PRP for carpal tunnel syndrome linked with earlier grip strength recovery
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Patients who received platelet-rich plasma during surgical treatment of carpal tunnel syndrome regained hand grip strength earlier than patients who received placebo, according to published results.
Researchers randomly assigned 50 patients with mild to extreme carpal tunnel syndrome undergoing open surgical release of the carpal ligament to receive 3 mL of either platelet-rich plasma (n=25) or platelet-poor plasma (n=25). Researchers considered hand grip strength as the primary outcome measure, while time taken off work after surgery and Wong-Baker Faces Scale, Boston Carpal Tunnel Questionnaire and Southampton Wound Assessment Scale scores were considered secondary outcomes. Patients were evaluated preoperatively and at 6-weeks postoperatively.
Results showed improvements in pain, severity of symptoms and functional status in both groups. Although a between-group analysis for hand grip strength showed no differences between the PRP and platelet-poor plasma group at 6-week follow-up, researchers found the PRP group regained pre-surgery hand grip strength significantly earlier vs. the platelet-poor plasma group. Researchers noted no statistically significant differences for Southampton Wound Assessment Scale scores at 6-week follow-up between the two groups. No surgical complications occurred in either group at 6-week follow-up and both groups had a similar amount of leave from work after their surgery, according to results.
“Exploration of the efficacy of PRP as an adjuvant to surgical [carpal tunnel syndrome] CTS treatment merits further study, although future experiments should address the mechanism by which PRP irrigation aids the early recovery of [hand grip strength] HGS and should optimize the conditions of its use to maximize the benefits of this potential therapy,” the authors wrote.
Perspective
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Randall W. Culp, MD, FACS
In orthopedics, the use of PRP has been increasing in popularity, however, its true effectiveness continues to be debated. In this prospective, randomized, triple-blinded controlled clinical trial, patients with mild to extreme CTS were divided into two groups. After an open carpal tunnel release, group 1 consisted of 25 patients who received an injection of PRP into the carpal tunnel and group 2 consisted of 25 patients who received autologous platelet-poor plasma (PPP). At 6-week follow-up, results showed that patients with PRP as an adjuvant to surgical release regained preoperative grip strength earlier than patients who received the placebo control. However, PRP did not improve pain, severity of symptoms or functional status more effectively than the control.
As a practicing orthopedic hand surgeon, I have been looking for years at methods to improve outcomes after carpal tunnel surgery, and this study adds to that goal. Further research and longer term results at 3, 6 and 12 months is needed. If these later data shows no difference other than subjective grip strength, is it worth the added cost of the PRP preparation. Future studies should explore the mechanism of PRP action and standardized PRP preparation methods, as well as assess optimal dosage for this type of adjuvant treatment.
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