…Second, the possible bias of using two different types of PRP in one study could be of concern, although both of them proved to be beneficial for CTS. 8,14,17 Only 14 patients received PLTenus, and there was no significant difference in baseline characteristics and percentage of good/poor outcomes between the two PRP groups.…”

Section: Although Other Characteristics Have Been Reported As Predictorsmentioning

confidence: 91%

“…15,16 In 2021, a randomised double-blinded study provided evidence for the long-term efficacy (1-year duration) of a single PRP injection for patients with moderate-to-severe CTS. 17 Therefore, physicians have increasingly been using PRP injection to treat CTS. Hence, it is very important to identify the prognostic predictors of PRP injection for CTS because this information may assist in decision-making and meeting patient expectations.…”

mentioning

confidence: 99%

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Outcome predictors of platelet‐rich plasma injection for moderate carpal tunnel syndrome

Shen

Chou

et al. 2021

Int J Clin Pract

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Carpal tunnel syndrome (CTS), resulting from the entrapment of the median nerve (MN) in the carpal tunnel, is the most common peripheral entrapment neuropathy. It may cause numbness, tingling, and pain in the hand, especially in the thumb and first three fingers.Weakness and atrophy of the thenar muscle may be observed in severe cases and further results in disability in daily life activities. 1 The management of CTS is either through conservative or surgical treatment. Conservative treatment is recommended for patients with mild-to-moderate CTS, whereas surgical management is generally reserved for patients with severe CTS and those with poor responsiveness to conservative treatment. 2 Platelet-rich plasma (PRP) is autologous plasma with a high concentration of platelets. It contains platelet α-granules with abundant bioactive factors, such as transforming growth factorβ,

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 64%

Section: Although Other Characteristics Have Been Reported As Predictorsmentioning

confidence: 91%

mentioning

confidence: 99%

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Outcome predictors of platelet‐rich plasma injection for moderate carpal tunnel syndrome

Shen

Chou

et al. 2021

Int J Clin Pract

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“…Previous animal studies approved the benefit of PRP for nerve regeneration [ 41 ]. Since 2015, some studies have investigated the efficacy of PRP injection for CTS with positive results [ 42 – 50 ]. Even though the definite mechanism of PRP for CTS remains ambiguous, the therapeutic effect is thought to be derived from mechanical hydrodissection, biological effects of PRP for MN's surrounding tissue, and neuroregenerative effect for MN [ 50 ].…”

Section: Novel Motor-sparing Neural Injection For Ctsmentioning

confidence: 99%

Novel Motor-Sparing Ultrasound-Guided Neural Injection in Severe Carpal Tunnel Syndrome: A Comparison of Four Injectates

Lam

Lai

et al. 2022

BioMed Research International

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Nerve hydrodissection uses fluid injection under pressure to selectively separate nerves from areas of suspected entrapment; this procedure is increasingly viewed as potentially useful in treating carpal tunnel syndrome (CTS). The usage of normal saline (NS), 5% dextrose water (D5W), platelet-rich plasma (PRP), and hyaluronic acid (HA) as primary injectates for hydrodissection without an anesthetic can limit anesthetic-related toxicity and preserve the motor functions of the median nerve. Here, we describe a novel motor-sparing neural injection and compare the effect of these four injectates for severe CTS. We retrospectively reviewed the outcomes of 61 severe CTS cases after a single neural injection with NS, D5W, PRP, or HA. Outcomes were evaluated on the 1st and 6th months postinjection, including the Boston Carpal Tunnel Questionnaire (BCTQ) scores and the nerve cross-sectional area (CSA). The results revealed that PRP, D5W, and HA were more efficient than NS at all measured time points ( p < 0.05 ), except for CSA at the 1st month between the NS and D5W groups. Single-injections of PRP and D5W seemed more effective than that of HA within 6 months postinjection for symptom and functional improvement (6th-month BCTQ-symptom, D5W vs. HA, p = 0.047 ; 1st-month BCTQ-symptom, PRP vs. HA, p = 0.018 ; 1st- and 6th-month BCTQ-function, D5W vs. HA, p = 0.002 and 0.016, respectively; 1st-month BCTQ-function, PRP vs. HA, p < 0.001 ). For reducing CSA, PRP and HA seemed more effective than D5W ( HA > PRP > D 5 W on the 1st month and HA vs. D5W, p = 0.001 ; PRP > HA > D 5 W on the 6th month and PRP vs. D5W, p = 0.012 ).

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Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome

Huang,

Lai,

Reeves

et al. 2023

J of Ultrasound Medicine

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ObjectivesThis study compared ultrasound‐guided nerve hydrodissection (HD) outcomes using two commonly used injectate volumes (10 and 5 mL) of normal saline to explore if there is a volume effect of HD for patients with moderate carpal tunnel syndrome (CTS).MethodsTwenty‐four participants were randomly assigned to treatment with HD using ultrasound‐guidance and either 10 mL or 5 mL of normal saline (HD‐10 and HD‐5 groups respectively). Our primary outcome measures were the change scores of the two subscales of the Boston Carpal Tunnel Syndrome Questionnaire: The Symptom Severity Scale (SSS) and Functional Status Scale (FSS). We conducted a one‐way repeated analysis of variance for 3 time points (4, 12, and 24 weeks) for both SSS and FSS, respectively, for change scores from time 0, and percentage change from time 0.ResultsAll participants (n = 12 per group) completed the study. From 0 to 24 weeks the HD‐10 group outperformed the HD‐5 group for improvement in SSS (median ± IQR; −0.8 ± 0.4 versus −0.5 ± 0.5; P = .024) and FSS scores (mean ± SD; −0.8 ± 0.2 versus −0.5 ± 0.5; P = .011). The HD‐10 group improvement in FSS subtest significantly exceeded the MCID percentage‐change‐based threshold of 27% (34%; P = .039).ConclusionsDespite the limitations of small study size, a largely inert injectate, and a single injection approach, these findings in favor of the 10 mL group suggest that the volume used for ultrasound‐guided HD in moderate CTS matters, and a higher volume is more effective.

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One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial

Cited by 23 publications

References 35 publications

Outcome predictors of platelet‐rich plasma injection for moderate carpal tunnel syndrome

Outcome predictors of platelet‐rich plasma injection for moderate carpal tunnel syndrome

Novel Motor-Sparing Ultrasound-Guided Neural Injection in Severe Carpal Tunnel Syndrome: A Comparison of Four Injectates

Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome

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