Adhesive Capsulitis (“Frozen Shoulder”)

CAUSES

• Unknown (idiopathic) capsule inflammation and thickening (most common)
• Diabetes or thyroid disease can raise the risk
• Immobilization after shoulder injury or surgery

SYMPTOMS

• Progressive, significant loss of both active and passive shoulder motion
• Pain that is often worse at night
• Phases: painful “freezing” phase, stiff “frozen” phase, and a gradual “thawing” phase
• Difficulty with basic tasks like reaching behind the back or overhead

IMAGING

Frozen shoulder is usually a clinical diagnosis based on the exam. Shoulder X-rays help rule out arthritis or calcific tendinitis, and MRI is reserved for cases where the diagnosis is unclear.

CAN PRP HELP?

A network meta-analysis found PRP injected into the joint improved both pain and function compared with physical therapy alone at 12 weeks, and it was the only treatment studied that improved range of motion beyond physical therapy. It appears most effective in the early, painful “freezing” stage.

Leukocyte Preparation: Leukocyte-Poor

Dosing: Single or Short Series

Target Platelet Dose in Studied Protocols: 1.72–7.56 billion platelets across the positive trials informing ASPN’s emerging-indication note.

ASPN 2024 CONSENSUS GUIDELINE

Worth noting directly: adhesive capsulitis is not one of ASPN’s 49 formally graded consensus points — the guideline flags it only as an “emerging” indication, with dosing data drawn from positive trials rather than a consensus Level/Grade rating. We still find the independent network meta-analysis evidence reasonably compelling, which is why this page’s overall tier reads “Well-Supported” even though ASPN itself hasn’t formally weighed in with a grade yet.

Sources: D’Souza et al. (ASPN Consensus), Journal of Pain Research, 2024 · Berner et al., Rheumatology, 2024

FREQUENTLY ASKED QUESTIONS

Does PRP help frozen shoulder?

Yes. Studies show PRP injected into the joint improves both pain and motion better than physical therapy alone, and it is the only treatment shown to improve motion beyond therapy.

What’s the best stage of frozen shoulder for PRP?

PRP seems to work best in the early, most painful ‘freezing’ stage, before the shoulder becomes very stiff.

What causes frozen shoulder?

Often there is no clear cause. It is more common in people with diabetes or thyroid disease, and it can happen after a shoulder injury or surgery that limits movement for a while. 

Does PRP work better at a particular stage of frozen shoulder?

It appears most effective in the early, painful “freezing” stage. A network meta-analysis found intra-articular PRP improved both pain and function compared with physical therapy alone at 12 weeks, and was the only treatment studied that improved range of motion beyond physical therapy alone.

What PRP protocol is used for frozen shoulder?

Leukocyte-poor PRP, given as a single injection or a short series, with platelet doses in the positive trials ranging from about 1.72 to 7.56 billion.

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