Journal CME September 2025, Comparative efficacy of platelet rich plasma, hyaluronic acid, and corticosteroid injections in adhesive capsulitis management: A meta-analysis-PM R - 2025 - Valencia - Comparative efficacy of platelet rich plasma hyaluronic acid and corticosteroid injections in

PM R - 2025 - Valencia - Comparative efficacy of platelet rich plasma hyaluronic acid and corticosteroid injections in

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This 2025 systematic review and meta-analysis by Valencia et al. evaluates the comparative efficacy of platelet-rich plasma (PRP), hyaluronic acid (HA), and corticosteroid injections in managing adhesive capsulitis (AC), commonly known as frozen shoulder. AC causes fibrosis and contracture of the shoulder joint capsule, leading to pain and limited range of motion (ROM). While corticosteroids are widely used for symptom relief, their side effects, especially in patients with comorbidities like diabetes, prompt investigation of orthobiologics like PRP and HA as alternatives.<br /><br />The authors performed a comprehensive literature search (2019-2024), selecting six relevant studies comparing one-time orthobiologic injections to corticosteroids in adults with AC. Key measured outcomes included pain via visual analog scale (VAS) and functional scores—Disabilities of the Arm, Shoulder, and Hand (DASH), Shoulder Pain and Disability Index (SPADI), and UCLA Shoulder score—assessed at 3 and 6 months post-injection.<br /><br />Qualitative analysis suggested PRP and HA offer superior long-term benefits over corticosteroids, particularly beyond 3 months, with enhanced pain reduction and improved shoulder function. Quantitatively, meta-analysis demonstrated no significant difference in pain or function at 3 months. However, at 6 months, PRP showed statistically significant and clinically meaningful improvements in pain (VAS SMD -1.31) and function (DASH SMD -1.23; UCLA SMD 0.74) compared to corticosteroids. HA showed a non-significant trend toward benefit but with fewer studies available for analysis.<br /><br />The study noted substantial heterogeneity across included trials (I^2 often >80%), attributed to variations in study design, injection protocols, patient demographics, follow-up timing, and outcome measures, complicating definitive conclusions. Limitations include small sample sizes, inconsistent reporting of methodology (e.g., injection approach, ultrasound use), and lack of standardized MCID (minimal clinically important difference) adherence.<br /><br />Overall, the review supports orthobiologics, especially PRP, as promising alternatives or adjuncts to corticosteroids in AC management, providing better long-term pain relief and function improvements without corticosteroid-related side effects. The authors call for larger, well-designed randomized controlled trials with standardized protocols, longer follow-ups, and uniform outcome assessments to confirm these findings and optimize treatment strategies for adhesive capsulitis.

Keywords

adhesive capsulitis

frozen shoulder

platelet-rich plasma

hyaluronic acid

corticosteroid injections

pain management

shoulder function

meta-analysis

orthobiologics

randomized controlled trials