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Month: March 2016

Platelet Rich Plasma (PRP) in the Treatment of a Frozen Shoulder

A recent case report published in the Archives of Bone and Joint Surgery has shown positive results for the use of Platelet Rich Plasma (PRP) in the treatment of a frozen shoulder. The case was a 45 year old man with adhesive capsulitis (frozen shoulder). He underwent PRP injections beginning after 7 months of symptoms. Following the first treatment, he reported a 60% improvement in pain during the day and had no pain at night. His range of motion reportedly improved significantly and a 70% improvement in function (based on the DASH – Disabilities of the Arm, Shoulder, and Hand questionnaire) was noted. The patient did receive a second PRP injection one month later.

This is the first reported use of PRP in the treatment of a frozen shoulder. A frozen shoulder or adhesive capsulitis refers to a condition in which the shoulder joint tightens up due to the capsule becoming inflamed resulting in decreased and painful range of motion.

Adhesive capsulitis usually be found in patients in the 40 to 70 year old range with a slightly higher percentage of women affected. Hormonal changes in women are believed to play a part in this.

The true underlying cause of adhesive capsulitis remains unknown. It is known that this condition can result from a traumatic event or surgery. Diabetics are five times more likely to develop this condition. This is especially true amongst insulin dependent diabetics. It is believed that the interaction of glucose molecules sticking to collagen fibers within the joint capsule may lead to or contribute to this condition.

Treatment of a frozen shoulder has traditionally focused around extended courses of physical therapy to preserve mobility of the shoulder. Anti-inflammatory medications (NSAIDs) and corticosteroids are also commonly used to reduce inflammation. Surgery is usually reserved as a last measure. A manipulation of the shoulder under anesthesia and/or a capsular release may be performed. Results have been shown to vary considerably.

Recovery is often slow, taking anywhere from a year or more.

Both prolotherapy and PRP treatments have been shown to provide positive results in the treatment of many soft tissue disorders. Several other published studies have shown the potential effectiveness of PRP in the management of rotator cuff disorders. While no solid conclusions can be drawn from this single case report, it does provide us with useful information and further investigational studies are needed to assess the efficacy of PRP in the treatment of a frozen shoulder.

References:

Aslani H, Nourbakhsh ST, Zafarani Z, et al. Archives of Bone and Joint Surgery. 2016. Jan; 4(1): 90-93.