Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial

Objective We evaluated the effect of ultrasound (US)-guided injection of platelet-rich plasma (PRP) into the shoulder joint in patients with adhesive capsulitis (AC) and compared its effect with that of conventional physiotherapy (CPT). Methods Sixty-four subjects with AC were included and randomly allocated into two groups, as follows: PRP (n=32; intra-articular [IA] PRP [4 mL] was injected); and CPT (n=32; short wave diathermy and exercise therapy were performed at three sessions/week for 6 weeks). Treatment outcomes evaluated therapeutic effectiveness before and at 1, 3, and 6 weeks after PRP injection and CPT initiation. Results Subjects in both groups showed a significant decrease in the visual analogue scale score for pain and shoulder and hand scores, and they a significant increase in shoulder passive range of motion at all evaluation time points. There was no significant difference in the measured outcomes between the two groups. However, there was less acetaminophen consumption after IA PRP injection compared with that after CPT. Conclusions IA PRP injection is a useful option for treating patients with AC, particularly those who have low therapeutic compliance for exercise therapy or have contraindications for corticosteroid injection or oral pain reduction medication.

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A comparative study of functional outcome between platelet rich plasma injection versus steroid infiltration in plantar fasciitis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200744 ◽

2020 ◽

Vol 6 (2) ◽

pp. 393

Author(s):

Harpreet Singh ◽

Malay P. Gandhi ◽

Aliasgar J. Rampurwala ◽

Tej S. Rudani

Keyword(s):

Comparative Study ◽

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Injection Group ◽

Plasma Injection ◽

Significant Difference ◽

The Difference ◽

The Individual

Background: Plantar fasciitis (PF) is considered as degenerative tendinopathies. Repeated micro trauma is the major etiology of these diseases. Autologous platelet rich plasma (PRP) injections are becoming more popular in the treatment of enthesopathies like PF. The growth factors in PRP cause tissue healing. We compared the result of injecting intra-lesional autologous PRP injections versus steroid infiltration in chronic PF.Methods: A prospective, interventional and analytic comparative study was done and 81 patients (120 heels) were included in this study and were followed up for 6 months. We assessed the outcome of each patient using visual analog score (VAS) and foot and ankle disability index (FADI) on follow-up at 1, 3, and 6 months. Results: In our study, female preponderance was seen. Left side was more common as compared to right side. Unilateral PF is more common than bilateral. The difference with in the individual group at baseline and at 1,3 and 6 months was statistically highly significant in terms of VAS and FADI (p=0.0001) But the difference in the between the two groups was insignificant for VAS and FADI at 1, 3 and 6 months.Conclusions: In our study, as there is no significant difference in VAS and FADI score between corticosteroid injection group and PRP injection group at 1, 3 and 6 months follow up. So, it’s reasonable to conclude that both are equally effective in PF. But as PRP injection comes out to be more time consuming and more costly, corticosteroid seems to be more efficient, cost and time wise. Hence, the latter should be a better choice.

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Effects of platelet-rich plasma injection on pain, range of motion, and disability in adhesive capsulitis: A prospective, randomized-controlled study

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2021.6690 ◽

2021 ◽

Vol 67 (4) ◽

pp. 462-472

Author(s):

Çağlar Karabaş ◽

Havva Talay Çalış ◽

Ulaş Serkan Topaloğlu ◽

Çiğdem Karakükçü

Keyword(s):

