Efficacy of Pericapsular Platelet-Rich Plasma Injection Combined With Brachial Plexus Block-Assisted Manipulation in Adhesive Capsulitis: A Randomized Controlled Trial.

Adhesive capsulitis causes severe shoulder pain and functional limitation, and single treatment modalities often fail to prevent relapse after manipulation under anesthesia. In this randomized controlled trial, we examined whether adding ultrasound-guided multitarget platelet-rich plasma injections to manipulation under brachial plexus block could improve pain, function, and health-related quality of life. We enrolled 68 adults with adhesive capsulitis confirmed by magnetic resonance imaging and randomly assigned them to manipulation plus standardized rehabilitation or to the same regimen plus pericapsular platelet-rich plasma injections at baseline, two weeks, and one month. Blinded assessors evaluated outcomes before treatment and at one day, 2 weeks, 1 month, and 3 months. The primary endpoint was shoulder pain on the visual analogue scale at end. Secondary endpoints included the Disabilities of the arm, shoulder, and hand questionnaire; the Oxford shoulder score, the 36-Item Short Form Health Survey; the Constant Murley shoulder score, and serum inflammatory marker levels. The combined strategy led to faster and more pronounced pain relief, with clinically meaningful differences between group immediately after treatment and at the 3-month follow-up. In addition, patients who received platelet-rich plasma showed greater gains in shoulder function and health-related quality of life, and a higher proportion of them reached predefined thresholds for clinically important improvement. Short-term changes in inflammatory markers were exploratory and nonspecific and should not be interpreted as evidence of a causal immunomodulatory effect. Taken together, these findings suggest that multitarget platelet-rich plasma combined with manipulation under brachial plexus block was well tolerated in this trial and was associated with significant short-term improvement in pain and function for patients with adhesive capsulitis.