Ultrasound-guided pulsed radiofrequency versus perineural platelet rich plasma injection for the treatment of idiopathic carpal tunnel syndrome: a prospective randomized controlled study.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy caused by the compression of the median nerve within the carpal tunnel. Ultrasound-guided hydrodissection with corticosteroids, platelet-rich plasma injection, and median nerve pulsed radiofrequency are all potential treatments for relieving symptoms of CTS in mild and moderate cases, comparison between their clinical outcomes is yet to be studied.The primary outcome was pain measured by Visual Analog Scale (VAS). The secondary outcomes included functional outcome evaluated by the Boston Carpal Tunnel Questionnaire (BCTQ), Nerve Conduction Velocity (NCV) and median nerve cross-sectional area (CSA). METHODS: This prospective, double-blinded, randomized controlled study was conducted on Seventy-five patients diagnosed with mild to moderate CTS, they were randomly allocated into three equal groups. The control group received a median nerve perineural injection of bupivacaine with methylprednisolone. The PRF group received median nerve pulsed radiofrequency in addition to bupivacaine. Finally, the PRP group received a perineural injection of platelet-rich plasma. MEASUREMENTS: Were conducted at specific time intervals: before the intervention, at one week, two months, and four months post-intervention for VAS, BCTQ, and CSA. NCV was only evaluated before the intervention and after four months. RESULTS: All patients experienced a statistically significant improvement in pain, symptoms, function, CSA of the median nerve and NCV following intervention. The PRF and steroid groups exhibited greater improvements than the PRP group. The PRP group showed the least improvement compared to the other two groups. LIMITATIONS: Short study period, single centred study. CONCLUSIONS: The current study suggests that ultrasound-guided hydrodissection of the median nerve, with local anesthetic/steroids or PRP and PRF are effective in alleviating pain and improving the functional outcome. Nevertheless, it was revealed that PRF and steroid injection were more efficacious in enhancing short term functional outcomes compared to PRP injection. TRIAL REGISTRATION: The study was retrospectively registered in the “Clinical Trials Library for Protocol Registration and Results System” under NCT05053477 on September 11, 2021.