Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN

Platelet Rich Plasma therapy uses the component’s of a patient’s blood to make a healing solution. From the blood platelets and growth factors are separated and injected into a damaged joint. In our practice PRP is seldom given as a stand alone treatment. We also use Prolotherapy in a combined treatment. Prolotherapy is the injection of a simple dextrose or sugar to create a healing response. These treatments are further explained below.

While a frozen shoulder is treatable with Prolotherapy and Platelet Rich Plasma Therapy,  healing occurs over a longer period of time. The term adhesive capsulitis refers to scar tissue that forms inside the joint due to a lack of movement. If a joint is not moved through its full range of motion every day, scar tissue will form inside the joint. Generally, physical therapy exercises must accompany Prolotherapy and PRP to restore proper motion to the shoulder.  The first line of treatment for a frozen shoulder is physiotherapy. Physical therapy modalities, such as myofascial release, massage, range-of-motion exercises, and ultrasound, can often release scar tissue. If these do not relieve the problem, then the scar tissue can be broken up within the joint by the physician by injecting the shoulder full of a solution made up of sterile water mixed with an anesthetic. The numb shoulder can then be gently manipulated. Often several sessions of this treatment regimen are needed to achieve the shoulder’s original full range of motion.

Since the initial cause of the adhesive capsulitis was supraspinatus (rotator cuff) weakness, Prolotherapy injections to strengthen the rotator cuff can be performed in conjunction with the above techniques. Complete to near-complete resolution can be accomplished using this combined approach.

It is important that the other therapists know you are receiving Prolotherapy and PRP and they understand how it works in order to not interrupt or stop the progress made with Prolotherapy and PRP. It is also wise to make the Prolotherapist aware of exactly what type of therapies are being done between Prolotherapy visits and even to have some communication with the other therapist.

A February 2026 study in the journal Frontiers in medicine (1) performed a review of previously published research regarding the efficacy of platelet-rich plasma (PRP) versus corticosteroid  injections in the treatment of adhesive capsulitis. This meta-analysis incorporated 13 studies, comprising a total of 1,056 patients. Among these participants, 531 received PRP injections, while 525 were treated with corticosteroid injections. The primary outcomes evaluated were the Visual Analog Scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) score for function.  Secondary outcomes included measurements of range of motion (ROM), specifically abduction, flexion, external rotation, and internal rotation.

The analysis revealed no statistically significant differences between the two groups in terms of VAS and DASH scores at the 1-month mark, VAS scores at 3 months, or ROM in flexion. Nevertheless, the PRP group showed notably better results compared to the corticosteroid  group in several areas: VAS scores at 6 months, DASH scores at both 3 and 6 months, as well as in ROM for abduction, external rotation, and internal rotation.

A July 2024 paper in the journal Shoulder & Elbow (2) suggested Platelet-rich plasma (PRP) has shown promising results for adhesive shoulder capsulitis and devlved further into the patient data of patients who received PRP treatment. Here is what they found: The data of 578 patients from six previously publish studies with 263 patients receiving PRP (45.5%). PRP was part of a non-surgical treatment method. PRP was compared to another intervention in all six studies. Four of these studies found PRP to be more effective. No major adverse effects were reported in any study.

A January 2021 (3) study published in the journal International Orthopaedics investigated whether PRP injections are effective in the management of adhesive capsulitis of the shoulder. This study was PRP alone. At our center, we recommend a combined Prolotherapy and PRP treatment as discussed in the above video.

• In this study 32 patients, 21 female and 11 male, with an average age of 57.
• The patients in this study had to have shoulder pain and restrictions in movements (at least 25% when compared to the other side, and at least in two directions) for three months minimum and nine months maximum.
• Patients were randomized into two groups, one group took PRP injections three times every two weeks, while the other group took saline injections at the same frequency and volume. A standardized exercise program was also applied to all patients.

How did the patients do? According to the researchers: “PRP injections were found to be effective in both pain and disability, and showed improvements in a restricted shoulder due to adhesive capsulitis. These findings might point out PRP as a therapeutic option in the management of adhesive capsulitis.”

Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy

A December 2020 study (4) published in The Journal of International Medical Research looked at how effective PRP injections could be for patients with adhesive capsulitis in comparison to conventional physical therapy. The conventional physical therapy included short-wave diathermy (heat) and exercise therapy performed at three sessions a week for 6 weeks for a total of 18 sessions). The PRP treatment was one injection.

Treatment outcomes evaluated therapeutic effectiveness before and at one, three, and six weeks after PRP injection and conventional physical therapy initiation. How did these patients do?

