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Dec 19, 2023

Journal Watch: What is the Evidence for PRP for Treating Frozen Shoulder?

Adhesive capsulitis, or a frozen shoulder, has been reported to affect 2 to 5.3% of patients (Kelley et al.). Patients with adhesive capsulitis can experience pain and stiffness from diffuse inflammation and progressive fibrosis of the joint capsule (Millar et al.; Mertens et al.). Physical therapy, corticosteroid injections, hydrodilatation and surgery have been used to treat frozen shoulders (Challoumas et al.; de Sire et al.; Zhang et al.; Mertens et al.).

Patients are often only offered corticosteroid injections for adhesive capsulitis, but steroid injections often only provide short-term pain relief (Koh; Buchbinder et al.). Recent studies have indicated that excessive corticosteroid injections can cause hyperglycemia, atrophy of subcutaneous tissue and detrimental effects on cartilage (Mohamadi et al; Waterbrook et al.). Therefore, platelet rich plasma or PRP has attracted increased attention as an alternative to corticosteroid injections. PRP is obtained from a patient’s own blood, and the platelets are concentrated and reinjected into the affected body part (Descalzi et al.; Yin et al.). PRP contains a variety of growth factors that are helpful in the healing process (Kaux et al.; Yerlikaya et al.).

In a recent systematic review, Lin et al. performed a systematic review and meta-analysis of articles comparing the effect of PRP and corticosteroid injections in patients with adhesive capsulitis. In this study, the authors reviewed 14 studies that met inclusion criteria.

The authors found that there was not a significant difference between PRP and non-PRP treatments 1-month after the procedure, the PRP group did show a significant improvement in range of motion, pain and disability at 3-months when compared with other non-PRP treatments. At the 6-month follow up PRP also demonstrated superiority when compared to other non-PRP treatments.

The authors conclude that PRP injections are effective for adhesive capsulitis and recommended PRP injections as a treatment option for patients with adhesive capsulitis (Lin et al.).

Reference

Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;2003(1):CD004016.

de Sire A, Agostini F, Bernetti A, Mangone M, Ruggiero M, Dinatale S, Chiappetta A, Paoloni M, Ammendolia A, Paolucci T. Non-Surgical and Rehabilitative Interventions in Patients with Frozen Shoulder: Umbrella Review of Systematic Reviews. J Pain Res. 2022 Aug 19;15:2449-2464.

Descalzi F, Ulivi V, Cancedda R, Piscitelli F, Luongo L, Guida F, Gatta L, Maione S, Di Marzo V. Platelet-rich plasma exerts antinociceptive activity by a peripheral endocannabinoid-related mechanism. Tissue Eng Part A. 2013 Oct;19(19-20):2120-9.

Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw
Open. 2020 Dec 1;3(12):e2029581.

Kaux JF, Drion P, Croisier JL, Crielaard JM. Tendinopathies and
platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use. J Stem Cells Regen Med. 2015 May 30;11(1):7-17.

Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, Godges JJ, McClure PW. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013 May;43(5):A1-31.

Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Med J. 2016 Dec;57(12):646-657.

Lin HW, Tam KW, Liou TH, Rau CL, Huang SW, Hsu TH. Efficacy of Platelet-Rich Plasma Injection on Range of Motion, Pain, and Disability in Patients With Adhesive Capsulitis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2023 Dec;104(12):2109-2122.

Mertens MG, Meert L, Struyf F, Schwank A, Meeus M. Exercise Therapy Is Effective for Improvement in Range of Motion, Function, and Pain in Patients With Frozen Shoulder: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022 May;103(5):998-1012.e14.

Mertens MG, Meeus M, Verborgt O, Vermeulen EHM, Schuitemaker R, Hekman KMC, van der Burg DH, Struyf F. An overview of effective and potential new conservative interventions in patients with frozen shoulder.
Rheumatol Int. 2022 Jun;42(6):925-936.

Millar NL, Meakins A, Struyf F, Willmore E, Campbell AL, Kirwan PD, Akbar M, Moore L, Ronquillo JC, Murrell GAC, Rodeo SA. Frozen shoulder. Nat Rev Dis Primers. 2022 Sep 8;8(1):59.

Mohamadi A, Chan JJ, Claessen FM, Ring D, Chen NC. Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis. Clin Orthop Relat Res. 2017 Jan;475(1):232-243.

Waterbrook AL, Balcik BJ, Goshinska AJ. Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review. Sports Health. 2017 Jul/Aug;9(4):372-374.

Yerlikaya M, Talay Çaliş H, Tomruk Sütbeyaz S, Sayan H, Ibiş N, Koç A, Karakükçü Ç. Comparison of Effects of Leukocyte-Rich and Leukocyte Poor Platelet-Rich Plasma on Pain and Functionality in Patients With Lateral Epicondylitis. Arch Rheumatol. 2017 Oct 16;33(1):73-79.

Yin W, Xu H, Sheng J, Xu Z, Xie X, Zhang C. Comparative evaluation of the effects of platelet‑rich plasma formulations on extracellular matrix formation and the NF‑κB signaling pathway in human articular chondrocytes. Mol Med Rep. 2017 May;15(5):2940-2948.

Zhang J, Zhong S, Tan T, Li J, Liu S, Cheng R, Tian L, Zhang L, Wang Y, Liu F, Zhou P, Ye X. Comparative Efficacy and Patient-Specific Moderating Factors of Nonsurgical Treatment Strategies for Frozen Shoulder: An Updated Systematic Review and Network Meta-analysis. Am J Sports Med. 2021 May;49(6):1669-1679.

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