Skip to main content

Advertisement

Log in

Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The goal of this study is to investigate whether platelet-rich plasma (PRP) injections are effective in the management of adhesive capsulitis of the shoulder (AC). A triple-blind, randomized controlled trial was designed and conducted in a medical school hospital.

Methods

32 adult patients with adhesive capsulitis (21 female, 11 male with a mean age of 57, ranging from 23 to 70) were included in this study. Patients had to have shoulder pain and restrictions in movements (at least 25% when compared to the other side, and at least in two directions) for three months minimum and nine months maximum. Patients were randomized to two groups, and one group took PRP injections for three times every two weeks, while the other group took saline injections in same frequency and volume. A standardized exercise program was also applied to all patients. Patients were evaluated with Shoulder Pain and Disability Index (SPADI), Visual Analogue Scales for pain and disability, ranges of movements, and use of analgesics in before, after, and third month after the initiation of the therapy.

Results

Baseline comparisons between groups showed no differences. SPADI and ranges of motion in all directions showed significant improvements with therapy, and the group which took PRP injections showed better improvements when compared to the control group (p < 0.05). Visual Analogue Scale was found to be better for the PRP group after therapy and third month, and not for the control group (0.4 ± 1.06 and 0.17 ± 0.72 vs. 2.5 ± 2.6 and 2 ± 2.2, respectively, p < 0.05). Use of analgesics was not found to be significant for both groups (p > 0.05).

Conclusion

PRP injections were found to be effective in both pain and disability, and showed improvements in a restricted shoulder due to adhesive capsulitis. These findings might point out PRP as a therapeutic option in the management of adhesive capsulitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, Godges JJ, McClure PW, Altman RD, Davenport T (2013) Shoulder pain and mobility deficits: adhesive capsulitis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 43(5):A1–A31

    Article  PubMed  Google Scholar 

  2. Ewald A (2011) Adhesive capsulitis: a review. Am Fam Physician 83(4):417–422

    PubMed  Google Scholar 

  3. Hagiwara Y, Ando A, Onoda Y, Takemura T, Minowa T, Hanagata N, Tsuchiya M, Watanabe T, Chimoto E, Suda H (2012) Coexistence of fibrotic and chondrogenic process in the capsule of idiopathic frozen shoulders. Osteoarthr Cartil 20(3):241–249

    Article  CAS  Google Scholar 

  4. Lho Y-M, Ha E, Cho C-H, Song K-S, Min B-W, Bae K-C, Lee K-J, Hwang I, Park H-B (2013) Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder. J Shoulder Elb Surg 22(5):666–672

    Article  Google Scholar 

  5. Kelley MJ, Mcclure PW, Leggin BG (2009) Frozen shoulder: evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther 39(2):135–148

    Article  PubMed  Google Scholar 

  6. Park KD, Nam H-S, Lee JK, Kim YJ, Park Y (2013) Treatment effects of ultrasound-guided capsular distension with hyaluronic acid in adhesive capsulitis of the shoulder. Arch Phys Med Rehabil 94(2):264–270

    Article  PubMed  Google Scholar 

  7. D-w R, Park G-Y, Kim Y-K, Kim MT, Lee SC (2013) Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil 27(2):113–122

    Article  Google Scholar 

  8. Spaková T, Rosocha J, Lacko M, Harvanová D, Gharaibeh A (2012) Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil 91(5):411–417

    Article  PubMed  Google Scholar 

  9. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T (2013) Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline a randomized, double-blind, placebo-controlled trial. Am J Sports Med 41(3):625–635

    Article  PubMed  Google Scholar 

  10. Nguyen RT, Borg-Stein J, McInnis K (2011) Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach. PM&R 3(3):226–250

    Article  Google Scholar 

  11. Zhang J, Middleton KK, Fu FH, Im H-J, Wang JH (2013) HGF mediates the anti-inflammatory effects of PRP on injured tendons. PLoS One 8(6):e67303

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Spreafico A, Chellini F, Frediani B, Bernardini G, Niccolini S, Serchi T, Collodel G, Paffetti A, Fossombroni V, Galeazzi M (2009) Biochemical investigation of the effects of human platelet releasates on human articular chondrocytes. J Cell Biochem 108(5):1153–1165

    Article  CAS  PubMed  Google Scholar 

  13. Aslani H, Nourbakhsh ST, Zafarani Z, Ahmadi-Bani M, Ananloo MES, Beigy M, Salehi S (2016) Platelet-rich plasma for frozen shoulder: a case report. Archives of Bone and Joint Surgery 4(1):90