Range Of Motion ◽

External Rotation ◽

Platelet Rich Plasma ◽

Adhesive Capsulitis ◽

Controlled Study ◽

Control Group ◽

Plasma Injection ◽

Active Flexion ◽

Home Based ◽

Significant Difference

Objectives: In this study, we aimed to investigate the effectiveness of intra-articular platelet-rich plasma (PRP) injection in adhesive capsulitis. Patients and methods: Between January 2019 and December 2019, a total of 40 patients (21 males, 19 females; mean age: 57.1±6.5 years; range, 44 to 72 years) with idiopathic adhesive capsulitis were included. The patients were randomly assigned into two equal groups as the PRP and the control group. The PRP group received two doses of PRP via intra-articular route biweekly under ultrasound guidance. No injection was performed to the control group. In both groups, stretching and Codman exercises were applied as a home- based program. The Visual Analog Scale (VAS), range of motion (ROM), and Shoulder Pain and Disability Index (SPADI) scores were evaluated before the treatment and at 2, 6 and 12 weeks after the treatment. Results: There were significant differences in all VAS, SPADI, and ROM scores at all time points after treatment compared to baseline in both groups. At the end of the study, there were significant differences in the active flexion, passive flexion, active abduction, passive abduction, and active external rotation scores at 12 weeks between the groups (p=0.012, p=0.015, p=0.008, p=0.019, and p=0.040, respectively). No significant difference was observed between the groups in terms of VAS and SPADI scores and the other parameters (active and passive extension, active and passive internal rotation, passive external rotation) at 2, 6, and 12 weeks (p>0.05). Conclusion: The addition of PRP to exercise treatment can improve patients' joint mobility, but not pain and disability in patients with adhesive capsulitis.

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Comparison between platelet rich plasma injection, corticosteroid injection and short-wave diathermy in the management of pain and the improvement of functional outcome in the patients suffering from adhesive capsulitis of the shoulder: a randomized controlled trial

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20204069 ◽

2020 ◽

Vol 7 (10) ◽

pp. 1546

Author(s):

Debasish Deb ◽

Yumnam Singh Nandabir ◽

Naorem Bimol Singh ◽

Rakesh Das ◽

Shanavas Anoth Meethal

Keyword(s):

Randomized Controlled Trial ◽

Range Of Motion ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Controlled Trial ◽

Adhesive Capsulitis ◽

Short Wave ◽

Treatment Modalities ◽

Secondary Outcome ◽

Randomized Controlled

Background: Adhesive capsulitis of shoulder is characterized by pain and restricted range of motion and has a wide variety of treatment options without any substantial evidence. Platelet rich plasma (PRP) is one of the newer treatment modalities and its efficacy needs to be compared with other routine treatment modalities.Method: A randomized controlled trial was conducted in the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences (RIMS), Imphal for a period of 1-year February 2019 to January 2020. One hundred ninety-five patients with adhesive capsulitis recruited and randomized, patients received single PRP injection (2 ml) or corticosteroid (80 mg methyl prednisolone) or shortwave diathermy (10 settings continuous mode using 27.12 MHz).Results: The primary outcome measure was active range of motion of the shoulder and the secondary outcome measures included Visual analogue scale (VAS) for pain and a shortened version of Disabilities of the Arm, Shoulder and Hand (Quick DASH) for function. Patients were evaluated at 0, 3, 6 and 12 weeks. Chi-square test and ANOVA were used to determine significant differences. PRP treatment resulted in statistically significant improvement over corticosteroid at 12 weeks and over short-wave diathermy therapy at 6 weeks.Conclusion: This study demonstrates that single injection of PRP is more effective than corticosteroid or short-wave diathermy in the treatment of adhesive capsulitis of shoulder.

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Allogenic Pure Platelet-Rich Plasma Therapy for Adhesive Capsulitis: A Bed-to-Bench Study With Propensity Score Matching Using a Corticosteroid Control Group

The American Journal of Sports Medicine ◽

10.1177/03635465211018636 ◽

2021 ◽

pp. 036354652110186

Author(s):

Min Ji Lee ◽

Kang Sup Yoon ◽

Sohee Oh ◽

Sue Shin ◽

Chris Hyunchul Jo

Keyword(s):

Muscle Strength ◽

Propensity Score ◽

Inflammatory Cytokines ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Adhesive Capsulitis ◽

