Hashem Engi Yousry, Shamandy Faten Saeed, Elmulla Ahmed Fawzy, Mansour Magdy AbdelAziz
Department of Anesthesia and Pain Management, Medical Research Institute, University of Alexandria, 165 El-Horeya Rd, Al Ibrahimeyah Qebli WA Al Hadrah Bahri, Qesm Bab Sharqi, Alexandria, Egypt.
BMC Anesthesiol. 2025 Aug 13;25(1):406. doi: 10.1186/s12871-025-03257-x.
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).
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.
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.
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.
Short study period, single centred study.
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.
The study was retrospectively registered in the “Clinical Trials Library for Protocol Registration and Results System” under NCT05053477 on September 11, 2021.
The online version contains supplementary material available at 10.1186/s12871-025-03257-x.
腕管综合征（CTS）是最常见的由腕管内正中神经受压引起的局灶性单神经病。超声引导下皮质类固醇溶液注射、富血小板血浆注射和正中神经脉冲射频都是缓解轻中度CTS症状的潜在治疗方法，它们的临床疗效对比尚待研究。主要结局指标是采用视觉模拟评分法（VAS）测量的疼痛。次要结局指标包括采用波士顿腕管问卷（BCTQ）评估的功能结局、神经传导速度（NCV）和正中神经横截面积（CSA）。
本前瞻性、双盲、随机对照研究纳入75例诊断为轻至中度CTS的患者，将他们随机分为三组，每组人数相等。对照组接受布比卡因联合甲泼尼龙的正中神经周围注射。PRF组在布比卡因基础上接受正中神经脉冲射频治疗。最后，PRP组接受富血小板血浆的周围注射。
在特定时间间隔进行测量：干预前、干预后1周、2个月和4个月时测量VAS、BCTQ和CSA。NCV仅在干预前和4个月后进行评估。
所有患者在干预后疼痛、症状、功能、正中神经CSA和NCV均有统计学意义的改善。PRF组和类固醇组的改善程度大于PRP组。与其他两组相比，PRP组的改善程度最小。
研究周期短，单中心研究。
本研究表明，超声引导下正中神经水分离联合局部麻醉剂/类固醇或PRP和PRF可有效缓解疼痛并改善功能结局。然而，研究发现与PRP注射相比，PRF和类固醇注射在改善短期功能结局方面更有效。
本研究于2021年9月11日在“临床试验注册与结果系统临床试验库”中进行回顾性注册，注册号为NCT05053477。
在线版本包含可在10.1186/s12871-025-03257-x获取的补充材料。