    PubMed  PubMed Central  Google Scholar 

  14. Dogru H, Basaran S, Sarpel T (2008) Effectiveness of therapeutic ultrasound in adhesive capsulitis. Joint Bone Spine 75(4):445–450

    Article  PubMed  Google Scholar 

  15. Johansson K, Bergström A, Schröder K, Foldevi M (2011) Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care—a randomized clinical trial. Fam Pract 28(4):355–365

    Article  PubMed  Google Scholar 

  16. Williams JJ, Holleman JD, Simel D (1995) Measuring shoulder function with the shoulder pain and disability index. J Rheumatol 22(4):727–732

    PubMed  Google Scholar 

  17. BÜYÜKAKINCAK Ö, AKYOL Y, ÖZEN N, ULUS Y, CANTÜRK F, TANDER B, BÜYÜKAKINCAK S, BİLGİCİ A, KURU Ö (2014) Meme Kanseri Olan Hastalarda Cerrahi Sonrası Erken Dönemde Yaşam Kalitesi: Omuz Ağrısı, El Kavrama Gücü, Dizabilite ve Emosyonel Durum ile İlişkisi. Turkish Journal of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 60 (1)

  18. Ma S-Y, Je HD, Jeong JH, Kim H-Y, Kim H-D (2013) Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder. Arch Phys Med Rehabil 94(1):9–16

    Article  PubMed  Google Scholar 

  19. Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V (2012) Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial. Arch Phys Med Rehabil 93(6):957–964

    Article  PubMed  Google Scholar 

  20. Koh PS, Seo BK, Cho NS, Park HS, Park DS, Baek YH (2013) Clinical effectiveness of bee venom acupuncture and physiotherapy in the treatment of adhesive capsulitis: a randomized controlled trial. J Shoulder Elb Surg 22(8):1053–1062

    Article  Google Scholar 

  21. Manske RC, Prohaska D (2008) Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 1(3–4):180–189

    Article  PubMed  PubMed Central  Google Scholar 

  22. Harris JD, Griesser MJ, Copelan A, Jones GL (2011) Treatment of adhesive capsulitis with intra-articular hyaluronate: a systematic review. Int J Shoulder Surg 5(2):31

    Article  PubMed  PubMed Central  Google Scholar 

  23. Song A, Higgins LD, Newman J, Jain NB (2014) Glenohumeral corticosteroid injections in adhesive capsulitis: a systematic search and review. PM&R 6(12):1143–1156

    Article  Google Scholar 

  24. Barman A, Mukherjee S, Sahoo J, Maity R, Rao PB, Sinha MK, Sahoo D, Tripathy S, Patro BK, Bag ND (2019) 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

  25. Jain TK, Sharma NK (2014) The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. J Back Musculoskelet Rehabil 27(3):247–273

    Article  PubMed  Google Scholar 

  26. Yoon S-H, Lee HY, Lee HJ, Kwack K-S (2013) Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial. Am J Sports Med 41(5):1133–1139

    Article  PubMed  Google Scholar 

  27. Liu Y, Kalén A, Risto O, Wahlström O (2002) Fibroblast proliferation due to exposure to a platelet concentrate in vitro is pH dependent. Wound Repair Regen 10(5):336–340

    Article  PubMed  Google Scholar 

  28. Marx RE (2001) Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 10(4):225–228

    Article  CAS  PubMed  Google Scholar 

  29. Soh E, Li W, Ong KO, Chen W, Bautista D (2011) Image-guided versus blind corticosteroid injections in adults with shoulder pain: a systematic review. BMC Musculoskelet Disord 12(1):137

    Article  PubMed  PubMed Central  Google Scholar 

  30. Raeissadat SA, Rayegani SM, Langroudi TF, Khoiniha M (2017) Comparing the accuracy and efficacy of ultrasound-guided versus blind injections of steroid in the glenohumeral joint in patients with shoulder adhesive capsulitis. Clin Rheumatol 36(4):933–940

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Burcu Ünlü or Göksel Tanıgör.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ünlü, B., Çalış, F.A., Karapolat, H. et al. Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder. International Orthopaedics (SICOT) 45, 181–190 (2021). https://doi.org/10.1007/s00264-020-04518-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04518-9

Keywords

Navigation