Title : Effectiveness of single dose corticosteroid vs. platelet rich plasma injection in mild-to-moderate carpal tunnel syndrome: A prospective, randomized, double blind study
Abstract:
Carpal Tunnel Syndrome (CTS) is the most commonly occuring entrapment neuropathy abd results in nocturnal paresthesia, numbness, and weakness of the hands in the distribution of the median nerve. Many different treatment options are available in the treatment of CTS including physical therapy, exercises and injections. Steroid injections into the wrist can be a practical solution to the problem but may cause side effects such as weakening of the tendons. Platelet rich plasma’s nerve fiber regenerating properties have been shown in animal studes. However, to date there is no concrete evidence for either of these treatments and their superiority over one another.
The aim of the study is to reveal the efficacy of single dose Platelet Rich Plasma injection (PRP) vs. corticosteorid (CS) injection to carpal tunnel in the treatment of CTS.
A total of 59 female patients (78 wrists) with a diagnosis of mild to moderate CTS were included in the study and blindly randomized into two treatment groups; one group received single dose PRP and the second group single dose CS injections administered into the carpal tunnel by the same physician. Baseline, first and 6th month evaluations were conducted by a second physician blind to the treatment received. Boston carpal tunnel questionnaire (BTCQ), grip strength, CTS symptom provocation tests and electrophysiological parameters were used to evaluate patients.
There was a significant improvement in BTCQ in both treatment groups (p<0.001) with no between group difference. No significant improvement in physical examination findings was seen in either treatment group. Within group comparisons of baseline – 6 month electrophysiological parameters showed significant improvement in sensory nerve conduction studies in both treatment groups (p<0.001) with no between-group difference. All motor nerve conduction study parameters significantly improved in the CS group.
Audience Take Away:
- The results of our study suggest that CS is more effective in treating signs and symptoms of CTS when compared to PRP. The findings of this study will help guide physiatrists management plan when considering use of injections in the treatment of CTS. Injection of choice may also be guided by the exact aim of the treatment, for example in severe CTS in which all eletrophysiological parameters are affected, CS maybe the preferred treatment of choice.
- This research will help guide further studies in the area; long term effects of CTS and PRP in the treatment of CTS and comparison of the effects of repeated CS and PRP injections are areas for future studies.
