Approach to treating frozen shoulder using Prolotherapy – Shoulder Adhesive Capsulitis Treatment

Dr. David Woznica ProlotherapistDavid N. Woznica, MD

Adhesive Capsulitis of the shoulder, or more commonly “a frozen shoulder,” can be treated non-surgically with Prolotherapy and Platelet Rich Plasma PRP Prolotherapy injections. In this article we will explain Prolotherapy, PRP Prolotherapy and look at some other non-surgical options including cortisone and hyaluronic acid.

The term adhesive capsulitis refers to scar tissue that forms inside a joint due to lack of movement. In the simplest terms, “use it or lose it.” If you do not move your shoulder through its normal range of motion, you may lose your ability to.

What caused your shoulder to freeze is open to debate.

Frozen shoulder is an interesting entity we are not really sure why it happens it seems to be more prevalent in people with diabetes. There appears also to be a connection  with some type of autoimmune reaction (inflammation) in the shoulder.

Frozen shoulder appears to occur in three main phases:

As controversial as the origins of shoulder adhesive capsulitis are, so are the treatments. Especially treatments that may make a patient worse.

Some patients improve when they have another surgery such as arthroscopic capsular release,(1some patients will move onto a shoulder nerve block.(2Some patients may “get away” with a cortisone injection that will offer temporary relief.(3)

Other treatments for frozen shoulder include shoulder exercise, manual therapy and anti-inflammatory or NSAIDs which have been shown to produce short-term pain benefit, but both have been shown to result in long-term loss of function and even more chronic pain by inhibiting the healing process of soft tissues and accelerating cartilage degeneration.

Particular in arthroscopic frozen shoulder procedures is a significantly worse result in diabetic patients (of whom frozen shoulder can be as common as occurring in nearly 20% of diabetic patients) with a tendency towards persistent limitation of movement two years after operation.(4)

Prolotherapy for Frozen Shoulder

We typically inject a shoulder capsule with a large amount of Prolotherapy numbing solution to stretch out the shoulder joint. The numb shoulder can then be gently manipulated. Often several sessions of this treatment regiment are needed to achieve the shoulder’s original full range of motion.

In our clinical observations we have seen Prolotherapy offer the most curative results as a frozen shoulder treatment at getting the shoulder more motion, eliminating pain, and restoring the structures of the joint.

In independent research, doctors in Iran commented on a case history of a patient treated with Platelet Rich Plasma injections for frozen shoulder.

The doctors noted that Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing.

 References

1 Barnes CP, Lam PH, Murrell GA. Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. J Shoulder Elbow Surg. 2016 Sep;25(9):e256-64. [Pubmed] [Google Scholar]

2. Chang KV, Wu WT, Hung CY, Han DS, Yang RS, Chang CH, Lin CP. Comparative Effectiveness of Suprascapular Nerve Block in the Relief of Acute Post-Operative Shoulder Pain: A Systematic Review and Meta-analysis. Pain Physician. 2016 Sep-Oct;19(7):445-56. [Pubmed] [Google Scholar]

3. Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Med J. 2016 Aug 29. [Pubmed] [Google Scholar]

4. Mehta SS, Singh HP, Pandey R. Comparative outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. Bone Joint J. 2014 Oct;96-B(10):1355-8. doi: 10.1302/0301-620X.96B10.34476. [Pubmed] [Google Scholar]

5. Aslani H, Nourbakhsh ST, Zafarani Z, et al. Platelet-Rich Plasma for Frozen Shoulder: A Case Report. Archives of Bone and Joint Surgery. 2016;4(1):90-93. [Pubmed] [Google Scholar]

 

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