826 - Leukocyte Concentration in Platelet-Rich Plasma Injection for Carpal Tunnel Syndrome: A Systematic Review and Pooled Analysis

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

TI

Tanya Israel, BS

Medical Student
Rowan-Virtua School of Osteopathic Medicine
Blackwood, New Jersey, United States

Co-Author(s)

SM

Sweta Mukhopadhyay, BA

Medical Student
Rowan-Virtua School of Osteopathic Medicine
Voorhees, New Jersey, United States
MD

Musa Dolley, BS

Medical Student
Rowan Virtua SOM
Stratford, New Jersey, United States
Nicholas J. Averell, BS

Medical Student
Rowan Virtua SOM
WILLIAMSTOWN, New Jersey, United States
BG

Brandon Goodwin, n/a (he/him/his)

Medical Student (OMS-IV)
Rowan-Virtua School of Osteopathic Medicine
Stratford, New Jersey, United States
AR

Altamash Raja, DO

Associate Program Director-PM&R, Inspira Health Network
Rowan Virtua SOM
Stratford, New Jersey, United States

Objectives: Platelet-rich plasma (PRP) injections are a novel alternative to current treatment options for carpal tunnel syndrome (CTS). The objective of this systematic review is to investigate the relationship between leukocyte concentration in PRP injections and improvements in symptom severity and functional status when treating patients with CTS.

Design: A systematic review was conducted into PubMed, Scopus, Embase, Cochrane Library, and Science Direct to explore the use of PRP injections for the treatment of CTS. The outcome of interest includes the symptom severity scale (SSS) and functional status scale (FSS) of the Boston Carpal Tunnel Questionnaire (BCTQ). All studies containing primary data on the use of PRP for treating CTS were included.

Results: Initial querying of the databases yielded 352 results. After duplicate removal, 200 remained. After screening for relevance, 37 studies remained for full-text appraisal, of which 5 were included. Pooled analysis evaluated pre-treatment and 3 months or end-of-study post-treatment BCTQ SSS and FSS scores. For the SSS, leukocyte-rich PRP (LR-PRP) had a pooled effect size of 7.33 ± 2.92 (95% CI 1.60 - 13.05; p = 0.012), and leukocyte-poor PRP (LP-PRP) yielded 5.500 ± 4.44 (95% CI -3.201 - 14.202; p = 0.215). For the FSS, LR-PRP had an effect size of 5.85 ± 2.64 (95% CI 0.63 - 11.028; p = 0.027), and LP-PRP yielded 4.29 ± 3.67 (95% CI -2.88 -11.47; p = 0.241).

Conclusions: Pooled and subgroup analysis showed that LR-PRP had a greater reported pain reduction and functional improvement than LP-PRP, with the more significant reduction in both treatment groups being in pain. Future research on injection techniques, platelet concentration differences, PRP preparation method, and duration of symptoms at the time of treatment would aid in standardizing the protocol for PRP injections.