Comparison of the Short-Term Clinical Effectiveness of 5% Dextrose Water, Platelet-rich Plasma and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Gao, Nan; Yan, Liang; Ai, Fen; Kang, Jiamin; Wang, Lixia; Weng, Yuxiong

doi:10.1016/j.apmr.2022.11.009

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…The choice of HD regimens significantly influences the effectiveness of the procedure and it is worth observing that the effect of saline is less than that of corticosteroid, platelet-rich plasma, or D5W, in head to head comparisons. 32,33 Thus, even if NS injection has a pharmacological benefit that complements a mechanical HD effect, it appears to be limited, reinforcing NS as the injectate-of-choice in this study. The modest improvements in SSS and FSS from either NS volume in our study may be a result of our participant selection.…”

Section: Discussionmentioning

confidence: 66%

“…For those reasons, a critical assessment of the impact of increasing injectate volumes is not feasible. The choice of HD regimens significantly influences the effectiveness of the procedure and it is worth observing that the effect of saline is less than that of corticosteroid, platelet‐rich plasma, or D5W, in head to head comparisons 32,33 . Thus, even if NS injection has a pharmacological benefit that complements a mechanical HD effect, it appears to be limited, reinforcing NS as the injectate‐of‐choice in this study.…”

Section: Discussionmentioning

confidence: 69%

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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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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 69%

Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome

Huang,

Lai,

Reeves

et al. 2023

J of Ultrasound Medicine

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“…A similar conclusion was reached in an NMA by Gao et al, which included 12 randomized controlled trials with 749 patients (817 hands). Their results showed that PRP injections were most likely to provide symptomatic relief, improve function, and relieve pain; among the injections of CS, D5W, and PRP, the PRP injections were the most recommended treatment ( Gao et al, 2023 ). However, the aforementioned study did not include a comparison of local injections combined with splinting.…”

Section: Discussionmentioning

confidence: 99%

Local injection therapy for carpal tunnel syndrome: a network meta-analysis of randomized controlled trial

Zhou,

Wu,

Gou

et al. 2023

Front. Pharmacol.

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Objective: Clinical research has shown that local injections for carpal tunnel syndrome reduce the symptoms of patients and enhance their quality of life considerably. However, there are several therapy options, and the optimal choice of regimen remains uncertain. Therefore, we comprehensively evaluated the variations in clinical efficacy and safety of several medications for treating carpal tunnel syndrome.Methods: Computer searches of Embase, PubMed, Cochrane Library, and Web of Science databases were used to collect articles of randomized controlled trials on local injections for treating carpal tunnel syndrome from database creation till 10 June 2023. Two researchers independently screened the literature, extracted information, evaluated the risk of bias in the included studies, and performed network Meta-analysis using Stata 17.0 software. Drug efficacy was assessed using symptom severity/function and pain intensity. Surface under the cumulative ranking curve (SUCRA) ranking was used to determine the advantage of each therapy.Results: We included 26 randomized controlled trials with 1896 wrists involving 12 interventions, such as local injections of corticosteroids, platelet-rich plasma, 5% dextrose, progesterone, and hyaluronidase. The results of the network meta-analysis showed the following: (i) symptom severity: at the 3-month follow-up, D5W combined with splinting (SUCRA = 95%) ranked first, and hyaluronidase (SUCRA = 89.6%) at 6 months; (ii) functional severity: either at the 3-month follow-up (SUCRA = 89.5%) or 6 months (SUCRA = 83.6%), iii) pain intensity: 5% dextrose in water combined with splinting was the most effective at the 3-month (SUCRA = 85%) and 6-month (SUCRA = 87.6%) follow-up.Conclusion: Considering the combination of symptoms/function and pain intensity, combining 5% dextrose in water with splinting is probably the treatment of choice for patients with carpal tunnel syndrome. It is more effective than glucocorticoids and no adverse effects have been observed.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022370525.

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“…The differentiation of CTS from other conditions that present with similar symptoms, such as cervical radiculopathy or other peripheral neuropathies, is crucial for accurate diagnosis and treatment. Management strategies for CTS range from conservative methods, including splinting and lifestyle modifications, to more invasive approaches like corticosteroid injections and surgical interventions in severe or unresponsive cases (9)(10)(11). Within this clinical context, the Boston Carpal Tunnel Questionnaire emerges as a pivotal tool.…”

Section: Introductionmentioning

confidence: 99%

Urdu Translation and Adaptation of the Boston Carpal Tunnel Questionnaire: A Reliability and Validity Study

Khalid,

Sana Ashraf,

Saleem

et al. 2023

JHRR

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Background: Carpal Tunnel Syndrome (CTS) is a common neuropathic disorder, and its assessment often relies on the Boston Carpal Tunnel Questionnaire (BCTQ). However, there is a lack of a validated Urdu version of this tool for use in Pakistan. Objective: To translate and adapt the BCTQ into Urdu and to validate this version among native Urdu-speaking patients diagnosed with CTS. Methods: A cross-sectional observational study was conducted at the University of Lahore over six months. The study involved 142 native Urdu-speaking CTS patients. The translation followed Beaton's guidelines and included forward translation, reconciliation, back-translation, expert committee review, pre-testing, and cognitive debriefing. The translated questionnaire's reliability and validity were assessed using Cronbach's Alpha, the Intraclass Correlation Coefficient (ICC), and correlation analyses. Floor and ceiling effects were also examined. Results: The Urdu BCTQ demonstrated high internal consistency (Cronbach's Alpha: 0.85 for SSS and 0.87 for FSS) and good test-retest reliability (ICC: 0.75 for SSS and 0.78 for FSS). Construct validity was confirmed with substantial correlations with established measures (0.65 for SSS and 0.70 for FSS), and the questionnaire showed responsiveness to treatment effects (statistical significance at 0.05). Demographic analysis indicated a balanced representation of participants, and minimal floor and ceiling effects were observed. Conclusion: The Urdu version of the BCTQ is a reliable and valid tool for assessing CTS in Urdu-speaking patients. Its high internal consistency, good test-retest reliability, and proven construct validity make it an effective instrument for clinical and research settings in Pakistan.

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Comparison of the Short-Term Clinical Effectiveness of 5% Dextrose Water, Platelet-rich Plasma and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Cited by 6 publications

References 32 publications

Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome

Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome

Local injection therapy for carpal tunnel syndrome: a network meta-analysis of randomized controlled trial

Urdu Translation and Adaptation of the Boston Carpal Tunnel Questionnaire: A Reliability and Validity Study

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