Jun 30, 2025
Protocol for PRP Therapy with Physiotherapy for Shoulder Adhesive Capsulitis
- Abid Hasan Khan1,
- K M Amran Hossain1
- 1Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Bangladesh
- Musculoskeletal Medicine
Protocol Citation: Abid Hasan Khan, K M Amran Hossain 2025. Protocol for PRP Therapy with Physiotherapy for Shoulder Adhesive Capsulitis. protocols.io https://dx.doi.org/10.17504/protocols.io.36wgqpr9ovk5/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: June 28, 2025
Last Modified: June 30, 2025
Protocol Integer ID: 221218
Keywords: physiotherapy for shoulder adhesive capsulitis background, shoulder adhesive capsulitis, shoulder adhesive capsulitis background, managing adhesive capsulitis, adhesive capsulitis, patients with shoulder, approaches to frozen shoulder management, protocol for prp therapy, frozen shoulder management, prp therapy, sham prp with physiotherapy, shoulder pain, capsulitis, effectiveness of platelet, physiotherapy, combination with physiotherapy, shoulder, joint inflammation, prp, future integrative rehabilitation protocol, platelet, mobility due to joint inflammation, synovial fluid, evaluating muscle
Funders Acknowledgements:
Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore 7408, Bangladesh
Abstract
Background and Purpose: Adhesive capsulitis, or frozen
shoulder, leads to pain and reduced mobility due to joint inflammation and
fibrosis. While physiotherapy is the standard treatment, recovery is often a
slow process. Platelet-rich plasma (PRP), rich in growth factors, may enhance
healing. This study aims to evaluate the effectiveness of Platelet-Rich Plasma
in combination with physiotherapy on biomarkers, soft tissue morphology, and
function in patients with shoulder adhesive capsulitis.
Methods: From June to December 2025, a double-blinded
randomized control trial will be conducted at Jashore University of Science and
Technology, Bangladesh, enrolling 60 patients with shoulder adhesive
capsulitis. Participants will be randomly assigned to either PRP with
physiotherapy (experimental) or sham PRP with physiotherapy (control),
receiving 24 therapy sessions over 6 weeks. Primary outcomes include pain
sensitivity, blood cell counts from synovial fluid, and soft tissue morphology.
The secondary outcome is functional ability measured by Shoulder Pain and
Disability Index (SPADI) at multiple time points. Ethical approval and trial
registration will be obtained, and ICH-GCP guidelines will be followed. All
adverse effects will be monitored and reported.
Discussion: The findings from this trial
will highlight the synergistic effects of platelet-rich plasma (PRP) and
physiotherapy in managing adhesive capsulitis. By addressing both the
biological and mechanical contributors to the condition, the combined
intervention could offer greater improvements in pain modulation, soft-tissue
restoration, and functional outcomes compared to physiotherapy alone. Notably,
changes in blood biomarkers and soft-tissue morphology may provide deeper
insight into the therapeutic mechanisms of PRP. These results could inform
future integrative rehabilitation protocols and support more personalized
approaches to frozen shoulder management. However, long-term effects,
cost-effectiveness, and broader applicability should be explored in future
studies.
Conclusion: This study will provide
essential evidence on the effectiveness of PRP therapy in evaluating muscle
morphology and improving functional recovery in patients with adhesive
capsulitis. The findings will contribute to advancing diagnostic accuracy,
optimizing treatment strategies, and enhancing future research in musculoskeletal
rehabilitation.Background and Purpose: Adhesive capsulitis, or frozen
shoulder, leads to pain and reduced mobility due to joint inflammation and
fibrosis. While physiotherapy is the standard treatment, recovery is often a
slow process. Platelet-rich plasma (PRP), rich in growth factors, may enhance
healing. This study aims to evaluate the effectiveness of Platelet-Rich Plasma
in combination with physiotherapy on biomarkers, soft tissue morphology, and
function in patients with shoulder adhesive capsulitis.
Methods: From June to December 2025, a double-blinded
randomized control trial will be conducted at Jashore University of Science and
Technology, Bangladesh, enrolling 60 patients with shoulder adhesive
capsulitis. Participants will be randomly assigned to either PRP with
physiotherapy (experimental) or sham PRP with physiotherapy (control),
receiving 24 therapy sessions over 6 weeks. Primary outcomes include pain
sensitivity, blood cell counts from synovial fluid, and soft tissue morphology.
The secondary outcome is functional ability measured by Shoulder Pain and
Disability Index (SPADI) at multiple time points. Ethical approval and trial
registration will be obtained, and ICH-GCP guidelines will be followed. All
adverse effects will be monitored and reported.
