Platelet-Rich Plasma in the Treatment of Patients With Idiopathic Carpal Tunnel Syndrome
Platelet-Rich Plasma in the Treatment of Patients With Idiopathic Carpal Tunnel Syndrome
This is a randomized controlled trial in a cohort of Egyptian patients suffered from mild to
 moderate idiopathic carpal tunnel. They were randomly divided into two groups. Group 1:
 patients received ultrasound-guided platelet-rich plasma injection and group 2 patients
 received ultrasound-guided corticosteroid injection. The outcome measures were assessed via
 Visual Analogue Scale, the Boston Carpal Tunnel Syndrome Questionnaire, electrophysiological
 findings in sensory and motor function of the median nerve and morphological changes of
 median nerve detected by ultrasound.
Intervention:

 PRP Injection Group(PRP-inj-G) - This group included 49 patients (40 females and 9 males).
 Their age ranged from 20 to 60 years.

 PRP Preparation: 16 ml of blood was obtained from each patient using special PRP kits (GD
 medical pharma, Dutch company). The blood was collected on citrated tubes with a mixing ratio
 of 9:1 by volume. Tubes underwent 1st centrifugation at speed of 3000 rpm (704g) for 3
 minutes (to separate red blood cells from plasma). Plasma was then removed by syringe and
 then placed into another sterile tube with no anticoagulant and then underwent 2nd
 centrifugation at speed of at 4000 rpm (1252g) for 15 min. The supernatant platelet-poor
 plasma was then removed leaving 2 ml of PRP pellets in the sediment, and suspend the PRP
 pellets by gentle shaking of the tube. PRP is activated by adding 200 μl of 0.025 calcium
 chloride(Dhurat and Sukesh, 2014).

 Ultrasound-Guided Injection: Proper preparation with an antiseptic solution of skin overlying
 the point of injection was performed guided by ultrasonography (Siemens Acuson P300 machine).
 With the palm facing upward and the wrist joint in slight extension, the MN will be
 recognized at the inlet of the CT(Wu et al., 2017). The injection was guided by ultrasound
 with the use of the ulnar in-plane technique(Lee et al., 2014). Ulnar artery was identified
 by the means of Doppler imaging, and a 25-gauge needle was introduced from the ulnar side of
 the wrist between CT and MN. Then the entire CT was scanned to confirm that the injection had
 dispersed through the proximal to the distal area of the CT. All patients were observed for
 30 minutes post-injection for the possibility of dysesthesia or bleeding(Wu et al., 2017).

 PRP injection: A 25-gauge needle was gently introduced one cm proximal to the distal
 wrist-flexion crease just to the ulnar side of the palmaris longus tendon and 2 ml of PRP was
 injected into the CT.

 Steroid injection Group(St-inj-G) - included 49 patients (41 females and 8 males)with their
 age ranged from 20 to 60 years. A single injection of methylprednisolone acetate 40 mg/ml
 using a technique similar to that described for the PRP injection

 Post-injection care for both groups:

 -  Some patients may have minimal to moderate discomfort after injection. So, to control
 pain, patients should apply ice on the injection site and also modify activity as
 tolerated.

 -  Rest for one day.

 -  The patient immediately returns to work two days after injection.

 -  Pain medication in the form of paracetamol only was allowed for the next 3 months if
 needed. The patients were instructed to stop analgesics 48 hours before the visit to
 allow proper symptoms assessment.
Inclusion Criteria:

 -  Patients with mild-to-moderate idiopathic CTS with clinical manifestations failed to
 respond to conservative treatment ( such as splint, medications, Physical therapy) for
 at least 3 months and they were diagnosed by electrophysiological study and
 musculoskeletal ultrasound.

 Exclusion Criteria:

 -  Diabetes

 -  Hypothyroidism

 -  Rheumatoid arthritis

 -  Previous carpal tunnel decompressive surgery

 -  Cervical radiculopathy, polyneuropathy, brachial plexopathy, traumatic nerve injury,
 thoracic outlet syndrome

 -  Previous corticosteroid injection into the carpal tunnel in the preceding 4 weeks

 -  Anemia (hemoglobin <10gm%)

 -  Coagulopathy

 -  Pregnancy