Platelet-Rich Plasma (PRP) for Frozen Shoulder

Frozen Shoulder Overview

While you may not be familiar with adhesive capsulitis, frozen shoulder cases are more common than you’d think. Today, it is estimated that up to 5% of the population will suffer from at least one episode of frozen shoulder in their lifetime.

Primarily, a frozen shoulder causes stiffness in the glenohumeral joint in the shoulder. This joint connects the head of the humerus (the top of your arm bone) to the scapula (shoulder blade). The glenohumeral joint is a “ball and socket” joint, where the head of the humerus is the “ball” and the glenoid cavity of the scapula is the “socket.” These two components of the joint are surrounded by cartilage, synovial fluid, and connective tissue, which keeps them mobile, lubricated, and protected from friction damage.

When this connective tissue becomes inflamed, it can thicken, grow, and swell, thus preventing the components of the joints from contracting and expanding as needed during shoulder movements. Prolonged inflammation can also lead to the development of scar tissue (adhesions), which bind components of the joint together and further restrict movement. This is known as “frozen shoulder.”

What causes adhesive capsulitis isn’t well understood, but there are some risk factors that may increase your likelihood of developing this disorder. These include:

• Immobilization: If you are forced to keep your shoulder still for too long, you may be at risk of developing adhesive capsulitis. According to a 2016 study, this is because immobilization causes inflammatory cells to infiltrate the synovial fluid around the joint, thus causing the joint’s capsule to swell and thicken. Shoulder immobilization often occurs when patients are recovering from a stroke, an injury (such as fractures), or surgery (such as mastectomy). 
• Diabetes and other chronic diseases: Studies have shown that, in people with diabetes, the risk of a frozen shoulder increased fivefold. Other diseases that are risk factors for adhesive capsulitis include thyroid dysfunction, cardiovascular disease, and Parkinson’s disease.
• Age and gender: Given the smaller shoulder frame, females are at greater risk of developing this condition. Peak incidence is in adults aged between 40 and 60.

Symptoms Of Frozen Shoulder

Frozen shoulder develops over time, usually in three phases:

• Freezing – During the initial stage of adhesive capsulitis, you are likely to experience intense shoulder pain, which intensifies with movement. To avoid such pain, you may prefer to keep your shoulder still. However, immobilization contributes to inflammation, which causes the joint’s capsule to become thicker and stiffer. This stage can last for up to nine months.
• Frozen – In this phase, the development of inflammation, swelling, and scar tissue begins to restrict shoulder movement. While you may no longer experience intense pain but just mild discomfort, a frozen shoulder prevents you from performing simple movements like lifting your arm overhead. The “frozen” stage can last up to a year. 
• Thawing – In the thawing phase, you’ll slowly begin to regain shoulder function. However, this phase can last anywhere between five and 24 months.

During the development of a frozen shoulder, you are likely to experience a range of symptoms, including:

• Shoulder pain, which usually appears as dull or aching, and reaches peak intensity during the “freezing” stage
• Pain that radiates from the outer aspect of the shoulder into the upper arm
• Inhibited range of motion 
• Swelling, stiffness, and sensations of warmth

Conventional Treatment Options

The most common lines of treatments for adhesive capsulitis involve pain medications, corticosteroid injection, and, in severe cases, surgery. However, before choosing one of these traditional therapies, it is important to understand that frozen shoulders can last up to three years.

Taking pain medications chronically for such extended periods of time can lead to severe side effects, including dependency. Below, we’ll look at the treatments commonly prescribed for adhesive capsulitis – but given the nature of this condition, it is paramount to look beyond medications and surgery to treat your frozen shoulder.

Corticosteroid Injections

Corticosteroids are a synthetic version of cortisol, which is a hormone naturally produced by the body. This chemical is responsible for regulating the inflammatory response and regulating pain levels.

Corticosteroids are usually delivered via injections directly into the shoulder joint. Each injection contains crystals that release cortisol over time. This offers longer-lasting relief from pain compared to pain medications.

