What is Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a painful condition characterized by stiffness and restricted movement in the shoulder joint. This condition often develops gradually, causing significant discomfort and limiting daily activities. While physical therapy and corticosteroid injections are common treatments, recent research suggests that Platelet-Rich Plasma (PRP) therapy offers a highly effective, natural solution for treating frozen shoulder by accelerating the body’s healing processes.

How PRP Therapy Works

PRP therapy involves injecting a concentration of a patient’s own platelets into the shoulder joint. These platelets contain growth factors that help reduce inflammation and promote tissue repair. PRP is gaining popularity as a regenerative treatment that can speed recovery and restore mobility, in a wide array of musculoskeletal and pain complaints.

The Progression of Frozen Shoulder

Adhesive capsulitis progresses through three main stages, each lasting several months or even years:

1. Freezing Stage:
   In this initial phase, shoulder pain increases gradually, and stiffness sets in, often lasting 6 to 9 months. Activities like lifting, reaching, and even sleeping become increasingly painful.

2. Frozen Stage:
   During this stage, which can last 4 to 12 months, the pain may start to subside, but shoulder stiffness remains. Range of motion is severely limited, making even basic movements difficult.

3. Thawing Stage:
   The final stage may take anywhere from 6 months to 2 years. During this phase, the shoulder’s range of motion slowly improves, and stiffness gradually decreases. However, full recovery without treatment can take a long time, which is why treatments like PRP can help expedite the healing process.

Clinical Evidence Supporting PRP for Frozen Shoulder

Several studies have demonstrated the efficacy of PRP therapy in reducing pain, improving function, and restoring shoulder mobility in patients with frozen shoulder.

• Zhang et al. conducted a 2024 systematic review and meta-analysis of 14 randomized controlled trials (RCTs) involving 1,024 patients. The study found that PRP therapy significantly improved pain scores, shoulder function, and range of motion compared to control groups, including corticosteroid and saline injections. Key outcome measures included the Visual Analog Scale (VAS) for pain, the UCLA Shoulder Scale, and the Shoulder Pain and Disability Index (SPADI). PRP was shown to provide superior pain relief and functional improvements, with fewer side effects than corticosteroids.

• Nudelman et al. reviewed prospective cohort studies and concluded that PRP injections for adhesive capsulitis were at least equivalent to, if not better than, corticosteroid or saline solution injections. They found that PRP led to improved pain, motion, and functional outcomes at 3- to 6-month follow-ups, providing a viable alternative to more traditional treatments.

• In a triple-blind RCT, Ünlü et al. showed that PRP injections significantly improved pain, disability, and range of motion in patients with frozen shoulder, outperforming saline injections. Their study emphasized the superior efficacy of PRP in both reducing pain and improving function.

• Lin et al. also conducted a systematic review and meta-analysis, highlighting the benefits of PRP therapy. They found that PRP significantly improved passive abduction, flexion, external rotation, pain, and disability at 3 and 6 months post-intervention, with no reported adverse effects. This positions PRP as a safe and effective treatment option for frozen shoulder.

Why PRP May Be Safer than Corticosteroids

While corticosteroids have traditionally been used to reduce inflammation in frozen shoulder, they carry risks like osteonecrosis, cartilage injury and may lose effectiveness over time. PRP, on the other hand, promotes natural tissue healing without the risks associated with steroids. As the 2024 Zhang et al. study concluded, PRP provides more durable pain relief and improves shoulder function over a longer period, making it a safer and more effective option for many patients.

Conclusion

For those dealing with the debilitating effects of frozen shoulder, PRP therapy offers a natural and effective solution to reduce pain, restore mobility, and speed recovery. Backed by multiple high-quality studies, PRP has been shown to provide significant improvements in shoulder function and pain relief, especially in the short to mid-term. It is also a safer alternative to corticosteroid injections, making it a valuable treatment option for patients seeking to regain shoulder mobility and avoid prolonged recovery periods. While more long-term studies are needed to establish definitive guidelines, current research strongly supports the use of PRP in treating frozen shoulder.

References

1. Zhang et al., 2024. "The clinical efficacy and safety of platelet-rich plasma on frozen shoulder: a systematic review and meta-analysis of randomized controlled trials."

2. Nudelman et al. "Platelet-Rich Plasma Injections for Shoulder Adhesive Capsulitis Are at Least Equivalent to Corticosteroid or Saline Solution Injections: A Systematic Review of Prospective Cohort Studies“. Systematic review of PRP injections for adhesive capsulitis.

3. Ünlü et al. "Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder”. Triple-blind RCT showing PRP efficacy for frozen shoulder.

4. Lin et al. "Efficacy of Platelet-Rich Plasma Injection on Range of Motion, Pain, and Disability in Patients With Adhesive Capsulitis: A Systematic Review and Meta-analysis“. Meta-analysis of PRP for pain and motion improvement in frozen shoulder.