Date of Award

2020

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine “Is platelet-rich plasma injection effective for reducing pain & symptom severity in adults with carpal tunnel syndrome?”

STUDY DESIGN: Systematic review of two randomized controlled trials and one nonrandomized controlled trial to analyze the overall effectiveness of platelet-rich plasma (PRP) injections as a management for carpal tunnel syndrome (CTS). All three articles were published in peer-reviewed journals after the year 2016.

DATA SOURCES: These two RCTs and one non-RCT were found using Pubmed and were selected based on their year of publication, population of individuals with mild to moderate CTS, relevance to clinical question, and ability to meet POEM criteria.

OUTCOMES MEASURED: Patients in these three studies reported pain level measured by the Visual Analog Scale (VAS) and symptom severity measured by the Symptom Severity Scale (SSS)

RESULTS: Raeissadat et al. reported that PRP is not an effective treatment for CTS since there was no statistically significant evidence to support that at 10 weeks, PRP injections with a wrist splint added any benefit in VAS and SSS scoring compared to splinting alone (BMC Musculoskelet Disord. 2018;19(1). doi:10.1186/s12891-018-1963-4.). Wu et al. concluded that PRP is an effective treatment for CTS if used for 6 months. However, applying an endpoint of 3 months to make the study directly comparable to the others shows that a 3 month treatment period was not long enough to demonstrate statistically significant benefit of using PRP on the VAS, despite yielding statistically significant positive results on the SSS in month 3 (Sci Rep. 2017;7(1). doi:10.1038/s41598-017-00224-6.). In contrast, Atwa et al. showed that at the 1 and 3 month follow-ups, PRP injections were sometimes significantly better in relieving pain and symptom severity than corticosteroid injections since the PRP group overall scored lower on the VAS and SSS with p values <0.05 at both times, however the standard deviation was high enough to cause concern in the validity of these results. (The Egypt Rheum. 2018. doi:10.1016/j.ejr.2018.07.008.).

CONCLUSIONS: Based on the three studies analyzed, it can be concluded that PRP injection is not an effective treatment for reducing pain and symptom severity in adults with CTS.

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