Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial

Trull-Ahuir, Carmen; Sala, Diego; Chismol-Abad, Joaquín; Vila-Caballer, Marian; Lisón, Juan Francisco

doi:10.1038/s41598-020-59113-0

“…Three articles were identified for PRP use in hand surgery (1 level I and 2 level IV). 18 The level-I study was on the effect of PRP on the carpal tunnel release. Level-IV studies were on the use of PRP in the setting of amputation and in patients with basal thumb arthritis.…”

Section: Resultsmentioning

confidence: 99%

Level of Evidence on Platelet-rich Plasma in Plastic Surgery

Cho

¹

,

Rohrich

²

2021

Plastic and Reconstructive Surgery - Global Open

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Background: Despite the increased popularity of platelet-rich plasma (PRP) in plastic surgery, there is no detailed analysis on the level of evidence on PRP use in plastic surgery. As the number of applications of PRP in plastic surgery increases, it is important for plastic surgeons to understand the scientific and validated evidence behind its use. Therefore, we performed a literature review to identify current level of evidence on platelet-rich plasma in plastic surgery. Methods: We performed a computerized search of platelet-rich plasma in plastic surgery using the MEDLINE, Cochran Library, and EMBASE databases. Data regarding the type of study, PRP application, and outcomes were collected. Then, the level of evidence was assigned using the American Society of Plastic Surgeons Level of Evidence Rating. Results: Our search identified 105 articles, and about 78.1% of studies were lower-quality studies: 37 level-III articles (35.2%), 32 level-IV articles (30.5%), and 13 level-V articles (12.4%). There were only 6 level-I articles and 17 level-II studies. Level-I studies were on facial rejuvenation using a laser, carpal tunnel release, cleft lip repair, trauma wounds, breast reconstruction using latissimus dorsi, and hair regrowth. Conclusions: Our review of the literature shows that the level of evidence on PRP use in plastic surgery is low (21.9%). Nevertheless, we believe level-III to level-V studies are still valuable, as performing high-level quality studies in plastic surgery is difficult due to variability in surgical techniques, experiences, and materials.

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“…CTS usually occurs with repetitive movements of wrist and resulting in synovial sheath hypertrophy, tenosynovitis, intracarpal swelling and MN compression (1,15,16). Rheumatoid arthritis, scleroderma, systemic lupus erythematosus, polymyalgia rheumatica, collagen tissue diseases, diabetes mellitus, pregnancy, estrogen and oral contraceptive use, acromegaly, myxedema, hyperparathyroidism, amyloidosis, tumors such as lipoma and ganglioma, chronic trauma are diseases and conditions associated with CTS.…”

Section: Resultsmentioning

confidence: 99%

“…Carpal tunnel syndrome ( CTS ) is the most common peripheral nerve entrapment and is seen in 3% of the general population (1). The carpal tunnel ( CT ) is formed by the wrist bones, the transvers ligament ( TL ), exor retinaculum, and the median nerve ( MN ) passes into the CT (2).…”

Section: Introductionmentioning

confidence: 99%

“…Due to its speci c location in CT, MN is highly susceptible to compression, and in repeated wrist exion/extansion movement, the pressure in CT increases and compresses MN and symptoms begin (2). Typical syptoms include numbness, paraesthesia and pain in the areas innervated by MN, weakness and atrophy of the thenar muscles which affects the quality of life and work e ciency in affected patient (1,6). Electromyography (EMG) is 49-84% sensitive and 95-99% speci c for diagnosis (3).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison between Carpal Tunnel Syndrome and Individuals with Symptoms of Obsessive- Compulsive Disorder

Papaker

¹

,

Abdallah

²

,

Seyithanoğlu

³

et al. 2020

Preprint

0

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Objective: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment neuropathy and is seen in 3 % of the general population. The aim to this study was examine the relationship between the symptoms of cleaning compulsion with using Moudsley obsessive compulsive inventory ( MOCI ) and patients with CTS. Methods: Sixty patients with CTS and 60 healty controls were evaluated in Bezmialem Vakif University Faculty of Medicine Neurosurgery Clinic. Neurological examination, Electrophysiological findings, the presence of neuropathic pain evaluated by the Leeds assessment of neuropathic symptoms and signs (LANSS) , the symptoms of obsessive- compulsive disorder using with MOCI and anxiety levels assessed by the Beck Anxiety Inventory (BAI) were evaluated. Results: No statistically significant relationship was observed between anxiety levels and CTS (p › 0.005). No statistically significant relationship was found MOCI rumination, control and doubting subscale scores (p › 0.005). Patient group had higher MOCI cleaning subscale scores than the control group and the difference was statistically significant (p=0.008). Patient group had higher MOCI slowness subscale scores than the control group and the difference was statistically significant (p=0.004). Conclusion: Increased wrist movement in people that have the symptoms of compulsive cleaning is associated with the risk of CTS. Our study show that a reduction of high level of wrist flexion-extansion movements may decrease the new CTS cases.

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“…However, another recent two nonblinded trials with very short-term follow-up (<10 weeks) reported inconsistent benefit of additional 1 mL PRP in patients with mild CTS treating wrist splint [ 45 , 47 ]. Trull-Ahuir et al [ 49 ] shared a randomized, triple-blind trial and shown significant improvement of hand grip strength at 6 th weeks in patient receiving surgical release of FR compared with platelet-poor plasma injection. The double-blind placebo-controlled study in 2021 had shown one-year efficacy of single-dose ultrasound-guided perineural injection with PRP in patients with moderate-to-severe CTS compared with NS injection [ 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

Wu

¹

,

Lam

²

,

Lai

³

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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Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial

Cited by 21 publications

References 89 publications

Level of Evidence on Platelet-rich Plasma in Plastic Surgery

Level of Evidence on Platelet-rich Plasma in Plastic Surgery

Comparison between Carpal Tunnel Syndrome and Individuals with Symptoms of Obsessive- Compulsive Disorder

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

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