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

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.

Current Status of PRP Manufacturing Requirements & European Regulatory Frameworks: Practical Tools for the Appropriate Implementation of PRP Therapies in Musculoskeletal Regenerative Medicine

“…The indications for PRP use are varied and are found in the fields of plastic surgery, hand surgery, septic conditions and sports medicine, anaesthesiology, radiology, and for many specific indications such as epicondylitis, patellar tendinopathy, Achilles tendinopathy, osteoarthritis, burns, wounds, grafts, scars, and hair loss [ 17 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Therefore, guidelines to aid the safe and correct use of PRP will potentially benefit many healthcare providers within diverse environments, whether in hospitals, clinics, or private practices [ 3 , 12 , 16 , 26 , 33 ].…”

Clinical Efficacy and Safety of Zoledronic Acid Combined with PVP/PKP in the Treatment of Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In addition, the sample size of each study was sufficient. The present meta-analysis was based on the PRISMA 12 reporting guidelines in accordance with the previous study [ 24 ] which maintained the reliability of the method. Therefore, with definite results from funnel plots comparing VAS scores between the two groups at baseline ( Figure 11 ), the accuracy and reliability of the pooled results were rather convincing.…”

Carpal tunnel syndrome conservative treatment: a literature review

“…The extracted plasma portion contains a high con- centration of platelets and growth factors that may play crucial roles in tissue regeneration [ 62 ]. Growth factors are effective in managing inflammation and promoting wound healing.…”

“…The in vivo studies of the effects of PRP injection demonstrated improved Schwann cell proliferation, function, and migration. PRP improved symptom severity scale [ 62 , 65 ] but not func- tional status scale. VAS and nerve conduction studies were no different compared to controls [ 65 ].…”