Effects of platelet rich plasma on adhesive capsulitis

Objective: In this study, our aim was to examine the effects of platelet rich plasma (PRP) on pain and functional outcomes in patients with adhesive capsulitis. We compared the effects of PRP against saline solution by designing a double blind, randomized, prospective study. Materials and Methods: Ege University School of Physical Therapy and Rehabilitation outpatient clinic were evaluated 89 patients diagnosed with adhesive capsulitis. In the 18-70 age range, 3-9 months, pain in the shoulder (in ≥40 mm violence VAS), compared with the active and the opposite side of the passive ROM of the affected side at least 2 moving in the direction, which can limit movement of at least 25% loss with 40 diagnosis of adhesive capsulitis were included in the study. Patients were divided into two groups based on age and gender in accordance with the predetermined randomization scheme. Group 1, the group administered PRP obtained by centrifugation of venous blood own, group 2 serum physiological in placebo. İnjections of a total of 3 times in all treatment groups, 2 week interval with the shoulder area, using a posterior injection technique and coated with the same material was performed to ensure blindness. In addition to the injection of all treatment groups were given treatment exercise. The first 4 weeks, was performed in the presence of a physiotherapist 3 days a week. It was then continued as a home exercise program. In the days to come to the hospital where the patient was recommended to continue the exercises at home as back 3 times in 10 days. Primary measurement parameter was Shoulder Pain and Disability iindeks [Shoulder Pain and Disability Index (SPADI)] as the for assessing the limitation of movement and pain. Secondary outcome measures were VAS (Visual Analogue Scale) - spontaneous pain, VAS- health, VAS- treatment satisfaction, measurement shoulder range of motion with goniometer , paracetamol dose used, the complication and side effects. All patients were evaluated before treatment and at 1st month 3 months. Results: In this study; both groups showed an improvement in the pain and disability evaluation with SPADI on 1st and 3rd month visits (p<0,05). PRP group were significantly greater improvement (p <0.05). In both groups, the SPADI pain and disability scores showed significant improvement in ratings between 1 and 3 month (p <0.05). In the placebo group the SPADI total no significant difference between 1 .and the 3rd month values. PRP group were more improved compared to the placebo group with assessment of the impact of disease on quality of life and spontaneous pain using the VAS (p <0.05). Both groups showed an improvement in shoulder passive ROM values on 1st and 3rd month visits (p <0.05). PRP group were significantly greater improvement in shoulder passive ROM values on 1st and 3rd month visits outside 1rst active ER. Similarly, VAS-treatment satisfaction was found to be better in the PRP group on the 1st and 3rd month visits (p <0.05). There was no difference between the two groups in the amount of paracetamol used. Discussion: PRP is part of autologous plasma of blood that is obtained by centifugation of whole blood and that contains higher platelet concentrations. Hiperfizyolojik rate include growth factor led to the use for treating a variety of musculoskeletal disorders. PRP is effective in treating tendon and ligament injuries by increasing the synthesis of collagen, to stimulate angiogenesis, increasing cell migration, differentiation, proliferation and extracellular matrix formation. Based on these beneficial effects, we hypothesized that PRP may effective treatment on AK, this study showed that both groups demonstrated improvement over time. However, compared groups PRP group were statistically significantly greater improvement on both pain and disability and satisfaction parameters. It can be interpreted as PRP therapy in addition to exercise providing additional benefits. In our study, finding significant improvement from baseline in the 2 groups connected to the exercise program applied to patients. Another possible reason the saline effect placebo, distention and needle. There is still need for further research that study on more patient, following longer made,compare the effectiveness of PRP with exercise therapy alone or with KS injection. Keywords: Adhesive capsulitis, shoulder, platelet rich plasma