INTRODUCTION:

Periarthritis first described by Duplay in 1896, frozen shoulder was later referred to as such by Codman in 1932 and adhesive capsulitis by Nevaiser. Periarthritis of the shoulder is characterised by a loss of passive and active shoulder mobility.¹ Incidence stands at 2-5% in the general population^2,3 with a higher prevalence among females, particularly in the 40-60-year age group.^4,5

Periarthritis shoulder is thought to be caused by adhering axillary recess, constricted soft tissues, and shoulder capsule adhesions, all of which impede shoulder mobility. However, the exact origin of the condition is unknown.⁶

Primary periarthritis occurs without a known cause, while secondary periarthritis follows trauma or joint-related injuries. Risk factors include diabetes, thyroid disease, and autoimmune disorders.^7,8 The progression of periarthritis occurs in four stages. First phase is the inflammatory phase in which patients feel discomfort during both passive and active shoulder movement. At this point, range of motion is largely unaffected. Phase two, sometimes referred to as the freezing phase, is characterised by increased discomfort and decreased range of motion. Phase three (Frozen phase) is characterised by stiffness and limited use of the arms because the capsular contraction limits external rotation, abduction, and flexion of the shoulder. Ultimately, phase four, or the recovery phase, lasts between 12 to 42 months and is characterised by a progressive return of shoulder joint mobility along with a steady improvement in range of motion.⁹

Treatment options include physical therapy, pharmacological interventions like analgesics and corticosteroids, and procedures such as manipulation under anaesthesia and capsular release.¹⁰ Since the 1990s, platelet-rich plasma (PRP) has played a significant role in medicine, serving both therapeutic and cosmetic purposes.¹¹ Platelet-rich plasma (PRP) injections have gained attention for their regenerative potential, with studies suggesting their efficacy in immune-mediated and inflammatory conditions like frozen shoulder.¹² While corticosteroid injections have been effective, their notable side effects have spurred the exploration of alternatives such as PRP.¹³

Upon injection, platelet degranulation occurs, releasing growth factors such as Transforming Growth Factor-Beta (TGF-beta), Platelet-Derived Growth Factor (PDGF), Epidermal Growth Factor (EGF), Vascular Endothelial Growth Factor (VEGF), Fibroblast Growth Factor (FGF), and Insulin-Like Growth Factor. These growth factors are believed to possess regenerative properties and may mitigate inflammatory effects on chondrocytes by modulating Nuclear Factor Kappa-Light-Chain-Enhancer of Activated B Cells (NF-kB) and Interleukin 1 (IL-1) pathways.¹⁴

To assess the efficacy of PRP versus corticosteroids in periarthritis, a randomised trial was conducted. The hypothesis posited PRP as more effective in pain relief and functional improvement. Previous studies outside India have compared these treatments, while limited research within India, notably by Kothari et al.,¹³ and Kumar et al.,¹⁵ addressed this comparison. However, a study by Barman et al.¹⁶ Thus, the purpose of this study was to compare the effectiveness of PRP and corticosteroids in treating periarthritis in Northern Indian patients with a 6-month follow-up.

MATERIALS AND METHODS:

The study was conducted in a tertiary care centre with a prospective randomised clinical design. From August 2021 to December 2022, fifty patients diagnosed with periarthritis shoulder from the outpatient department (OPD) were recruited after giving written informed consent. The study procedures were explained to the participants in their native language. Randomisation was done on the basis of the lottery system and divided into two groups.

The study focuses on patients over 30 years of age who present with shoulder pain lasting at least one month, accompanied by a loss of more than one-third of active shoulder flexion, abduction, and external rotation and normal shoulder radiograph. Patients with history of trauma or surgical intervention to the shoulder, local injection, with intrinsic shoulder pathology or pain attributable to other causes and patients with haematological/platelet disorders and co morbid conditions were excluded.

Procedure:

A pre-designed form was used to record all relevant information about the patients' history, clinical features, examination results, and past therapies. All patients underwent routine blood tests and radiographic evaluations of their cervical spines and affected shoulders. Povidone-iodine and ethyl alcohol were used to prepare the skin for the injection. The first group received 2mL of triamcinolone (40mg/mL) and 2% lignocaine, whereas the second group received 2mL of PRP. PRP was made by drawing approximately 15mL of the patient's blood and centrifuging it twice. The platelet count in the PRP preparation was evaluated, and newly prepared PRP was used for injection within 30 minutes of preparation to keep its functional properties. Post-injection oral paracetamol (650mg twice a day) for 5-7 days was prescribed to relieve pain discomfort, and patients were advised to avoid strenuous activity for the first two weeks after the injection. Physiotherapy was advised for both groups.

Assessment and Follow-up:

Demographic information, baseline clinical findings, pain duration, and afflicted side dominance were noted at the time of registration. All patients in both groups were scheduled for follow-up appointments at 1, 3, and 6 months after injection. At each follow-up, the Visual Analog Scale (VAS) and the Disabilities of Arm, Shoulder, and Hand (DASH) score were used to measure pain and function, respectively. Any negative consequences were noted.

Evaluation tools:

The primary evaluation measure was pain reduction using the Visual Analog Scale. Secondary outcomes included assessment of functional improvement using the DASH scores.

RESULT

For the trial, 50 patients in total were enrolled, and they were split evenly into two groups at random. Table 1 displays the mean age, sex distribution, side involvement, and symptom duration that were comparable between the two groups, with p-values indicating no statistically significant differences.