Shoulder Function ◽

Control Group ◽

Inflammatory Condition

Background: While platelet-rich plasma (PRP) has been widely studied for musculoskeletal disorders, few studies to date have reported its use for adhesive capsulitis (AC). Fully characterized and standardized allogenic PRP may provide clues to solve the underlying mechanism of PRP with respect to synovial inflammation and thus may clarify its clinical indications. Purpose: To clinically evaluate the safety and efficacy of a fully characterized pure PRP injection in patients with AC and to assess the effects of pure PRP on synoviocytes with or without inflammation in vitro. Study Design: Controlled laboratory study and cohort study; Level of evidence, 3. Methods: For the clinical analysis, a total of 15 patients with AC received an ultrasonography-guided intra-articular PRP injection and were observed for 6 months. Pain, range of motion (ROM), muscle strength, shoulder function, and overall satisfaction in the patients were evaluated using questionnaires at 1 week as well as at 1, 3, and 6 months after the PRP injection and results were compared with the results of a propensity score−matched control group that received a corticosteroid injection (40 mg triamcinolone acetonide). For the in vitro analysis, synoviocytes were cultured with or without interleukin-1β (IL-1β) and PRP. The gene expression of proinflammatory and anti-inflammatory cytokines as well as matrix enzymes and their inhibitors was evaluated. Results: At 6-month follow-up, pure PRP significantly decreased pain and improved ROM, muscle strength, and shoulder function to levels comparable with those after a corticosteroid injection. All pain values, strength measurements, and functional scores significantly improved up to 6 months in the PRP group, but these measures improved up to 3 months and then were decreased at 6 months in the corticosteroid group. ROM was significantly improved in the 2 groups at 6 months compared with baseline. Allogenic PRP did not cause adverse events. For the in vitro findings, PRP induced inflammation but significantly improved the IL 1β−induced synovial inflammatory condition by decreasing proinflammatory cytokines such as IL-1β, tumor necrosis factor−α, IL-6, cyclooxygenase-2, and microsomal prostaglandin E synthase−1 and decreased matrix enzymes (matrix metalloproteinase−1, −3, and −13 as well as a disintegrin and metalloproteinase with thrombospondin motifs−4 and −5) and further increasing anti-inflammatory cytokines such as vasoactive intestinal peptide. Conclusion: This study showed that PRP decreased pain and improved shoulder ROM and function to an extent comparable with that of a corticosteroid in patients with AC. Allogenic pure PRP acted in a pleiotropic manner and decreased proinflammatory cytokines only in the inflammatory condition. Clinical Relevance: Allogenic PRP could be a treatment option for the inflammatory stage of AC.

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Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: A pilot study

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-171066 ◽

2018 ◽

Vol 31 (4) ◽

pp. 603-610 ◽

Cited By ~ 10

Author(s):

Yalkin Camurcu ◽

Hakan Sofu ◽

Hanifi Ucpunar ◽

Nizamettin Kockara ◽

Adem Cobden ◽

...

Keyword(s):

Single Dose ◽

Pilot Study ◽

Knee Osteoarthritis ◽

Clinical Outcomes ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Plasma Injection

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Comparison of combined intra-articular and sub-acromial injection with intra-articular injection in adhesive capsulitis

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v10i1.38969 ◽

2021 ◽

Vol 10 (1) ◽

pp. 33-38

Author(s):

Rajeev Raj Manandhar ◽

Krishna Raj Khanal ◽

Himal Khanal ◽

Saroj Gautam

Keyword(s):

Corticosteroid Injection ◽

Adhesive Capsulitis ◽

Shoulder Function ◽

Mean Value ◽

Constant Murley Score ◽

Significant Difference ◽

Clinical Benefits ◽

The Mean ◽

Group 2 ◽

Group 1

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive. Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis. Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score. Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week. Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.

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MANAGEMENT OF ADHESIVE CAPSULITIS OF SHOULDER JOINT BY SINGLE PLATELET RICH PLASMA INJECTION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1826 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Himanshu Suman ◽

Puneet Kumar Acharya ◽

Jyoti Krishna ◽

Yash Sharma ◽

Oaj Dosaj

Keyword(s):

Glenohumeral Joint ◽

Platelet Rich Plasma ◽

Adhesive Capsulitis ◽

Cost Effective ◽

College Hospital ◽

Duration Of Symptoms ◽

Medical College ◽

Vas Score ◽

Plasma Injection ◽

Hospital Patients

Introduction: Adhesive capsulitis is a painful impairment characterized by the restriction of movement of shoulder due to the adhesions across the glenohumeral joint, injection of platelet-rich plasma is effective treatment to reduce the pain and restore the movement of shoulder. Aim: To assess the effectiveness single PRP injection in management of adhesive capsulitis. Material and Methods: This study enrolled 12 patients experiencing the shoulder pain for at least 3 months and attending our medical college hospital. Patients with adhesive capsulitis were given a single injection of PRP (4 ml) and followed up for 12 weeks, VAS scores and Disability Index scores were recorded and compared with the baseline scores. Result: In present study majority of patients were females with mean duration of symptoms was 3 months. Post PRP treatment all the patients have shown significant improvement on pains VAS score, movement VAS score on 2nd, 6th, and 12th weeks follow up. Conclusion: Present studies conclude that the AC is more prevalent among females which can be treated effectively with PRP technique. PRP as is a simple, safe and cost-effective management of AC without any adverse effects. Keywords: Adhesive Capsulitis, Platelet-Rich Plasma, Corticosteroid, Intra-articular

