Comparison of the Efficacy of Platelet-Rich Plasma (PRP) and Local Corticosteroid Injection in Periarthritis Shoulder: A Prospective, Randomized, Open, Blinded End-Point (PROBE) Study

Abstract

BackgroundPeriarthritis or frozen shoulder, also called adhesive capsulitis, is characterized by stiffness and pain along with gradual loss of active and passive movement in the glenohumeral joint. More than 2-5% of the population suffers from periarthritis with a higher incidence in the age group of 40-60 years. The various treatment modalities used for its management include simple physiotherapy, short-wave therapy, ultrasonic therapy, transcutaneous electrical nerve stimulation, hydrotherapy, analgesics, intra-articular injections, manipulation under general anesthesia (MUA), and surgical management. The application of intra-articular steroid injection has been a common and efficacious option in rapidly diminishing shoulder pain and disability. Some recent studies reported a better outcome using platelet-rich plasma (PRP) injections in frozen shoulder cases. Hence, this randomized controlled trial was conducted to compare the efficacy of intra-articular injections of PRP and triamcinolone in patients of shoulder periarthritis in a population from the eastern region of India MethodologyA total of 60 patients with periarthritis shoulder were allocated into two groups after randomization. Group A received 2 mL autologous PRP, and Group B received 2 mL of triamcinolone (40 mg/mL) intra-articular injection. Patients were followed up on the 4th week, 12th week, and 24th week. The assessment of pain and function using the visual analog scale (VAS) score and the Disabilities of Arm, Shoulder, and Hand (DASH) score, respectively, was done at each follow-up. The primary analyses of both primary and secondary outcomes were conducted in the intention-to-treat (ITT) population. SPSS version 24 (IBM Corp., Armonk, NY, USA) was used for data analysis. ResultsThe mean VAS score in the PRP and triamcinolone groups was 14.33 ± 3.79 and 31.63 ± 7.62, respectively (p = 0.0001) after 24 weeks. The mean DASH score in the PRP and triamcinolone groups was 18.08 ± 8.08 and 31.76 ± 3.63, respectively (p = 0.0001), which shows significant improvement in both pain and disability scores in the PRP group after 24 weeks. ConclusionsThe triamcinolone group showed better short-term outcomes whereas PRP showed better long-term outcomes in reducing pain and disability scores in terms of VAS and DASH scores.

Comparing the Efficacy of Intra-articular Platelet-Rich Plasma and Corticosteroid Injections in the Management of Frozen Shoulder: A Randomized Controlled Trial

“…The proportion of comorbidities, such as diabetes and hypertension, was insignificant between the groups. Diabetes mellitus (38%) was the most common comorbidity in the study population, followed by hypertension (15%), which is consistent with the findings of Gupta et al [6].…”

“…Aslani et al [18] also reported similar findings to our study, demonstrating improvements in QuickDASH score, reduction in shoulder pain, and improvement in ROM when assessing the role of PRP in managing FS. Ünlü et al [19] evaluated the efficacy of IA PRP injection versus normal saline in managing FS and found improvements in SPADI score and reductions in VAS score, similar to our results obtained in the PRP group.…”

“…Platelet-rich plasma has chemotactic and mitogenic properties and functions as a growth factor agonist. The combination of large amounts of activated platelets, growth factors, and anti-inflammatory compounds alters the healing cascade and inflammatory pathway, reversing the degenerative process [6,14,20]. Our study found a significant decrease in SPADI scores at all follow-up intervals.…”

“…Treating a frozen shoulder often involves temporary relief through intra-articular (IA) corticosteroid (CS) injections. A randomized control study has shown that IA CS results in pain relief and improved ROM in patients suffering from FS [6]. However, recent advancements have introduced platelet-rich plasma (PRP) as a promising alternative therapy.…”

The method of correction of hemorrhagic shock action on the pro- and antioxidant system of the periulceral stomach tissues in an experiment

“…Research in recent years shows a large amount of data on the successful use of platelet-rich plasma, not only in experimental, but also in clinical medicine [1,4,6,8,9,16,19,20].…”