Nonetheless, studies have shown that corticosteroids may not be the safest or most efficient treatment option for some musculoskeletal conditions. Taking corticosteroids regularly can lead to dysfunction of the adrenal glands (which are responsible for producing cortisol), as well as cartilage degeneration.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX enzyme, which is the enzyme responsible for producing prostaglandins. Prostaglandins are the chemicals in charge of triggering the inflammatory response. When the production of prostaglandins is inhibited, the levels of inflammation – and, therefore, pain – decrease.

While NSAIDs can temporarily relieve pain and stiffness, in the long term, they can lead to a cascade of side effects, including:

• Increased risk of heart attack and stroke
• Stomach ulcers
• Kidney dysfunction 
• Addiction

Manipulation Under Anesthesia

If medications have not helped your frozen shoulder, your doctor may recommend therapies such as shoulder manipulation. After you are put to sleep with anesthesia, the surgeon will manipulate the shoulder to force it to move. This tears the scar tissue that has been building up and frees up the joint capsule, thus increasing the range of motion.

This therapy may help increase your shoulder mobility but comes with significant risks, including fractures, dislocations, and long-lasting joint instability.

Hydrodilatation

Hydrodilatation is an invasive procedure that involves injecting a large volume of sterile fluids, local anesthetic, and steroids into the shoulder joint. The fluids will expand and stretch the joint capsule, which can help you regain partial joint function. This treatment option can lead to shoulder pain, as well as risks such as joint capsule rupture.

Shoulder Arthroscopy

Shoulder arthroscopy is a low-invasive surgical procedure that involves inserting a thin viewing instrument into the shoulder joint via small incisions. The instrument can be used to obtain detailed images of the internal part of the joint, determine the extent of damage and inflammation, and choose a treatment option.

During the same operation, the surgeon may clean up the joint from debris and cut through the scar tissue that may be binding the joint’s components together. Aside from common surgical risks such as blood clotting and infection, arthroscopy can also lead to tissue or nerve damage and comes with lengthy recovery times.

What Is Platelet-Rich Plasma, Or PRP?

Platelet rich plasma, or PRP, refers to a form of therapy that uses samples of a patient’s blood, processed to maximize the concentrations of platelets in the plasma. Platelets are a component of the blood responsible for several of the processes involved with the healing of wounds and damaged tissues, such as blood clotting.

Platelets are also exceptionally rich in growth factors, which are contained in “packets” called alpha granules. Growth factors are proteins capable of stimulating the activity of repair cells around the site of injury – as well as calling to action repair cells from across the body to the areas in need.’

Simply, growth factors are like “espresso shots” that are able to amplify the healing power of repair cells. Given the high concentrations of growth-factor-rich platelets in platelet rich plasma, PRP represents a simple, efficient, and non-invasive way of delivering growth factors to damaged body tissues.

PRP for Frozen Shoulder

Due to the ability of PRP to support the body’s own healing capabilities, this is considered a form of regenerative medicine. In regenerative orthopedics, PRP can help treat a variety of conditions, including minor arthritis, joint instability, ligament or tendon tears, and muscle strains.

To this day, there are over 30 randomized trials available showing the efficacy of PRP to help the body heal itself by means of stimulating stem cells around the damaged tissues.

In particular, in the treatment of frozen shoulders, PRP has been seen to be a safer and more efficient alternative to traditional treatment options such as corticosteroid injections. A 2022 study highlights that PRP can reduce pain in people with adhesive capsulitis by 50% or more. At the same time, 2016 research shows that a single platelet-rich plasma injection can lead to a 60% improvement in daytime shoulder pain and no nighttime pain, while also improving shoulder range of motion and function by 70%.

More recent studies published in September 2022 and May 2023 confirm the superior efficacy and safety of PRP compared to standard lines of treatment such as corticosteroid injections, manipulation under anesthesia, and triamcinolone, especially in the long term.

Why Are Orthagenex PRP Injections Superior?

As we have seen above, in general, PRP is an innovative, more efficient, and safer alternative to pain medications or surgery for adhesive capsulitis. But not all platelet rich plasma is created equally: the concentrations of platelets and the purity of the solutions matter most in the treatment of musculoskeletal conditions.

