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Platelet-Rich Plasma for Frozen Shoulder

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5b6b3750a94377053656e416
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Frozen shoulder is a glenohumeral joint disorder that movement because of adhesion and the existence of fibrosis in the shoulder capsule. Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing. To date, there is no evidence regarding the effectiveness of platelet-rich plasma in frozen shoulder. A 45-year-old man with shoulder adhesive capsulitis volunteered for this treatment. He underwent two consecutive platelet-rich plasma injections at the seventh and eighth month after initiation of symptoms. We measured pain, function, ROM by the visual analogue scale (VAS), scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and goniometer; respectively. After first injection, the patient reported 60% improvement regarding diurnal shoulder pain, and no night pain. Also, two-fold improvement for ROM and more than 70% improvement for function were reported. This study suggests the use of platelet-rich plasma in frozen shoulder to be tested in randomized trials. Keywords: Disability, Frozen shoulder, Pain, Platelet-rich plasma, Range of motion Introduction Frozen shoulder (FS) is a common disease that causes significant morbidity (1). The term frozen shoulder was first described in 1934 by Codman (2). Frozen shoulder affects the glenohumeral (GH) joint and limits active and passive movement because of adhesion and fibrosis in the GH capsule, which decreases joint space (3). Frozen shoulder is thought to have an incidence of 3-5% in the general population (4). The prevalence of FS in diabetic patients has been reported between 10-20% (5). No difference was found regarding the level of pain and disability of FS patients with or without diabetes (6). Although this disorder has a benign period and physicians think that this kind of disease improves after two or three years, in some cases disease symptoms and signs are permanent for patients. To the best of our knowledge, up to 40% of patients have permanent symptoms after three years (7, 8). Accurate diagnosis is of particular importance because the treatment approaches for these separate entities (subgroups) are different. Recent studies showed that magnetic resonance imaging (MRI) might provide reliable imaging indicators of FS. MRI is a satisfactory method for coracohumeral ligament (CHL) depiction so that a thickened CHL is highly suggestive of FS (9). Non-surgical treatment has been demonstrated to be beneficial for a great majority of patients with FS. The first treatment option for the recovery of these patients is rehabilitation. Passive mobilization and capsular stretching are two of the most commonly used techniques (1). Furthermore, corticosteroid injections might be the reason for long-term clinical problems such as increased probability of rupture, post-injection pain, subcutaneous atrophy and skin depigmentation (10). Platelet-rich plasma (PRP) is an autogenous concentration of human platelets in a small volume of plasma. Platelet-rich plasma development via centrifugation has been greatly simplified so that it can be used in office settings as well as operating rooms (11). The use of PRP has increased, given its safety as well as the availability of new devices for outpatient preparation and delivery (12). Platelet-rich plasma can produce collagen and growth factors and might increase stem cells, which consequently enhances the healing process by delivering high concentrations of alpha-granules containing biologically active moieties (such as vascular endothelial growth factor and transforming growth factor-β) to the areas of soft tissue damage (13). As this method has good results in the repair of tendons, muscles and ligaments and even fractures; and because there is no evidence of complications related to PRP injections and since we are not aware of the efficacy of the PRP injection on FS, we used PRP on a patient with FS.

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