The Efficacy of Ultrasound Guided Platelet Rich Plasma Injection Versus Perineural Dextrose Injection in the Treatment of Severe Carpal Tunnel Syndrome

Abstract

Aims: To compare the ultrasound-guided platelet rich plasma efficacy to ultrasound guided 5% dextrose perineural   injection therapy in severe idiopathic carpal tunnel syndrome patients. Patients and Methods: This research involved 60 patients with severe idiopathic CTS diagnosed by electrophysiological study. Patients were evaluated at three months after injection   clinically, electrophysiological, and US examinations. Patients were divided into 2 groups according to line of treatment: Group I: 30 patients (34 hands) treated by two ultrasound guided injection with 3 mL PRP two weeks apart. Group II: 30 patients (35 hands) treated by two ultrasound guided perineural injection therapy with 3 ml of 5% dextrose two weeks apart. Results: There was significant clinical improvement (BCTQ and, VAS), electrophysiological improvement (DML, AMP, sensory amplitude and sensory conduction velocity of median nerve) and, ultrasonic improvement (CSA and FR) 3 month after treatment as compared to before treatment in both groups with better improvement in group 1. There was significant difference between the 2 groups regarding VAS for pain and VAS for paresthesia 3 months after treatment with better improvement in PRP group. There was significant difference between the 2 groups regarding BCTQ 3 months after treatment with better improvement in PRP group. Conclusion: Ultrasound guided injection of PRP or dextrose 5% is an effective and safe treatment for severe idiopathic CTS.  -Both modalities lead to significant reduction in pain, paresthesia, disability and also significant improvement in electrophysiological and ultrasound parameters of the median nerve with better improvement in PRP group.