At Orthagenex, our goal is to offer superior and entirely customized injections that lead to optimal outcomes and full patient satisfaction. To achieve this, we use a proprietary protocol known as super concentrated platelets (SCP).

SCP involves the use of imaging guidance, specialized cell lab environments, and injections performed by uniquely trained physicians. Here’s how Orthagenex is able to offer better, purer, and more concentrated PRP formulations:

Image-Guidance To Place PRP Solutions

Not using imaging guidance can compromise the results of any PRP therapy: injections performed blindly miss the target locations 20-40% of the time. Nonetheless, today, most orthopedic clinics offering PRP do not use any form of imaging guidance – and those that do are not able to rely on physicians trained to interpret results.

At Orthagenex, our specialists leave nothing to chance when it comes to achieving the best outcomes. To deliver PRP exactly to the area in need, we combine two of the most advanced imaging guidance tools available: ultrasound guidance and fluoroscopy.

• Ultrasound guidance: This form of imaging guidance uses ultrasound waves to deliver real-time images of the location of the needle from the moment it enters the skin. 
• Fluoroscopy: Using a C-shaped mechanical arm, fluoroscopy offers real-time X-ray images of needle placement during PRP injections.

These tools, combined with the expertise of physicians trained in performing imaging guidance and interpreting results, allow the team at Orthagenex to reduce reliance on tactile sensations and improve needle placement accuracy.

The innovative protocols introduced by Orthagenex have paved the way for the emergence of interventional orthopedics, which is a new, recognized field of medicine based on three principles:

• The use of injections – such as PRP – to promote the healing of tissues
• The use of imaging guidance to maximize needle placement accuracy, and
• The continuous improvement of injection formulations and delivery techniques

Lab-Processed For Higher Concentrations Of Platelets

There are three main aspects that can influence the efficiency of PRP injections:

• The concentrations of platelets
• The purity of the formulations
• The customization of each injection to the patient’s needs

However, most clinics across the US offering PRP today create PRP injections using standard centrifuge machines, which are not powerful enough to optimize platelet concentrations – nor efficient in removing unfavorable components. To make things worse is the fact that standard PRP injections are created bedside and immediately delivered to the patient, which means that no customization happens in the process. 

In stark contrast with this standard procedure, Orthagenex uses in-house and state-of-the-art cellular lab environments. After collection, the patient’s blood sample is delivered to these laboratories located within each clinic. Here, extremely concentrated, purer, and entirely customized PRP injections are created to meet each patient’s health needs. 

Here’s how the Orthagenex protocol compares to the standard procedures used by other orthopedic clinics:

Amber PRP vs. Red PRP

PRP can take two forms: red PRP and amber PRP. The color of the injectate tells a lot about its level of pureness and platelet concentrations – and it may even predict the outcome of each injection.

Here’s the difference between the two formulations:

• Red PRP: Red PRP (leukocyte-rich PRP or LR-PRP) contains high concentrations of platelets as well as white and red blood cells. It’s usually the result of standard bedside centrifuge machines. 
• Amber PRP: Amber PRP (leukocyte-poor PRP or LP-PRP) is poor in white and red blood cells, and high in platelets. Amber PRP can be achieved through a specialized lab that is efficient in concentrating platelets and removing unfavorable substances.

According to our lab tests, red PRP can have a counteractive effect. This is because the presence of white and red blood cells in the mixture may have an inflammatory effect around the site of injection. What’s more, these components of the blood have an inhibiting effect on stem cells – which are the same cells that the platelets in PRP are attempting to stimulate.

On the other hand, amber PRP is purer, which makes it less inflammatory and more efficient in stimulating the body’s ability to repair damaged tissues. This characteristic makes amber LP-PRP the formulation of choice at Orthagenex.

Next-Generation Platelet Lysate

Platelet lysate (PL) injections work similarly to PRP: they, too, leverage the stimulating power of platelets on stem cells and other repair cells. However, this more advanced form of treatment offers unique characteristics that make it preferable in certain cases, such as in the treatment of sensitive areas around nerves.