Discussion: The findings from this trial
will highlight the synergistic effects of platelet-rich plasma (PRP) and
physiotherapy in managing adhesive capsulitis. By addressing both the
biological and mechanical contributors to the condition, the combined
intervention could offer greater improvements in pain modulation, soft-tissue
restoration, and functional outcomes compared to physiotherapy alone. Notably,
changes in blood biomarkers and soft-tissue morphology may provide deeper
insight into the therapeutic mechanisms of PRP. These results could inform
future integrative rehabilitation protocols and support more personalized
approaches to frozen shoulder management. However, long-term effects,
cost-effectiveness, and broader applicability should be explored in future
studies.
Conclusion: This study will provide
essential evidence on the effectiveness of PRP therapy in evaluating muscle
morphology and improving functional recovery in patients with adhesive
capsulitis. The findings will contribute to advancing diagnostic accuracy,
optimizing treatment strategies, and enhancing future research in musculoskeletal
rehabilitation.
Guidelines
CONSORT
Materials
Microscopic examination of Synovial fluid, MSK Ultrasound, Shoulder Pain and Disability Index (SPADI)
Troubleshooting
Eligibility Criteria
Inclusion Criteria:
Aged between 20 to 65 years.
Pain onset <3 months ago.
Shoulder pain aggravation when moving the shoulder joint.
Significant limitations of passive shoulder motion in more than one plane of the shoulder.
Exclusion Criteria:
Bilateral AC of the shoulder.
Previous GH joint injection within 6 months.
A history of using drugs due to adhesive capsulitis and surgery on the shoulder or manipulation under anaesthesia.
Neurologic deficits affecting shoulder functioning during ADL or diagnosed as brachial plexopathy by nerve conduction study (NCS).
Pain or disorders of the cervical spine, elbow, wrist or hand.
Contraindications to the injection procedure such as local cellulitis, septic arthritis, and acute fracture.
Study Sites with Contact Person
Musculoskeletal Lab Room - 301, Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Bangladesh.
Contact Person: Arafatuzzaman Babu. Email: [email protected] Phone: 01915900191.
Nurul Islam Orthopedic Rehabilitation and Physiotherapy Care, Jashore, Bangladesh.
Contact Person: Jahid Hasan. Email: [email protected] Phone: 01744129353.
Anticipated Date of Recruitment
20.07.2025
Study Method
Randomized Controlled Trial
Intervention Details
Experimental Group
PRP therapy: 4 mL of PRP mixed with 1 mL of 2% lidocaine in a 22-gauge spinal needle under aseptic conditions will be inserted in the affected joint.
Proprioceptive Neuromuscular Facilitation technique (PNF) Protocol: Shoulder Joint: D2 Flexion pattern (flexion+abduction+external rotation) Scapula: Anterior elevation and posterior depression then posterior elevation and anterior depression.
Capsular Stretching protocol: Caudal glide, posterior anterior glide, anterior posterior glide, Scapulothoracic articulation.
Rotator cuff strengthening exercise Protocol: Pendulum Swings, Isometric ER & IR (arm at side), Theraband exercise.
Control Group
Sham PRP therapy: 1 mL of 2% lidocaine in a 22-gauge spinal needle under aseptic conditions will be inserted in the affected joint.
Proprioceptive Neuromuscular Facilitation technique (PNF) Protocol: Shoulder Joint: D2 Flexion pattern (flexion+abduction+external rotation) Scapula: Anterior elevation and posterior depression then posterior elevation and anterior depression.
Capsular Stretching protocol: Caudal glide, posterior anterior glide, anterior posterior glide, Scapulothoracic articulation.
Rotator cuff strengthening exercise Protocol: Pendulum Swings, Isometric ER & IR (arm at side), Theraband exercise.
Treatment Duration
Both experimental and control group will receive physiotherapy intervention before performing the PRP injection for 30 mins; 4 times in a week up to 6 weeks. After completion of physiotherapy intervention, experimental group will receive a single dosage of PRP therapy while control group will receive a sham PRP therapy following same procedure.
Intervention Provider Qualification
Physiotherapist with Completed Bachelor and Master on Specific Discipline. PRP injections – by Orthopedic Surgeon.
Exercise Protocol Description
Proprioceptive Neuromuscular Facilitation technique (PNF)
Shoulder Joint: D2 Flexion pattern (flexion+abduction+external rotation) Scapula: Anterior elevation and posterior depression then posterior elevation and anterior depression.
Capsular Stretching
Caudal glide, posterior anterior glide, anterior posterior glide, Scapulothoracic articulation.
Rotator cuff strengthening exercise
Pendulum Swings, Isometric ER & IR (arm at side), Theraband exercise.
PRP Therapy
4 mL of PRP mixed with 1 mL of 2% lidocaine in a 22-gauge spinal needle under aseptic conditions will be inserted in the affected joint.