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Carpal Tunnel Syndrome Injections: PRP vs Steroid vs Dextrose Prolotherapy

Treatment options for carpal tunnel syndrome often include injections to deliver medications that reduce inflammation and provide pain relief. In a recent systematic review and network meta-analysis, three types of injections were compared for the treatment of carpal tunnel syndrome: platelet rich plasma, dextrose prolotherapy, and corticosteroids. Let’s look at which one had the best results and discuss which option may be good for you.

Carpal tunnel syndrome can cause significant pain and disability, and injections are often used to provide symptom relief. While cortisone injections have been around for a long time and are the most common type of injection, there are growing concerns about their potential side effects and limited therapeutic duration. PRP injections and dextrose prolotherapy are newer options that may have fewer side effects and longer-lasting symptom relief, but more research is needed to fully understand their effectiveness.

PRP, or platelet-rich plasma, injections are a treatment option that involves injecting a concentrated solution of the patient's own platelets into an affected area. Platelets are a type of blood cell that play a vital role in the healing process by releasing growth factors that stimulate the healing process. One of the main advantages of PRP is that it is a natural treatment that uses the patient's own cells, which minimizes the risk of side effects.

Dextrose prolotherapy is a treatment that involves injecting a solution of concentrated dextrose with the goal of stimulating the body’s natural healing process to improve function. Dextrose is a type of sugar very similar to glucose and has been used for over 70 years in the treatment of chronic pain. Dextrose just like PRP is incredibly safe with almost no side effects.

This recent study sought to determine which one of these three injections work the best. The authors conducted a systematic review and then performed a network meta-analysis of 12 randomized controlled trials comparing steroid injections, platelet rich plasma injections, and dextrose prolotherapy injections.

The authors calculated SUCRA scores also known as surface under the cumulative ranking curve. This is a statistical measure used in network meta-analysis to evaluate the ranking of different treatment options. A higher SUCRA score indicates a higher ranking for a treatment.

They found that PRP injections were the most likely to relieve symptoms, improve function and alleviate pain, with the SUCRA being 91.5%, 92.7%, and 80.8%, respectively, followed by D5W injection (74.4%, 72.2%, 72.1%), and corticosteroid injection (33.7%, 31.9%, 46.2%). The injection of three drugs was significantly better than that of a placebo.

The authors go on to conclude that “from the results of the network meta-analysis, PRP injection is the most recommended treatment among the injections of corticosteroid, dextrose prolotherapy, and platelet rich plasma.”

So at first glance, this study seems to suggest PRP is superior to dextrose prolotherapy. But now let’s dive into each individual outcome measure. In terms of carpal tunnel syndrome severity score, the meta-analysis showed that there was no statistical difference between dextrose prolotherapy and platelet rich plasma, though both were better than steroids.

In terms of functional status scores, the meta-analysis showed that platelet rich plasma was superior to steroid injections but that dextrose prolotherapy was not. When compared to each other, PRP was not statistically different from dextrose prolotherapy. In terms of visual analog pain scores, there were no statistical differences between steroids, PRP, and dextrose prolotherapy.

So when we break down the outcome measures individually, it does seem PRP is favored but it’s not a slam dunk. In addition, a prior systematic review and meta-analysis actually found the opposite in that dextrose prolotherapy was favored over PRP injection. That study also found that the effects of steroid injections were temporary and not as effective as PRP and dextrose prolotherapy.

So what does this mean for you and how do I use this data to counsel my patients? Well, I actually still recommend dextrose prolotherapy injections over PRP injections right now, strictly because of the cost. Dextrose is just so much cheaper than PRP. And if the outcomes are similar, then it makes sense to go with the cheaper option especially when they both have the same excellent safety profile. However, if insurances start to cover PRP injections then it would make sense to start recommending PRP more because it seems to be slightly more effective. Of course, more research will help us determine which treatment is ultimately the best.


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