Here are the differences between PRP and PL:

Depending on your unique health needs, Orthagenex can offer PL therapy in combination with or instead of PRP.

While standard orthopedic practices are just starting to offer platelet lysate injections, Orthagenex has been using this injectate for years. Today, we are able to make available the third and fourth generations of PL injections, and our focus remains on improving the concentrations and pureness of each injectate to provide each patient with superior treatment plans.

PRP Customized To Every Patient’s Need

Frozen shoulder manifests itself with a wide range of symptoms and can have a profound impact on a person’s life. But no two cases of adhesive capsulitis are exactly the same. Because of this, it is important to understand that a standard, one-size-fits-all approach to treatment should never be an option to consider.

At Orthagenex, we customize each treatment to achieve better outcomes and full patient satisfaction. To do so, we leverage our lab-processed PRP solutions and we combine PRP with other regenerative medicine therapies like bone marrow concentrate and platelet lysate.

Solutions Are Customized Using Lab-Processed PRP Solutions

Unlike standard bedside centrifuge machines, the state-of-the-art cellular lab environments used at Orthagenex to create injections allow our physicians to tap into unparalleled customization potential.

Specialized physicians carry out each step of the procedure to finetune machine settings, boost platelet concentrations, reduce unfavorable materials, and ultimately, create superior formulations.

Bone Marrow Concentrate Can Be Used

Bone marrow concentrate (BMC) is another regenerative therapy that can be used alongside PRP. The aim of BMC is to deliver high concentrations of stem cells to the areas in need (the shoulder, in the case of adhesive capsulitis).

The stem cells are harvested by creating a small tunnel into the bone, usually near the pelvis. The stem-cell-rich bone marrow is then concentrated and purified to maximize efficiency. It is then injected into the injured area to replenish the levels of stem cells, promote healing, and support the regeneration of damaged tissues.

Doctors Specializing in Interventional Orthopedics

As seen above, Orthagenex is able to offer super-concentrated platelets thanks to state-of-the-art lab environments and imaging guidance. But none of this would be possible without the expertise and experience of our team of highly trained physicians.

Each doctor at Orthagenex is:

• A musculoskeletal (MSK) expert
• A specialist in imaging guidance
• Board-certified
• Fellowship-trained in interventional orthopedics

Today, only 1% of doctors in the US are trained in interventional orthopedics. Because of this, Orthagenex has been able to help more orthopedic patients than other regenerative medicine clinics worldwide.

Core Competencies

• Using imaging guidance to boost needle placement accuracy during PRP injections
• Using our lab-processed PRP solutions to ensure that each injection is customized, pure, and entirely customized to the patient’s needs. 
• Choosing purer amber LP-PRP as the PRP injection of choice
• Offering other interventional orthopedics therapies alongside PRP, including platelet lysate (PL) and bone marrow concentrate BMC
• Using a proprietary method of evaluation: SANS

SANS (Stability, Articulation, Neuromuscular, and Symmetry) is an innovative evaluation protocol designed to offer patients accurate diagnoses of their pain conditions – and, in turn, recommend more efficient treatment plans.

Today, over a quarter of the population suffers from shoulder pain. However, shoulder conditions can often have overlapping symptoms, making diagnosing the cause of pain challenging – especially when standard diagnostic tools are used.

The SANS approach allows the physicians at Orthagenex to more accurately diagnose the cause of chronic pain, as well as the risk factors, extent, location, and nature of pain and inflammation. These insights provide invaluable guidance in the process of finding the best line of treatment for each patient.

Orthagenex – Your Alternative To Shoulder Surgery

Although, in most cases, a frozen shoulder resolves by itself, the pain, stiffness, and discomfort can last for months or years. During this time, you may suffer profound consequences, including disability, struggles in your daily life, and reduced performance at work.

This picture is further aggravated by the fact that you may be enduring the side effects of medications or living in fear of surgery. Fortunately, you can put these struggles behind you. Thanks to the superior PRP therapies offered at Orthagenex, you can ease the pain deriving from a frozen shoulder in an efficient, non-invasive, and non-pharmaceutical way.