STRONG RECOMMENDATION A randomized controlled trial with 12-month follow-up of PRP vs saline control showed similar improvement in symptom severity scale and functional status at all time points without clinically meaningful differences, though cross-sectional area and electrodiagnostic parameters showed some beneficial effect from PRP (Chen, 2021). While other high-level studies failed to follow patients long-term, short-term effects of PRP have shown mixed results. Raeissadat (2018) conducted a randomized controlled trial that compared the effects of wrist splitting alone versus wrist splinting combined with a single local PRP injection. They found that over the 10-week treatment period in comparison to control, a single PRP injection did not significantly enhance the effects of conservative treatment in terms of pain, symptom severity, functional status, and electrophysiological parameters. In contrast, Malhias (2018) performed an RCT which found PRP lead to increased success rates defined by a 25% difference in Q-DASH scores in comparison to placebo at 12 weeks.
Benefits/Harms of Implementation
PRP is an endogenously sourced blood product. Harvesting requires venipuncture and risks of injection are low. Benefits are unclear.
Cost Effectiveness/Resource Utilization
PRP is relatively expensive due to the cost of purification and separation equipment necessary to isolate and extract the platelet-rich fraction from whole blood. With no clear benefit to patient outcomes, its utilization may be wasteful.
Acceptability
PRP is performed by many practitioners despite limited evidence of effectiveness. It is not considered a standard treatment for carpal tunnel syndrome.
Feasibility
Implementation of this recommendation is feasible as it recommends against the use of PRP for the treatment of carpal tunnel syndrome.
Future Research
There are few placebo-controlled trials of PRP with long-term follow up. More high-level research with longer follow up is critical to evaluating any significant differences between PRP and placebo.
- Chen, S. R., Shen, Y. P., Ho, T. Y., Li, T. Y., Su, Y. C., Chou, Y. C., Chen, L. C., Wu, Y. T.. (2021). One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial. Archives of Physical Medicine & Rehabilitation, 102(5), 951-958.
- Malahias, M. A., Nikolaou, V. S., Johnson, E. O., Kaseta, M. K., Kazas, S. T., Babis, G. C.. (2018). Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: A placebo-controlled clinical study. Journal Of Tissue Engineering & Regenerative Medicine, 12(3), e1480-e1488.
- Raeissadat, S. A., Karimzadeh, A., Hashemi, M., Bagherzadeh, L.. (2018). Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial. BMC Musculoskeletal Disorders, 19(1), 49.