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Electromyographic and Clinical Investigation of the Effect of Platelet-Rich Plasma on Peripheral Nerve Regeneration in Patients with Diabetes after Surgery for Carpal Tunnel Syndrome

  • Yasak, Tugce (Department of Plastic Reconstructive and Aesthetic Surgery, Prof. Dr. Cemil Tascioglu City Hospital) ;
  • Ozkaya, Ozay (Prof Dr. Ozay Ozkaya Private Clinic) ;
  • Sahin, Ayca Ergan (Department of Plastic Reconstructive and Aesthetic Surgery, Prof. Dr. Cemil Tascioglu City Hospital) ;
  • Colak, Ozlem (Department of Plastic Reconstructive and Aesthetic Surgery, Prof. Dr. Cemil Tascioglu City Hospital)
  • Published : 2022.03.15

Abstract

Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Studies have shown that results of CTS surgery are poorer in patients with diabetes. In this study, the effect of platelet-rich plasma (PRP) on nerve regeneration was investigated through clinical and electromyographic findings in patients with diabetes who underwent CTS surgery. Methods A retrospective analysis of 20 patients with diabetes who had surgically decompressed CTS was conducted. Patients were divided into two groups. The study group received PRP treatment following surgery. The control group did not receive any treatment. Patients were assessed using electromyography and the Boston Carpal Tunnel Syndrome Questionnaire preoperatively as well as postoperatively at 3-month, 6-month, and 1-year follow-ups visits. Results There was a decrease in complaints and an improvement in sensory and motor examinations in both groups. The Boston Carpal Tunnel Syndrome Questionnaire scores did not show any statistically significant differences between the two groups. However, electromyographic findings showed that there were statistical differences between preoperative and postoperative (3 months, 6 months, and 1 year) results in both groups. When the two groups were compared using preoperative and postoperative (3 months, 6 months, and 1 year) electromyographic values, no statistically significant differences were seen. Conclusion Single injections of PRP did not have a significant impact on median nerve regeneration following CTS surgery in patients with diabetes. The effectiveness of multiple PRP injections can be investigated in patients with diabetes in future studies.

