Efficacy of Platelet-rich Plasma Versus Steroid Injections in Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis
Ahmed Fathallah1, Ibrahim Kamal2, Mohamed Mamdouh4, Mohamed Ahmed Ali4, Esraa Ragaey4, Abdulrahman Hagrass3, Anas Zakarya Nourelden2
1Faculty of Medicine, Minia University, Minia, Egypt., 2Faculty of Medicine, Al-Azhar University, Cairo, Egypt, 3Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, 4Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
Objective:
This review compares the effectiveness of platelet-rich plasma (PRP) vs. steroids in improving symptoms and function in carpal tunnel syndrome (CTS).
Background:
CTS is characterized by the compression of the median nerve as it traverses the carpal tunnel at the wrist. It manifests with pain, numbness, tingling, and weakness in the hand. Steroid injections lead to short-term improvement in CTS. PRP contains growth factors that promote tissue regeneration, with promising results in CTS.
Design/Methods:
We searched Web of Science, Cochrane, PubMed, Scopus, and Embase for relevant articles till June 2024. We included RTCs and observational studies investigating steroids and PRP. The differences were presented as mean differences (MD) alongside 95% CI, after pooling studies using indirect meta-analysis assuming a random effects model.
Results:
The review comprises 131 studies conducted over 9337 subjects. Both treatments significantly improved all parameters related to CTS. Studies measured the outcomes multiple times, and we subgrouped the measurements into <2-, 2-6-, and 6-12-months post-treatment to analyze trends in effects. There was no significant difference in BCTQ-S between both treatments up to six months. Beyond that, PRP was associated with a greater reduction in severity scores compared to steroids [-1.31 vs. -0.79; P=0.04). Effects on BCTQ-F exhibited no significant difference in the first two months. However, PRP patients had better function scores beyond that: 2-6 months (PRP: -1.11, Steroid: -0.77; P<0.00001) and 6-12 months (PRP: -1.17, Steroid: -0.46; P<0.00001). VAS scores for pain were significantly lower for PRP only after 6 months (PRP: -4.96, Steroid: -2.27; P=0.007). We observed no significant differences between both drugs in DML and SCNV across all three intervals.
Conclusions:
Both steroids and PRP reduce the severity and improve the function in patients with CTS. PRP was superior in reducing pain and improving function in the long term, whereas steroid effects waned over time.
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