Effectiveness of platelet rich plasma injections for non-surgical management of carpal tunnel syndrome: a systematic review and meta-analysis of randomized controlled trials

Publication date: Available online 7 December 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Michael Catapano, Joseph Catapano, Gregory Borschel, Seyed Mohammad Alavania, Lawrence R. Robinson, Nimish Mittal

Abstract

Objective

To systematically review and evaluate the efficacy and complication profile of platelet-rich plasma (PRP) injection into the carpal tunnel for management of carpal tunnel syndrome (CTS).

Data Sources

PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Sciences (from inception to January 1^st, 2019).

Study Selection

Controlled trials addressing PRP for CTS.

Data Extraction

Two reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. The outcomes of interest were the visual analog score (VAS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ), including the subscales of the symptom severity scale (SSS) and the functional status scale (FSS). Other reported outcome measures and complications were analyzed descriptively.

Data Synthesis

Four randomized control studies satisfied the inclusion criteria and analyzed a total of 191 cases with a final follow-up of either 3 or 6-months. Control groups included splinting in two studies, corticosteroid injection in one study, and saline injection in one study. There was a statistically and clinically significant improvement in the BCTQ {Std. Mean Difference(95%CI) = -2.06[-3.41, -0.70], p=.003} between groups. Subgroup analysis showed significant improvement in SSS {Std. Mean Difference(95%CI) = -1.95[-3.65, -0.25], p=.02} but not for FSS {Std. Mean Difference(95%CI) = -2.19[-4.77, 0.40], p=.10}. There was a similar improvement in VAS and nerve conduction studies in those receiving PRP compared to controls. Complication rate in the included studies was low with 4/97 participants receiving PRP injections experiencing transient pruritis, burning and/or tingling.

Conclusion

PRP represents a promising therapy for patients with mild to moderate CTS; however, included studies were limited as follow-up was short, included patients were heterogeneous, and the number of included studies was low. Further investigation is necessary to determine its true efficacy and effect and to better delineate the long-term results in patients with CTS.

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