Frozen shoulder is a common disease. It is also called periarthritis or adhesive capsulitis. It is caused by adhesion and fibrosis in the glenohumeral capsule which reduces the joint space. It is characterized by functional loss of passive and active shoulder motion. This disorder is defined by the American Shoulder and Elbow Surgeons as a condition of significant restriction of both active and passive motion of the shoulder joints because of an unknown etiology that occurs without intrinsic shoulder disorder.
Frozen shoulder restricts active and passive range of motion and is estimated to have a 3-5% incidence rate among adults.
Signs and symptoms typically begin slowly and then progress over time. Symptoms of frozen shoulder can improve over time usually 1-3 years. After a three-year period, up to 40% of patients have persistent problems.
Periarthritis can be either primary or secondary. The primary type (idiopathic) occurs without any known trauma or provoking event. The secondary type is usually preceded by periarticular trauma, fracture or dislocation of the glenohumeral joint.
Stages of Frozen Shoulder
Freezing stage- Usually 2-9 months in duration. The ability of the shoulders range of motion becomes limited and pain increases
Frozen stage- The shoulder becomes stiff, and pain may or not improve. Disability increases and this duration last from 4-12 months
Thawing stage- The shoulders ability to move in a normal range of motion gradually increases. This can last 5-24 months
Causes
The shoulder joint is a ball and socket joint and is enclosed in a capsule of connective tissue. As this capsule is constricted by fibrous tissue, the overall movement is restricted.
Decreased mobility of the shoulder joint over long periods of time causes a high risk of development.
Causes such as rotator cuff injury, fractures, stroke, prior surgery with extensive immobility are major contributing factors.
Systemic Diseases
Certain systemic diseases are more likely to develop frozen shoulder than the general population. They are,
- Diabetes- patients with type 1 diabetes have a 40% chance of development. Up to 29% of type 2 diabetics may develop this condition.
- Hyperthyroidism
- Hypothyroidism
- Cardiovascular Disease
- Parkinson’s Disease
- Autoimmune disease
- COPD
Treatment
Pain relievers and anti-inflammatory agents are usually given for this problem. However, they are not curative and used for symptomatic relief only.
Physical Therapy
Primary treatment modality is physical therapy to maintain and improve the range of motion of the joint. Physical Therapy solely or in combination with other modalities is the initial treatment of choice. Physical therapy may employ ultrasound, transcutaneous electrical nerve stimulation and heat/cold therapy as well as active/passive range of motion exercises.
Surgical and Other Procedure
- Steroid injections to decrease pain and improve mobility. The prominent side effects have limited the use of steroids. Multiple injections will damage and degrade the tissues and bones, again limiting their use.
- Hydro dilatation is accomplished by injecting sterile water into the joint space to stretch the tissue and allow an improved range of motion
- Shoulder manipulation under anesthesia. The surgeon forcibly manipulates the joint to tear the fibrous tissue. This will loosen the constriction on the joint.
- Surgery is rarely needed but in certain cases can be used to remove the scar tissue. Surgery is done arthroscopically.
- Platelet Rich Plasma Injection
Age and Sex
Typically, patients with frozen shoulder are older than 40 and women have a greater incidence than men. Women comprise of 70% of the affected population. The idiopathic type often involves the non-dominant extremity while 40-50% of cases have bilateral involvement. If frozen shoulder occurs younger than 40, extensive evaluation should take place.
Diagnosis
Physical examination with range of motion evaluation is the classic way to diagnose FS.
X Rays, ultrasound, CT or MRI can also be used to confirm the diagnosis and rule out other causes.
Multiple studies have been accomplished to compare the intraarticular injection of steroids versus platelet rich plasma in frozen shoulder patients.
Platelet Rich Plasma is an emerging entity in the field of regenerative medicine. As an autologous blood concentrate, PRP is readily available, safe and affordable. It prevents any immunological reaction due to its autologous nature. PRP has anti-inflammatory effects through the inhibition of nuclear factor kappa B signaling target cells and by tissue inhibitor of matrix metalloproteinase. The remodeling of the matrix is a function of the cytokines and growth factors contained in PRP.
In comparison of PRP and corticosteroids in frozen shoulder patients, PRP was found to be more effective than corticosteroids in the long-term comparison of pain and disability scores.
Long term improvements in the PRP patients can be explained by the action on all phases of tissue repair. The inflammatory, proliferative and remodeling phases are all significantly better with PRP.
Studies
Cureus 2022 Sept 17;14(9): e29253 PMID 36262947
Background: In this study, we compared the functional outcome of intra-articular injection of corticosteroid versus platelet rich plasma in patients with frozen shoulder
Conclusion: In comparison to intra-articular corticosteroid injection, there is substantial improvement in patients with frozen shoulder following intra articular injection of PRP. We believe that intra articular injections of PRP should be utilized frequently in the treatment of FS to achieve better outcomes.
Cureus 2021 Dec: 13(12): e20560 PMID 35103139
Background- In this study, we compared the functional outcome of intra-articular injection of corticosteroid versus platelet rich plasma in patients with frozen shoulder
Conclusions: In comparison to intra articular corticosteroid injection, there was substantial improvement in VAS score, UCLA and ROM in patients with FS following intra articular injection of PRP.
Am J Phys Med Rehabil 2019 Jul;98(7): 549-557 PMID 30676339
Objective: The aim of this study was to compare the effects of single intra-articular platelet rich plasma and corticosteroid injections in patients with adhesive capsulitis of the shoulder
Conclusions: At 12 week follow up, a single dose of IA-PRP injection was found to be more effective than IA-CS injection, in terms of improving pain, disability and shoulder range of motion in patients with adhesive capsulitis of the shoulder
Arthroscopy 2023 May;39(5):1320-1329 PMID 36708748
Purpose: To evaluate the role of platelet rich plasma for adhesive capsulitis as compared with other injectables
Conclusion: PRP injections for AC are at least equivalent to corticosteroid and saline solution injections and often lead to improved pain, motion and functional outcomes at 3 to 6 month follow ups.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits have been scientifically manufactured to provide a consistent platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
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Juventix Regenerative Medical supplies a Bio Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich fibrin, commonly called the “second generation of platelet products” has different growth factors and cytokines than the original PRP. These different cytokines provide a broader range of clinical applications due to their anti-inflammatory properties.
Juventix Regenerative Medical offers many more products and services for the regenerative professional. Our newest collaboration is with Evolutionary Biologics who supply exosomes, and other cellular regenerative products.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
