Our study evaluates the role of platelet-rich plasma injection in patients with mild-moderate carpal tunnel syndrome compared to surgical and medical procedure; we recruited a large sample of patients and rely on a longer period of follow-up (6 months), and the injection was ultrasound guided not blind that provide accurate findings compared to other similar studies; our results rely on an subjective and objective methods of assessment as electrophysiological study regarding motor and sensory conductive study for more accurate findings.
Our study revealed a significant improvement of pain and function at 6 months post-injection of platelet-rich plasma in the 1st and post-surgery in the 2nd group of patients compared to the baseline regarding VAS and Boston questionnaire of CTS.
In agreement to our results, Malahias et al. and Yung-Tsan et al. [15, 16] and their colleague reported a significant improvement of pain regarding VAS and function regarding QDASH (quick Disabilities of the Arm, Shoulder and Hand) score in patients with mild-moderate carpal tunnel syndrome who received single-dose injection of PRP and throughout 3 months of follow-up post-injection compared to baseline parameters.
There was a significant improvement of median nerve peak sensory latency and distal motor latency at 6 months post-injection compared to the baseline in the 1st and 2nd groups of patients compared to their baseline parameters.
This comes in agreement with Yung-Tsan et al. [16] and Zheng et al. [4] and their teams as they revealed a similar results, and they reported the gradual sustained improvement of electrophysiological parameters regarding median nerve peak sensory latency and distal motor latency in patients with mild-moderate CTS at 6 months post-injection with platelet-rich plasma and explain that by the role of PRP in facilitation of Schwann cell proliferation, production of neurotrophic, and nerve growth factors with subsequent improvement of nerve electrophysiological parameters.
In accordance to our results, Piskin et al. [17] reported that PRP has not a role in axonal regeneration of peripheral nerve healing, and its role limited to regeneration of myelin sheath with subsequent improvement of demyelinating neuropathy regarding peak sensory latency and distal motor latency in electrophysiological study such as in cases of mild-moderate CTS.
Gerritsen et al. [18] reported the significant improvement of pain and function in patients with mild-moderate CTS after surgery and documented that the optimal way of management of moderate CTS is the standard open carpal tunnel release surgery OCTR that is preferred than other non-surgical lines of treatment regarding lower risk of complications and of added costs.
The present study revealed significant improvement of pain and insignificant improvement of function, median nerve peak sensory latency, and distal motor latency at 6 months post-medical treatment and hand support in the 3rd group of patients compared to the baseline regarding electrophysiological study and Boston questionnaire of CTS.
There was a significant statically improvement of function and electrophysiological parameters of the first and second groups of patients compared to the third group at 6 months post intervention regarding median nerve distal motor, peak sensory latency, symptoms severity index, and functional state of Boston questionnaire of CTS.
In agreement with our results, Uzun et al. [19] reported a significant improvement of pain and function regarding VAS and BCTQ in patients with mild-moderate CTS who receiving PRP injection at 3 months post-treatment compared with patient group receiving steroid injection and medical treatment.
In another line Piazzini et al. [20] reported the efficacy of local and oral steroids, splints, NSAIDs, and diuretic medications in pain relief and improvement of function in patients with mild-moderate CTS.
Finally, O’Connor et al. [21] Carlson et al. [22] reported that non-surgical maneuvers as oral treatment, casting, and steroid injection have short-term relief of CTS symptoms and improvement of function.