Comparison of clinical and functional outcomes of physical therapy alone versus additional intraarticular injection of platelet rich plasma in treatment of frozen shoulder in Indian population


  • Tanmay A. Avhad Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Sahil Lombar Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Neeraj Kalra Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India



Platelet rich plasma, Adhesive capsulitis, Frozen shoulder, Intra-articular steroid, Physical therapy


Background: Frozen shoulder (adhesive capsulitis) involves significant restriction of shoulder motion due to an inflammatory process and typically follows stages of pain, stiffness, and recovery over 2-3 years. This study explores the efficacy of platelet-rich plasma (PRP) injections, alongside conventional physiotherapy, as a non-operative treatment to enhance recovery in patients with adhesive capsulitis.

Methods: This prospective, randomized, open, blinded, single-center clinical study involving 50 patients with adhesive capsulitis, comparing intra-articular PRP injections and physical therapy with physical therapy alone over 24 weeks. Primary outcomes were assessed using the shoulder pain and disability index (SPADI) and visual analog scale (VAS), with follow-ups at 6, 12, and 24 weeks to evaluate pain, function, and patient satisfaction.

Results: In adhesive capsulitis (AC), intra-articular platelet-rich plasma (IA-PRP) injections with physical therapy (PT) provided superior pain relief, functional improvement, and higher treatment satisfaction after 24 weeks compared to PT alone. The IA-PRP group also showed better VAS scores and reduced acetaminophen use, indicating more effective pain management.

Conclusions: In AC, IA-PRP injections showed greater pain relief and improved shoulder mobility compared to PT alone after 12 weeks. PRP's effectiveness highlights its potential, especially when corticosteroids are unsuitable, though longer-term studies are needed to confirm these results.


Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2011;20:322-5.

Tasto JP, Elias DW. Adhesive capsulitis. Sports Med Arthrosc Rev. 2007;15:216-21.

Robinson CM, Seah KT, Chee YH, Hindle P, Murray IR. Frozen shoulder. J Bone Joint Surg Br. 2012;94:1-9.

Mezian K, Coffey R, Chang KV. Frozen Shoulder. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

Jayson MI. Frozen shoulder: adhesive capsulitis. Br Med J (Clin Res Ed). 1981;283:1005-6.

Walmsley S, Osmotherly PG, Rivett DA. Movement and pain patterns in early stage primary/idiopathic adhesive capsulitis: a factor analysis. Physiotherapy. 2014;100:336-43.

Wolf EM, Cox WK. The external rotation test in the diagnosis of adhesive capsulitis. Orthopedics. 2010;33.

Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World J Orthop. 2015;6:263-8.

Rangan A, Hanchard N, McDaid C. What is the most effective treatment for frozen shoulder? BMJ. 2016;354:i4162.

Chan HBY, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore Med J. 2017;58(12):685-9.

Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg. 2004;62(4):489-96.

Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg. 2015;23(1):1-5.

Barman A, Mukherjee S, Sahoo J, Maiti R, Rao PB, Sinha MK, et al. 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. 2019;98(7):549-57.

Blajchman MA. Novel platelet products, substitutes and alternatives. Transfus Clin Biol. 2001;8:267-71.

Tveitå EK, Ekeberg OM, Juel NG, Bautz-Holter E. Responsiveness of the shoulder pain and disability index in patients with adhesive capsulitis. BMC Musculoskelet Disord. 2008;9:161.

Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Med J. 2016;57(12):646-57.

Kesikburun S, Tan AK, Yilmaz B, Yaşar E, Yazicioğlu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013;41(11):2609-16.

Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-72.

Moojen DJ, Everts PA, Schure RM, Overdevest EP, van Zundert A, Knape JT, et al. Antimicrobial activity of platelet-leukocyte gel against Staphylococcus aureus. J Orthop Res. 2008;26(3):404-10.

Mazzocca AD, McCarthy MB, Chowaniec DM, Cote MP, Romeo AA, Bradley JP, et al. Platelet-rich plasma differs according to preparation method and human variability. J Bone Joint Surg Am. 2012;94(4):308-16.

Sharma RR, Marwaha N. Leukoreduced blood components: Advantages and strategies for its implementation in developing countries. Asian J Transfus Sci. 2010;4(1):3-8.

Kothari SY, Srikumar V, Singh N. Comparative Efficacy of Platelet Rich Plasma Injection, Corticosteroid Injection and Ultrasonic Therapy in the Treatment of Periarthritis Shoulder. J Clin Diagn Res. 2017;11(5):RC15-8.

Scarpone M, Rabago D, Snell E, Demeo P, Ruppert K, Pritchard P, et al. Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study. Glob Adv Health Med. 2013;2(2):26-31.

Tahririan MA, Moezi M, Motififard M, Nemati M, Nemati A. Ultrasound guided platelet-rich plasma injection for the treatment of rotator cuff tendinopathy. Adv Biomed Res. 2016;5:200.






Original Research Articles