Comparative Efficacy of Orthobiologics and Corticosteroid Injections in Adhesive Capsulitis Management

Objective(s): To compare the efficacy of orthobiologics including platelet-rich plasma (PRP) and hyaluronic acid (HA) against corticosteroid injections in adult patients with adhesive capsulitis (AC), a condition with a lifetime prevalence ranging from 2-5%, with an estimated 20% prevalence in diabetic patients. This review focuses on adult patients with AC, comparing impacts on pain relief and range of motion (ROM).

Data Sources: A literature search was conducted between January and February 2024 through PubMed and Google Scholar using keywords: "PRP", "Hyaluronic Acid", "Bone Marrow Aspirate", "Frozen Shoulder", "Periarthritis", "Adhesive Capsulitis", "Corticosteroid Injections.”

Study Selection: Studies were included in the initial search if they met the following inclusion criteria: published between Jan 2019 - Feb 2024 and used corticosteroids as a comparison for orthobiologic treatment. The initial search yielded 47 studies, refined to 21 after applying eligibility criteria. Six studies, including randomized and non-randomized trials, were selected, focusing on AC treatment with orthobiologics vs. corticosteroid injections.

Data Extraction: PRISMA guidelines were followed and data from the evaluated six studies were independently extracted by multiple observers. Analysis considered confounders and cointerventions, including pain relievers and outpatient physical therapy regimens.

Data Synthesis: Qualitative data analysis demonstrated that studies with three month or longer follow-ups with patients demonstrated better long-term efficacy in pain reduction and ROM improvement, as measured by VAS, SPADI, and DASH scores with PRP or hyaluronic acid injections, compared to immediate relief from corticosteroid injections.

Conclusions: The review highlights the potential of orthobiologics as a promising alternative or adjunct to corticosteroid injections in managing AC. While corticosteroids provide rapid relief, most studies showed that orthobiologics provided greater pain relief and improvement of shoulder ROM & functioning, especially in long term measurements. Future studies can compare the efficacy of different orthobiologics on AC treatment.

Author(s) Disclosures: All authors involved affirm that there are no personal, financial, or professional affiliations that could be perceived as a conflict of interest in presenting this work.