Clinical outcome of platelet rich plasma versus steroid in treatment of frozen shoulder


  • Johney Juneja Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • Mahendra Prakash Jain Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • Raghvendra Choubisa Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • A. K. Mehra Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • Ramesh Sen Department of Orthopaedics, RNT, Udaipur, Rajasthan, India



Platelet rich plasma, Frozen shoulder, Corticosteroid


Background: Evaluate functional outcome of use of platelet rich plasma versus steroid in frozen shoulder.

Methods: The study was conducted in Department of Orthopaedics in RNT Medical College, Udaipur. Adult patients with periarthritis shoulder (frozen shoulder or adhesive capsulitis) admitted to Trauma centre in Maharana Bhupal Government hospital attached with R.N.T. Medical College, Udaipur were included in this study after obtaining their informed, valid written consent. This is a prospective study from October 2018 to February 2020.

Results: Our study demonstrated that PRP is not inferior to CS in any of the measured parameters. Both of the groups experienced similar benefits from the injection therapies with no statistical differences detected in ROM or VAS scores at 1 week, 1 month and 3 months. No adverse effects were detected in either of the two groups.

Conclusions: We can conclude that both PRP and MPS showed efficacy on treating frozen shoulder. The current study provides strong evidence in support of a statistically significant effect of platelet concentrates in the treatment of frozen shoulder in vivo where steroid contraindicated or refused by patient. However, inj. Methylprednisolone has sudden onset of action because of anti-inflammatory action with respect to inj. PRP, so has better result at 1 week follow up post injection. But in long term (at 3 months follow up) inj. PRP has better effect in compared to Inj. MPS.


Chambler AFW, Carr AJ. Aspects of current management. The role of surgery in frozen shoulder. J Bone Joint Surg. 2003;85-B:789-95.

Zuckerman J, Cuomo F. Frozen shoulder. In: Hawkins R, ed. The shoulder: a balance of mobility and stability. Rosemont, Il. AAOS. 1993;253-67.

MacInnes JD. Perarthritis of Shoulder. Canad MAJ. 1946;55:131-3.

Andews JR. Diagnosis and treatment of chronic painful shoulder: Review of nonsurgical interventions. Journal of Arthroscopic and Related Surg. 2005;21(3):333-47.

Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy – future or trend? Arthritis Res Ther. 2012;14(4):219.

Alsousou J, Ali A, Willett K, Harrison P. The role of platelet-rich plasma in tissue regeneration. Platelets. 2012.

Bava ED, Barber FA. Platelet-rich plasma products in sports medicine. Phys Sportsmed. 2011;39(3):94-9.

Rockwood CA, editor. The shoulder. Philadelphia: WBSaundersCo. 1990.

Codman EA. The shoulder. Boston: Thomas Todd Co.1934.

Anton HA. Frozen Shoulder. Can Fam Physician 1993;39:1773-7.

Sarwark JF. Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons. 2010.

Widmer B. Frozen Shoulder. AAOS. 2011.

Warner JJP. Frozen Shoulder: Diagnosis and Management. J Am Acad Orthop Surg. 1997;5:130-140.

Hsu JE, Anakwenze OA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20:502-14.

Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F. Platelet-rich plasma in muscle healing. Am J Phys Med Rehabil. 2010;89(10):854-61.

Schulte WV. Die Eigenblutfüllung: eine neue Methode zur Versorgung größerer Knochendefkte nach intraoralen Eingriffen. Deutsche Zahnarztliche Zeitschrift. 1960;12:910-4.

Schulte WV. Die Retraktion des Blutgerinnsels und ihre Bedeutung Für die primäre Heilung von Kieferknochen. München: Carl Hans Verlag. 1964.

Yamamoto K, Hayashi J, Miyamura H, Eguchi S. A comparative study of the effect of autologous platelet-rich plasma and fresh autologous whole blood on haemostasis after cardiac surgery. Cardiovascular Surgery. 1996;4(1):9-14.

Whitman DH, Berry RL, Green DM. A technique for improving the handling of particulate cancellous bone and marrow grafts using platelet gel. J Oral Maxillofac Surg. 1998;56:1217-8.

Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surgery Endod. 1998;85(6):638-46.

Murray MM, Spindler KP, Devin C, Snyder BS, Muller J, Takahashi M et al. Use of a collagen-platelet rich plasma scaffold to stimulate healing of a central defect in the canine ACL. J Orthop Res. 2006;24(4):820-30.

Ferrari M, Zia S, Valbonesi M, Henriquet F, Venere G, Spagnolo S et al. A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery. Int J Artif Organs 1987, 10:47-50.

Storrs C. Is Platelet-Rich Plasma an Effective Healing Therapy? Scientific American. 2009.

Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008;1:165-74.

Marx RE, Garg AK. Dental and Craniofacial Applications of Platelet-Rich Plasma. Carol Stream: Quintessence Publishing Co., Inc. 2005.

Academy of Sciences, Paris: M. Donné on the Blood Globules. Prov Med Surg J. 1842;3:498-9.

Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiol Rev 2003;83:835-70.

Rodeo SA, Hannafin JA, Tom J, Warren RF, Wickiewicz TL. Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res. 1997;15:427-36.

Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br. 1995;77:677-83.

Hazleman BL. The painful stiff shoulder. Rheumatol Phys Med. 1972;11:413-21.

van der Windt DAWM, Koes BW, Deville W, Boeke AJP, de Jong BA, Bouter LM. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care. BMJ. 1998;317:1292-6.

Gam AN, Schydlowsky P, Rossel I, Remvig L, Jensen EM. Treatment of “frozen shoulder” with distension and glucorticoid compared with glucorticoid alone, a randomized controlled trial. Scand J Rheumatol. 1998;27:425-30.

Bulgen DY, Binder AI, Hazleman BL, Dutton J, Roberts S. Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis. 1984;43:353-60.

Habib GS. Systemic effects of intra-articular corticosteroids. Clin Rheumatol. 2009;28:749-56.

Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J OrthopSurg Traumatol. 2016;26:837-42.

von Wehren, L. The effect of subacromial injections of autologous conditioned plasma versuscortisone for the treatment of symptomatic partial rotator cuff tears. Knee Surg Sports TraumatolArthrosc. 2016;24:3787-92.

Hurley ET, Lim FD, Moran CJ, Mullett H. The efficacy of platelet-rich plasma and plateletrich brin in arthroscopic rotator cuff repair: A meta-analysis of randomized controlled trials. Am J Sports Med. 2019;47:753-61.

Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza, P. Platelet rich plasma in arthroscopicrotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg. 2011;20:518-28.

Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016;23:57-68.

Diercks R. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85:314-22.

Ketola S, Lehtinen JT, Arnala I. Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years. Bone Joint J. 2017;99-B:799-805.






Original Research Articles