The outcome of platelet-rich plasma injection therapy in chronic plantar fasciitis

Background: Plantar Fasciitis is a frequently encountered problem in the everyday practice oforthopaedics. Treatment of Plantar Fasciitis is challenging to treating surgeon. Various conservativenon-invasive treatment modalities are available like rest, casting, night splinting, NSAIDs. Ifconservative management fails then corticosteroid injection over the medial tuberosity of calcaneumis an effective treatment. But in recent years Platelet-rich plasma (PRP) has proved to be a safealternative approach with less complication. This study aims to find out the effectiveness of PRPinjections in Plantar Fasciitis. Material and Method: In this study, 60 patients with Plantar Fasciitiswere included. Regular follow up was done at an interval of 4 weeks, 8 weeks and 6 months afterPRP injection. Pain intensity was measured before and after injection on every follow up using theVisual Analogue Scale (VAS). Patients who have undergone at least 4 weeks of conservativetreatment were included in the study. Results: After analysis of data, the average VAS score beforeinjection was 7.01±1.35. Whereas at the end of the last visit (i.e. 6 months) average VAS scorereduced to 2.2±1.25. This difference was statistically significant (ANNOVA test p <0.0001).Conclusion: we concluded that injection of PRP is a safe, convenient and effective approach to treatchronic Plantar Fasciitis.

P143 The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of an open-label, parallel group, randomised controlled trial

Background Patients with mild-to-moderate carpal tunnel syndrome (CTS) are commonly treated with night splints and/or local corticosteroid injection. In the INSTINCTS (INjection versus SplinTing in Carpal Tunnel Syndrome) trial, we previously reported that a single corticosteroid injection is more effective than night splinting at 6 weeks but not at 6 months. The aims of follow-up at 12 and 24 months were to examine whether corticosteroid injection is clinically and cost-effective in reducing symptoms in the longer-term compared to night splinting and to compare rates of CTS surgery. Methods INSTINCTS was a pragmatic clinical trial in adults ≥18 years with mild-to-moderate CTS diagnosed using standardised clinical criteria. Participants were recruited from primary care or musculoskeletal interface services and randomised 1:1 to receive either a single carpal tunnel injection of 20mg methylprednisolone acetate or a night splint. Follow-up questionnaires were mailed at 6 weeks and 6, 12 and 24 months. Key clinical outcomes at 12 and 24 months were the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity (0-10 numeric rating scale (NRS)) and the number of patients referred for and receiving CTS surgery. Longitudinal mixed effect models were fitted to estimate overall treatment effect at each time point by including interaction terms between treatment and time, adjusted for age, gender, symptom duration and baseline score. The cumulative number (%) of participants i) referred or ii) undergoing CTS surgery were examined by treatment group. Cost-utility analysis was conducted from an NHS perspective to determine the cost-effectiveness of injection versus night splinting. Results 118 participants were randomised to night splinting and 116 to corticosteroid injection. In the splint group, 88 (78%) and 81 (74%) completed follow-up at 12 and 24 months respectively compared to 87 (77%) and 78 (72%) in the injection group. There were no statistically significant differences between splint and injection groups in BCTQ score at 12 (adjusted mean difference -0.09; 95%CI -0.30, 0.12) or 24 months (0.06; -0.16, 0.28) or hand pain NRS (12 months 0.03; -0.79, 0.85. 24 months 0.41; -0.45, 1.26). By 24-month follow-up, a greater proportion of the injection group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery than the splint group. Injection was more costly (mean difference £68.59 (-120.84, 291.24)) with lower quality-adjusted life-years (QALYs) than splinting over 24 months (mean difference -0.022 (-0.074, 0.024)). Conclusion To our knowledge, this is the longest-reported follow-up of a randomised trial investigating the conservative management of CTS, with the largest sample size. Over 24-months, there were no differences in symptoms between groups and injection was not cost-effective compared with splinting. Surgical referral and intervention rates were low overall, but slightly more frequent in the injection group. Disclosures C.L. Burton None. T. Rathod-Mistry None. M. Blagojevic-Bucknall None. L.S. Chesterton None. G. Davenport None. K.S. Dziedzic None. S.M. Jowett Consultancies; Sue Jowett received payment as an independent advisor for a Pfizer chronic pain advisory board meeting in November 2018. H.L. Myers None. R.A. Oppong Consultancies; Raymond Oppong received payment as an independent advisor for a Pfizer Tanezumab HEOR Advisory Board Meeting in October 2018. D.A. Van der Windt None. E.M. Hay None. E. Roddy None.

The effectiveness of splinting and surgery on sleep disturbance in carpal tunnel syndrome

This controlled prospective study assessed the effectiveness of night splinting compared with non-splinting and surgery for severity of insomnia in patients with carpal tunnel syndrome. Sleep characteristics were observed for several days without a brace, with a brace and after surgery. The sleep measurements included the use of an actigraph worn on the wrist during night, a ‘sleep log’ that conveyed subjective impressions as to how the patient had slept and a short insomnia instrument, the Insomnia Severity Index. The Insomnia Severity Index scores showed that a night splint significantly improved insomnia symptoms compared with no splinting, and surgery significantly improved insomnia symptoms compared with splinting. The sleep log scores showed that the sleep quality and the number of awakenings when a splint was not worn were significantly different from the scores with the splint and the scores after surgery but showed no differences between splint and surgery. The actigraph did not show any significant differences between the treatment methods. Level of evidence: III

Night Splinting for Idiopathic Trigger Digits

Background: This study assessed nighttime splinting for 6 weeks as treatment for recent onset idiopathic trigger fingers. Methods: Patients over 18 years with a Quinnell grade 1 or 2, idiopathic trigger finger or thumb causing symptoms for less than 3 months were eligible for a custom-made hand-based orthoplast night orthotic. Improvement of symptoms and/or resolution of triggering were recorded. Patients also completed the short version of the Disabilities of the Arm, Shoulder and Hand and a numerical rating scale for pain at the initial visit, after 6 to 8 weeks, and after 3 months. Results: Thirty-four patients wore a night orthotic for at least 6 weeks. At final evaluation, there was a substantial reduction in disability and pain. Symptoms of triggering resolved completely in 18 patients (55%). Sixteen patients did not resolve their triggering after splinting and therefore underwent a steroid injection. Conclusion: Night splinting is a noninvasive treatment option for idiopathic trigger fingers/thumb with symptoms for less than 3 months.