Keywords

References

  1. Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014;49(05):429-436 https://doi.org/10.1016/j.rbo.2013.08.007
  2. Tekin F, Surmeli M, Simsek H, et al. Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome. Int Orthop 2015;39(12):2395-2401 https://doi.org/10.1007/s00264-015-2790-y
  3. Singh R, Gamble G, Cundy T. Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes. Diabet Med 2005;22(05):625-630 https://doi.org/10.1111/j.1464-5491.2005.01487.x
  4. de Krom MC, de Krom CJ, Spaans F. Carpal tunnel syndrome: diagnosis, treatment, prevention and its relevance to dentistry [in Dutch]. Ned Tijdschr Tandheelkd 2009;116(02):97-101
  5. Lundborg G. Nerve Injury and Repair: Regeneration, Reconstruction, and Cortical Remodeling. London, England: Elsevier/Churchill Livingstone; 2004
  6. Taspinar S, Sahin F, Ercalik C, et al. Comparison of the efficacy of corticosteroid injection, night splint and physiotherapy in diabetic carpal tunnel syndrome. Turk J Phys Med Rehabil 2007;53(02):54-60
  7. Ozkul Y, Sabuncu T, Kocabey Y, Nazligul Y. Outcomes of carpal tunnel release in diabetic and non-diabetic patients. Acta Neurol Scand 2002;106(03):168-172 https://doi.org/10.1034/j.1600-0404.2002.01320.x
  8. Ebrahimzadeh MH, Mashhadinejad H, Moradi A, Kachooei AR. Carpal tunnel release in diabetic and non-diabetic patients. Arch Bone Jt Surg 2013;1(01):23-27
  9. Albers JW, Brown MB, Sima AA, Greene DATolrestat Study Group For Edit (Early Diabetes Intervention Trial) Frequency of median mononeuropathy in patients with mild diabetic neuropathy in the early diabetes intervention trial (EDIT). Muscle Nerve 1996;19(02):140-146 https://doi.org/10.1002/(SICI)1097-4598(199602)19:2<140::AID-MUS3>3.0.CO;2-E
  10. Weiss A-PC, Sachar K, Gendreau M. Conservative management of carpal tunnel syndrome: a reexamination of steroid injection and splinting. J Hand Surg Am 1994;19(03):410-415 https://doi.org/10.1016/0363-5023(94)90054-X
  11. Mondelli M, Padua L, Reale F, Signorini AM, Romano C. Outcome of surgical release among diabetics with carpal tunnel syndrome. Arch Phys Med Rehabil 2004;85(01):7-13
  12. Thomsen NOB, Rosen I, Dahlin LB. Neurophysiologic recovery after carpal tunnel release in diabetic patients. Clin Neurophysiol 2010;121(09):1569-1573 https://doi.org/10.1016/j.clinph.2010.03.014
  13. Ozer K, Malay S, Toker S, Chung KC. Minimal clinically important difference of carpal tunnel release in diabetic and nondiabetic patients. Plast Reconstr Surg 2013;131(06):1279-1285 https://doi.org/10.1097/PRS.0b013e31828bd6ec
  14. Wroblewski AP, Mejia HA, Wright VJ. Application of platelet-rich plasma to enhance tissue repair. Oper Tech Orthop 2010;20(02):98-105 https://doi.org/10.1053/j.oto.2009.10.006
  15. Zheng C, Zhu Q, Liu X, et al. Effect of platelet-rich plasma (PRP) concentration on proliferation, neurotrophic function and migration of Schwann cells in vitro. J Tissue Eng Regen Med 2016;10(05):428-436 https://doi.org/10.1002/term.1756
  16. Lichtenfels M, Colome L, Sebben AD, Braga-Silva J. Effect of platelet rich plasma and platelet rich fibrin on sciatic nerve regeneration in a rat model. Microsurgery 2013;33(05):383-390 https://doi.org/10.1002/micr.22105
  17. Li H, Han Z, Liu D, Zhao P, Liang S, Xu K. Autologous platelet-rich plasma promotes neurogenic differentiation of human adipose-derived stem cells in vitro. Int J Neurosci 2013;123(03):184-190 https://doi.org/10.3109/00207454.2012.742077
  18. Thomsen NO, Cederlund R, Rosen I, Bjork J, Dahlin LB. Clinical outcomes of surgical release among diabetic patients with carpal tunnel syndrome: prospective follow-up with matched controls. J Hand Surg Am 2009;34(07):1177-1187 https://doi.org/10.1016/j.jhsa.2009.04.006
  19. Mojaddidi MA, Ahmed MS, Ali R, et al. Molecular and pathological studies in the posterior interosseous nerve of diabetic and nondiabetic patients with carpal tunnel syndrome. Diabetologia 2014;57(08):1711-1719 https://doi.org/10.1007/s00125-014-3271-3
  20. Ma J, Liu J, Yu H, Wang Q, Chen Y, Xiang L. Curcumin promotes nerve regeneration and functional recovery in rat model of nerve crush injury. Neurosci Lett 2013;547:26-31 https://doi.org/10.1016/j.neulet.2013.04.054
  21. Yasui G, Yamamoto Y, Shichinohe R, et al. Neuregulin-1 released by biodegradable gelatin hydrogels can accelerate facial nerve regeneration and functional recovery of traumatic facial nerve palsy. J Plast Reconstr Aesthet Surg 2016;69(03):328-334 https://doi.org/10.1016/j.bjps.2015.10.037
  22. Kucuk L, Gunay H, Erbas O, Kucuk u, Atamaz F, Coskunol E. Effects of platelet-rich plasma on nerve regeneration in a rat model. Acta Orthop Traumatol Turc 2014;48(04):449-454 https://doi.org/10.3944/AOTT.2014.13.0029
  23. Yu W, Wang J, Yin J. Platelet-rich plasma: a promising product for treatment of peripheral nerve regeneration after nerve injury. Int J Neurosci 2011;121(04):176-180 https://doi.org/10.3109/00207454.2010.544432
  24. Giannessi E, Coli A, Stornelli MR, et al. An autologously generated platelet-rich plasma suturable membrane may enhance peripheral nerve regeneration after neurorraphy in an acute injury model of sciatic nerve neurotmesis. J Reconstr Microsurg 2014; 30(09):617-626 https://doi.org/10.1055/s-0034-1372483
  25. Cho HH, Jang S, Lee SC, et al. Effect of neural-induced mesenchymal stem cells and platelet-rich plasma on facial nerve regeneration in an acute nerve injury model. Laryngoscope 2010;120(05):907-913 https://doi.org/10.1002/lary.20860
  26. Narai H, Nagano I, Ilieva H, et al. Prevention of spinal motor neuron death by insulin-like growth factor-1 associating with the signal transduction systems in SODG93A transgenic mice. J Neurosci Res 2005;82(04):452-457 https://doi.org/10.1002/jnr.20668
  27. Park GY, Kwon DR. Platelet-rich plasma limits the nerve injury caused by 10% dextrose in the rabbit median nerve. Muscle Nerve 2014;49(01):56-60 https://doi.org/10.1002/mus.23863
  28. Zayni R, Thaunat M, Fayard JM, et al. Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections. Muscles Ligaments Tendons J 2015;5(02):92-98
  29. Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc 2017;25(03):958-965 https://doi.org/10.1007/s00167-015-3705-6
  30. Malahias MA, Johnson EO, Babis GC, Nikolaou VS. Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome. Neural Regen Res 2015;10(11):1856-1859 https://doi.org/10.4103/1673-5374.165322
  31. Malahias MA, Nikolaou VS, Johnson EO, Kaseta MK, Kazas ST, Babis GC. Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: a placebo-controlled clinical study. J Tissue Eng Regen Med 2018;12(03):e1480-e1488
  32. Uzun H, Bitik O, Uzun O, Ersoy US, Aktas E Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg 2017;51(05):301-305 https://doi.org/10.1080/2000656X.2016.1260025
  33. Raeissadat SA, Karimzadeh A, Hashemi M, Bagherzadeh L. Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial. BMC Musculoskelet Disord 2018;19(01):49 https://doi.org/10.1186/s12891-018-1963-4
  34. Trull-Ahuir C, Sala D, Chismol-Abad J, Vila-Caballer M, Lison JF. Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial. Sci Rep 2020;10(01):2085 https://doi.org/10.1038/s41598-020-59113-0