Table 1: Demographic characteristics of study participants

Variables	Steroid group	PRP group	P- value
Age in years (Mean±SD)	45.80±6.86	46.70±7.64	0.6632
Sex
Male	11	10	0 .7744
Female	14	15	0 .7744
Side of involvement
Dominant	10	9	0 .7707
Non- dominant	15	16	0 .7707
Symptoms duration in months (Mean ± SD)	2.64± 0.76	2.83±1.04	0.4644

SD: standard deviation

Table 2: Comparison of pain and functional outcome.

Parameter	Steroid (Mean ±SD	PRP (Mean±SD)	P-value
VAS Score
Baseline	70.10 ± 6.20	68.20 ± 4.50	0.186
1 month	45.80 ± 8.00	51.20 ± 5.50	0.103
3 months	31.50 ± 10.00	43.00 ± 3.50	0.0002*
6 months	31.80 ± 7.00	14.00 ± 3.50	0.0001*
DASH Score
Baseline	76.00 ± 6.20	78.00 ± 7.00	0.210
1 month	42.80 ± 5.50	45.40 ± 5.00	0.073
3 months	36.20 ± 5.00	34.00 ± 4.00	0.084
6 months	31.60 ± 4.00	18.00 ± 8.00	0.0001*

Note:* Indicates statistically significant difference (P < 0.05)

The comparison between Triamcinolone and PRP groups as shown in table 2 reveals significant findings regarding pain and functional outcomes measured by VAS score and DASH scores at pre-decided time points. At the baseline, VAS or DASH scores were comparable between the two groups. However, as treatment progressed, notable distinctions emerged. By the 3 and 6 Months, the PRP group exhibited significantly lower VAS scores compared to the Triamcinolone group, indicating a greater reduction in pain intensity. Similarly, DASH scores, reflecting functional impairment, showed significant improvements favouring the PRP group at the 6 Months, indicating enhanced functional recovery compared to the Triamcinolone group. These findings suggest that PRP may offer superior long-term benefits in terms of pain relief and functional improvement compared to Triamcinolone for individuals with periarthritis of the shoulder.

DISCUSSION:

Shoulder periarthritis, another name for frozen shoulder, is characterised by pain/discomfort and stiffness that gradually worsens and causes the glenohumeral joint to lose its ability to move both passively and actively.¹³ Management options for frozen shoulder are physical therapy, local injection, hydrodilation, manipulation under anaesthesia and surgery.^1,17 Triamcinolone with anti-inflammatory and anti-fibrotic properties, is commonly used for intra-articular injections.¹⁵ Platelet-rich plasma (PRP) possesses the capacity to stimulate collagen production, promote the release of growth factors, and potentially amplify the activity of stem cells, thereby augmenting the healing process.¹⁴ This study aims to compare the effectiveness of intra-articular triamcinolone and PRP injections in treating periarthritis shoulder.

Fifty patients of frozen shoulder, aged between 32 to 67 years, were included in this study. The fifth decade of life had a greater disease incidence, which is in line with other research.^13,18 Female patients exhibited a higher prevalence of periarthritis than males, and the non-dominant side was more commonly affected, aligning with existing literature.^19,20

The study assessed VAS scores and DASH scores at initial presentation, 1, 3 and 6 Months after injection. The Triamcinolone group showed notable progress in VAS scores compared to the PRP group at 3 and 6 months. While both groups exhibited reduced DASH scores at 3 and 6 Months, the difference was statistically significant at 6 months. These findings contrast with Barman et al., study, which found no significant difference in pain and disability scores between PRP and corticosteroid injections at three weeks.¹⁶

At 6 months, the PRP group demonstrated substantial improvements in both VAS and DASH scores in comparison to the triamcinolone group. PRP's long-term efficacy is in line with earlier studies by Kumar et al.,¹⁵ and Kothari et al.¹³

The study suggests that while both steroid and PRP injections improve VAS and DASH scores at 3 months, PRP may offer superior long-term outcomes. Steroids efficacy may diminish over time, as reported in studies comparing steroid injections to physiotherapy for adhesive capsulitis.^21,22

In conclusion, while steroid injections provide short-term relief, PRP injections may offer longer-lasting benefits in treating periarthritis. This study contributes to the growing body of evidence supporting PRP as a promising alternative for managing frozen shoulder. Further research is warranted to explore optimal treatment protocols and long-term outcomes for PRP therapy in periarthritis management.

It's crucial to recognize some of the study's shortcomings, though. The study had a relatively small sample size and follow-up duration was restricted to six months. Multicenter, longer-term controlled trials with bigger sample sizes are necessary to assess the safety and effectiveness of platelet-rich plasma (PRP) therapy in comparison to corticosteroid injections for the treatment of shoulder periarthritis.

CONCLUSION:

This research offers significant perspectives on relative efficacy of platelet-rich plasma (PRP) versus triamcinolone intra-articular injections for the treatment of shoulder periarthritis.

While both triamcinolone and PRP injections demonstrated improvements in pain and functional outcomes, the PRP group exhibited superior long-term benefits. Our results suggest that PRP may offer prolonged relief and enhanced functional improvement compared to triamcinolone for individuals with periarthritis of the shoulder.

CONFLICT OF INTEREST:

There was no conflict of interest.

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Received on 19.04.2024 Revised on 17.08.2024

Accepted on 23.11.2024 Published on 01.07.2025

Available online from July 05, 2025

Research J. Pharmacy and Technology. 2025;18(7):3085-3088.

DOI: 10.52711/0974-360X.2025.00442

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.