Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome

Michael Alexander Malahias, Elizabeth O Johnson, George C Babis, Vasileios S Nikolaou, Michael Alexander Malahias, Elizabeth O Johnson, George C Babis, Vasileios S Nikolaou

Abstract

Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.

Keywords: carpal tunnel syndrome; nerve regeneration; neural regeneration; pilot study; platelet-rich plasma; ultrasound guidance.

Conflict of interest statement

Conflicts of interest: None declared.

Figures

Figure 1
Figure 1
Flow chart of patient selection.
Figure 2
Figure 2
Ultrasound-guided injection of PRP. (A) Injection of PRP around the median nerve (oval shape, honeycomb like, blue arrows) in a transverse plane at the carpal tunnel inlet. The tip of the needle (white arrow) with its acoustic shadowing (red arrows) is visible under the median nerve. (B) Injection of PRP (green arrows) at the opposite site (radial) of the needle insertion (ulnar approach). At the end of the infiltration, the hypoechoic swollen median nerve (oblique yellow arrows) is successfully hydrodissected (PRP: anechoic area, marked with the white arrows). PRP: Platelet-rich plasma.

References

    1. Allampallam K, Chakraborty J, Robinson J. Effect of ascorbic acid and growth factors on collagen metabolism of flexor retinaculum cells from individuals with and without carpal tunnel syndrome. J Occup Environ Med. 2000;42:251–259.
    1. Anjayani S, Wirohadidjojo YW, Adam AM, Suwandi D, Seweng A, Amiruddin MD. Sensory improvement of leprosy peripheral neuropathy in patients treated with perineural injection of platelet-rich plasma. Int J Dermatol. 2014;53:109–113.
    1. Bozek M, Gazdzik TS. The value of clinical examination in the diagnosis of carpal tunnel syndrome. Ortop Traumatol Rehabil. 2001;3:357–360.
    1. Cho HH, Jang S, Lee SC, Jeong HS, Park JS, Han JY, Lee KH, Cho YB. Effect of neural-induced mesenchymal stem cells and platelet-rich plasma on facial nerve regeneration in an acute nerve injury model. Laryngoscope. 2010;120:907–913.
    1. Farrag TY, Lehar M, Verhaegen P, Carson KA, Byrne PJ. Effect of platelet rich plasma and fibrin sealant on facial nerve regeneration in a rat model. Laryngoscope. 2007;117:157–165.
    1. Greenslade JR, Mehta RL, Belward P, Warwick DJ. Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire? J Hand Surg Br. 2004;29:159–164.
    1. Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, Li-Tsang CW, Wong LK, Boet R. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074–2078.
    1. Karadag YS, Karadag O, Cicekli E, Ozturk S, Kiraz S, Ozbakir S, Filippucci E, Grassi W. Severity of carpal tunnel syndrome assessed with high frequency ultrasonography. Rheumatol Int. 2010;30:761–765.
    1. Karadas O, Tok F, Akarsu S, Tekin L, Balaban B. Triamcinolone acetonide vs procaine hydrochloride injection in the management of carpal tunnel syndrome: randomized placebo-controlled study. J Rehabil Med. 2012;44:601–604.
    1. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, Martinoli C, Loscher WN. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250:171–177.
    1. Lambru G, Lagrata S, Matharu MS. Cutaneous atrophy and alopecia after greater occipital nerve injection using triamcinolone. Headache. 2012;52:1596–1599.
    1. Malahias MA, Chytas D, Babis GC, Nikolaou VS. Platelet-rich plasma guided injections: clinical application in peripheral neuropathies. Front Surg. 2014;1:41.
    1. Park GY, Kwon DR. Platelet-rich plasma limits the nerve injury caused by 10% dextrose in the rabbit median nerve. Muscle Nerve. 2014;49:56–60.
    1. Prime MS, Palmer J, Khan WS, Goddard NJ. Is there light at the end of the tunnel? controversies in the diagnosis and management of carpal tunnel syndrome. Hand. 2010;5:354–360.
    1. Smith J, Wisniewski SJ, Finnoff JT, Payne JM. Sonographically guided carpal tunnel injections: the ulnar approach. J Ultrasound Med. 2008;27:1485–1490.
    1. Yoshii Y, Zhao C, Schmelzer JD, Low PA, An KN, Amadio PC. Effects of hypertonic dextrose injections in the rabbit carpal tunnel. J Orthop Res. 2011;29:1022–1027.

Source: PubMed

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