• “Subjects in both groups showed a significant decrease in the visual analog scale score for pain and shoulder and hand scores, and they a significant increase in shoulder passive range of motion at all evaluation time points. There was no significant difference in the measured outcomes between the two groups. However, there was less acetaminophen consumption after PRP injection compared with that after conventional physical therapy.
• Conclusions: “PRP injection is a useful option for treating patients with adhesive capsulitis, particularly those who have low therapeutic compliance for exercise therapy or have contraindications for corticosteroid injection or oral pain reduction medication.”

In independent research, doctors writing in the journal The Archives of Bone and Joint Surgery (5) commented on a case history of a patient treated with Platelet Rich Plasma injections for a frozen shoulder.

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

• A 45-year-old man with shoulder adhesive capsulitis underwent two consecutive platelet-rich plasma injections in the seventh and eighth months after the initiation of symptoms. He was measured for pain, function, and Range of Motion ROM.
• After the first injection, the patient reported a 60% improvement in shoulder pain and no night pain.
• Also, two-fold improvement for ROM and more than 70% improvement in function were reported.

A July 2019 study in the American Journal of Physical Medicine & Rehabilitation (6) found that patients who were given a single PRP injection versus a single cortisone injection had better results from the PRP in terms of improving pain, disability, and shoulder range of movement at a 12 week follow up.

A February 2026 study in the Archives of physical medicine and rehabilitation (7) followed up and compared the effects of combined glenohumeral joint and subacromial-subdeltoid bursa injections using platelet-rich plasma (PRP), corticosteroids, or normal saline (NS), each administered alongside a standardized physical therapy (PT) regimen, on the management of frozen shoulder in a population of 90 patients.

The 90 patients were randomly assigned to one of three intervention groups. The first group received PRP injections in combination with physical therapy, the second group received corticosteroid injections with physical therapy, and the third group received NS injections together with physical therapy. All participants underwent two ultrasound-guided injections, which were precisely administered to both the glenohumeral joint and the subacromial-subdeltoid bursa.

The primary outcome assessed was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes included the Shoulder Disability Questionnaire (SDQ), pain intensity measured by visual analog scale (VAS), evaluations of both active and passive range of motion, assessment with the 36-Item Short Form Health Survey (SF-36), and patient self-assessment. All outcome measures were collected at baseline and subsequently at 1, 2, 4, and 6 months following the initiation of treatment.

The corticosteroid injections, when combined with physical therapy, provided superior outcomes compared with PRP injections, particularly during the freezing phase of frozen shoulder. However, all three treatment approaches—PRP, corticosteroid, and normal saline injections—were associated with significant improvements following the interventions.

Caring Medical Research

Ross Hauser, MD discusses the Prolotherapy treatment results that were published a few years ago as part of our article series on the use of Hackett-Hemwall dextrose Prolotherapy, as well as shows a treatment demonstration from a Prolotherapy symposium he taught in 2021

More information

PRP injections in the management of adhesive capsulitis – frozen shoulder

References

1 Chang X, Wang Z, Tan J, Zhou N, Zhong Q, Chen Y, Huang R. Comparison of the efficacy of platelet-rich plasma versus corticosteroid in the treatment of adhesive capsulitis: a systematic review and meta-analysis based on randomized controlled trials. Frontiers in Medicine. 2026 Feb 1;13:1766836. [Google Scholar]
2 El-Swaify ST, Refaat MA, AbdelWahab AA, Seddik ME, Mostafa Abdelrazek AE, Doas Y, Beshay PW. Is platelet-rich plasma a new solution for shoulder adhesive capsulitis? A systematic scoping review of the literature. Shoulder & Elbow. 2023 May 17:17585732231174184. [Google Scholar]
3 Ünlü B, Çalış FA, Karapolat H, Üzdü A, Tanıgör G, Kirazlı Y. Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder. International Orthopaedics. 2020 Nov 18:1-0. [Google Scholar]
4 Thu AC, Kwak SG, Shein WN, Htun LM, Htwe TT, Chang MC. Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial. Journal of International Medical Research. 2020 Dec;48(12):0300060520976032. [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. [Google Scholar]
6 Barman A, Mukherjee S, Sahoo J, Maiti R, Rao PB, Sinha MK, Sahoo D, Tripathy SK, Patro BK, Bag ND. Single intra-articular platelet-rich plasma versus corticosteroid injections in the treatment of adhesive capsulitis of the shoulder: a cohort study. American Journal of Physical Medicine & Rehabilitation. 2019 Jul 1;98(7):549-57. [Google Scholar]
7 Hsieh LF, Fu YS, Chen TA, Liu YF, Chang CS, Huang YH. Platelet-Rich Plasma Versus Corticosteroid Injection in Patients With Primary Frozen Shoulder: A Single-Blinded Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2026 Feb 26. [Google Scholar]