Platelet-rich plasma in non-operative management of mild to moderate carpal tunnel syndrome – A systematic review & meta-analysis of short-term outcomes

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.

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Effect of platelet-rich plasma injections on mild or moderate carpal tunnel syndrome: an updated systematic review and meta-analysis of randomized controlled trials

10.37766/inplasy2020.10.0077 ◽

2020 ◽

Author(s):

Chunke Dong ◽

Yan Sun ◽

Yingna Qi ◽

Hongyu Wei ◽

Chungen Li

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Randomized Controlled Trials ◽

Carpal Tunnel ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Tunnel Syndrome

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Short-term Effects of Neurodynamic Techniques for Treating Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2021.10533 ◽

2021 ◽

pp. 1-67

Author(s):

Sergio Núñez de Arenas-Arroyo ◽

Iván Cavero-Redondo ◽

Ana Torres-Costoso ◽

Sara Reina-Gutiérrez ◽

Celia Álvarez-Bueno ◽

...

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Meta Analysis ◽

Short Term ◽

Tunnel Syndrome ◽

Short Term Effects

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Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211001715 ◽

2021 ◽

pp. 175319342110017

Author(s):

Saskia F. de Roo ◽

Philippe N. Sprangers ◽

Erik T. Walbeehm ◽

Brigitte van der Heijden

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Meta Analysis ◽

Surgical Techniques ◽

Open Release ◽

Flap Coverage ◽

Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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Gabapentin as an adjuvant therapy to splinting in carpal tunnel syndrome (CTS): a systematic review and meta-analysis of randomized controlled trials

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00237-5 ◽

2020 ◽

Vol 56 (1) ◽

Author(s):

Ahmed M. Ahmed ◽

Osama G. Hassan ◽

Ahmed A. Khalifa

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Pinch Strength ◽

Symptom Severity Scale ◽

Significant Difference ◽

Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is a common upper limb entrapment neuropathy; severe cases are treated surgically and mild to moderate can be managed conservatively. The purpose of this systematic review and meta-analysis was to define the efficacy of gabapentin as an adjuvant to splinting in the treatment of mild to moderate CTS. Methods A systematic search through 13 databases, randomized clinical trials (RCTs) reporting the use of gabapentin with splinting in CTS were included and analyzed. Results Three RCTs including 170 patients were eligible. There was no significant difference between gabapentin plus splinting and splinting alone in 5 measured parameters: (1) Symptom Severity Scale (SSS) [MD (95% CI) = − 0.76 (− 2.46–0.93), p = 0.378], (2) Functional Status Scale (FSS) [MD (95% CI) = − 0.23 (− 1.40–0.94), p = 0.701], (3) visual analogue scale (VAS) to assess pain [MD (95% CI) = − 0.6 (− 1.47–0.27), p = 0.174], (4) Grip strength [MD (95% CI) = − 0.11 (− 0.70–0.48), p = 0.718], and (5) pinch strength [MD (95% CI) = 0.72 (− 0.10–1.54), p = 0.083]. Conclusion This review provides low-quality evidence that gabapentin plus nocturnal splinting is not superior to splinting alone. More high-quality trials are needed to determine the role of this drug as an adjuvant in the management of CTS.

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Utility of Ultrasound Elastography in Evaluation of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2019.07.409 ◽

2019 ◽

Vol 45 (11) ◽

pp. 2855-2865 ◽

Cited By ~ 14

Author(s):

Chih-Peng Lin ◽

Ing-Jeng Chen ◽

Ke-Vin Chang ◽

Wei-Ting Wu ◽

Levent Özçakar

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Meta Analysis ◽

Ultrasound Elastography ◽

Tunnel Syndrome

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Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

Pharmaceuticals ◽

10.3390/ph13030049 ◽

2020 ◽

Vol 13 (3) ◽

pp. 49 ◽

Cited By ~ 1

Author(s):

Chih-Peng Lin ◽

Ke-Vin Chang ◽

Yi-Kai Huang ◽

Wei-Ting Wu ◽

Levent Özçakar

Keyword(s):

Carpal Tunnel Syndrome ◽

Functional Status ◽

Carpal Tunnel ◽

Symptom Severity ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Symptom Relief ◽

Indirect Evidence ◽

Therapeutic Effects ◽

Tunnel Syndrome

This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections—including 5% dextrose (D5W) and platelet-rich plasma (PRP)—for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Ranking probabilities of the SMD of each treatment were acquired by using simulation. Ten studies with 497 patients and comparing five treatments (D5W, PRP, splinting, corticosteroid, and normal saline) were included. The results of the simulation of rank probabilities showed that D5W injection was likely to be the best treatment, followed by PRP injection, in terms of clinical effectiveness in providing symptom relief. With respect to functional improvement, splinting ranked higher than PRP and D5W injections. Lastly, corticosteroid and saline injections were consistently ranked fourth and fifth in terms of therapeutic effects on symptom severity and functional status. D5W and PRP injections are more effective than splinting and corticosteroid or saline injection for relieving the symptoms of CTS. Compared with splinting, D5W and PRP injections do not provide better functional recovery. More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.

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