What is adhesive capsulitis or a frozen shoulder?

Adhesive capsulitis or frozen shoulder is common and can limit shoulder motion. Contractures or scar tissue forms around the joint capsule. The cause is still unknown. However, frozen shoulder is often associated with shoulder surgery, trauma or metabolic disease such as diabetes. Learn more about frozen shoulder here.

How is adhesive capsulitis treated?

Current treatment options include physical therapy, medications, steroid injections and surgical release. Among these steroid injections are the most common treatment in clinical practice, although the effect is not long lasting and has been associated with adverse events to the tendon and bone.

In many cases, adhesive capsulitis resolves on its own. In other people conservative treatments don’t work and patients consider surgery (manipulation under anesthesia or shoulder arthroscopic surgery).

Why does PRP work in adhesive capsulitis?

PRP is a natural reservoir of cytokines and growth factors, and has been shown to inhibit the release of proinflammatory molecules in joints.

Other larger randomized controlled studies have found similar results.

• In a study by Dr. Junhong Lin in 2018, 60 patients with adhesive capsulitis or a frozen shoulder were divided into two groups. One group was treated with a platelet rich plasma (PRP) injection. The control group was injected with numbing medication (procaine). Patients were followed up to 6-months after the injection and the patients that received PRP had improved pain and function when compared to procaine.
• In a 2019 cohort study, Dr. Barman et al. compared patients who received a PRP injection to patients that received a steroid injection. Twenty-eight patients were included and at 3-months PRP was more effective than steroids in improving pain and shoulder range of motion.
• In a randomized controlled study by Dr. Thu et al. in 2020 64 patients were divide into PRP and physical therapy group. The study only included short term 6-week follow up. At the 6-week follow-up both groups had improved range of motion, but the PRP group also required less pain medication.
• In a study by Dr. Ünlü et al in 2021, 32 patients were included and randomized into 2 groups. On group received a series of PRP Injections and the other group was injected with saline. Both grops had a standardized exercise program. At 3 months the PRP group had showed decreased pain while the control group showed no change in symptoms.

Do you need surgery for adhesive capsulitis?

If you have not responded to traditional treatments for adhesive capsulitis PRP maybe an option. If you are considering surgery, schedule a consultation to discuss alternatives to surgery:

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References:

1. Barman A, Mukherjee S, Sahoo J, Maiti R, Rao PB, Sinha MK, Sahoo D, Tripathy SK, Patro BK, Bag ND. Single Intra-articular Platelet-Rich Plasma Versus Corticosteroid Injections in the Treatment of Adhesive Capsulitis of the Shoulder: A Cohort Study. Am J Phys Med Rehabil. 2019 Jul;98(7):549-557.
2. Lee MJ, Yoon KS, Oh S, Shin S, Jo CH. Allogenic Pure Platelet-Rich Plasma Therapy for Adhesive Capsulitis: A Bed-to-Bench Study With Propensity Score Matching Using a Corticosteroid Control Group. Am J Sports Med. 2021 Jun 24:3635465211018636.
3. Lin J. Platelet-rich plasma injection in the treatment of frozen shoulder: A randomized controlled trial with 6-month follow-up
. Int J Clin Pharmacol Ther. 2018 Aug;56(8):366-371.
4. Thu AC, Kwak SG, Shein WN, Htun M, Htwe TTH, Chang MC. Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial. J Int Med Res. 2020 Dec;48(12):300060520976032.
5. Ünlü B, Çalış FA, Karapolat H, Üzdü A, Tanıgör G, Kirazlı Y. Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder. Int Orthop. 2021 Jan;45(1):181-190.