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Platelet-rich plasma for the treatment of coccydynia: a case report and review of regenerative medicine for coccydynia

Regenerative Medicine ◽

10.2217/rme-2019-0102 ◽

2019 ◽

Vol 14 (12) ◽

pp. 1151-1154

Author(s):

Walter I Sussman ◽

Mairin A Jerome ◽

Lisa Foster

Keyword(s):

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Post Injection ◽

Ultrasound Guided ◽

Plasma Injection ◽

Patient Reported ◽

Sacral Hiatus ◽

Practice Patient ◽

Point Tenderness

Aim: To describe the successful treatment of coccydynia using ultrasound-guided injection of platelet-rich plasma. Setting: Outpatient orthopedic practice. Patient: 17-year-old female with BMI of 42.6. Case description: The patient presented with 6 months of nontraumatic coccygeal pain exacerbated by sitting. Physical exam was significant for point-tenderness over the sacral hiatus and coccyx. A corticosteroid injection around the sacrococcygeal ligament was administered with immediate resolution of her pain following the injection with the anesthetic. The patient reported significant pain relief for 1 week. The superficial sacrococcygeal ligament was then treated with a platelet-rich plasma injection under US guidance. Results: The patient reported a 70% improvement in pain and sitting tolerance at 6 weeks. By 6 months post injection, her pain was 100% resolved, and she remained pain free at the 12-month follow-up. Conclusion: Platelet-rich plasma may be considered as a treatment option in patients with refractory coccydynia.

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Intra-Articular versus Subacromial Corticosteroid Injection for the Treatment of Adhesive Capsulitis: A Meta-Analysis and Systematic Review

BioMed Research International ◽

10.1155/2019/1274790 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Xiaoke Shang ◽

Zhong Zhang ◽

Xuelin Pan ◽

Jian Li ◽

Qi Li

Keyword(s):

Internal Rotation ◽

Adverse Reactions ◽

Corticosteroid Injection ◽

Meta Analysis ◽

Adhesive Capsulitis ◽

Risk Of Bias ◽

Secondary Outcome ◽

Significant Difference ◽

Subgroup Analyses ◽

Corticosteroid Injections

Background. Adhesive capsulitis is one of the most well-known causes of pain and stiffness of the shoulder. Corticosteroid injections have been used for many years. However, it is still controversial where corticosteroid should be injected, whether subacromial or intra-articular. Objective. The objective of this meta-analysis was to compare the effects of intra-articular (IA) and subacromial (SA) corticosteroid injections for the treatment of adhesive capsulitis. Materials and Methods. Four foreign databases and two Chinese databases were searched for RCTs and quasi-RCTs involving the comparison of IA and SA corticosteroid injection for the treatment of adhesive capsulitis. The Cochrane risk of bias tool and PEDro score were used to evaluate the quality of the studies. The primary clinical outcomes including VAS, Constant score, ASES score, and ROM were collected. The secondary outcome of corticosteroid-related adverse reactions was also compared between the two groups. The results were evaluated and compared at five time points. Subgroup analyses were performed to further explore the differences between groups. Results. Eight RCTs and one quasi-RCT, involving 512 participants, were identified and included in this meta-analysis. All studies were of low risk of bias and medium-high quality with the PEDro score ≥5 points. The pooled effect showed that there was no significant difference in the primary outcomes between IA injection and SA injection, with an exception of VAS at 2-3 weeks (P=0.02) and ROM of internal rotation at 8–12 weeks (P=0.02). According to the results of subgroup analyses, the differences of VAS and ROM of internal rotation did not last beyond the 2-3-week time period. Additionally, SA injection had the advantage of avoiding adverse reactions from the corticosteroid, especially in avoiding a large fluctuation of serum blood glucose levels. Conclusions. When corticosteroid injection is used to treat adhesive capsulitis, both injection sites can be selected. However, due to the scarcity of related studies, more rigorous trials are needed to confirm the current findings.

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