Incidence of Adhesive Capsulitis following Platelet Rich Plasma (PRP) Injection for Rotator Cuff Tendonopathy: A Retrospective Review

Abstract

Context: Platelet-rich plasma (PRP) is increasingly used for rotator cuff tendinopathy due to its potential to enhance tissue healing and improve patient reported outcomes. Overall, there are few adverse outcomes reported following PRP. However, it is theorized that its pro-inflammatory effects may contribute to adverse outcomes, including adhesive capsulitis (AC). The purpose of this study is to evaluate the incidence of adhesive capsulitis following PRP injection for rotator cuff tendinopathy and to identify associated risk factors.

Design: Retrospective Cohort

Methods: A retrospective chart review was conducted at a large academic medical center, identifying patients who underwent PRP injections for rotator cuff tendinopathy between January 2022 and September 2025. Inclusion criteria included symptomatic tendinopathy refractory to conservative management with imaging confirmation. Patients with fullthickness rotator cuff tears or glenohumeral arthritis were excluded. The primary outcome was development of AC within three months of injection. Associations between patient characteristics, injection variables, and AC were analyzed using t-tests and chi-square tests.

Results: Seventeen patients (21 injections) were included. Five patients (29.4%) developed AC within three months of PRP injection. There were no significant differences in age or BMI between groups. Among patients without pre-existing AC, three cases (20%) of new-onset AC occurred, all in patients who received concomitant glenohumeral joint injections (3/7 vs. 0/8; p = 0.038). Female sex was significantly associated with AC development (57.1% vs. 10%; p = 0.036). Two patients with pre-existing signs of capsulitis progressed to clinically significant AC following injection.

Conclusion: Adhesive capsulitis occurred in a notable proportion of patients following PRP injection for rotator cuff tendinopathy, particularly among females and those receiving glenohumeral injections. Patients with pre-existing capsular symptoms may be at elevated risk. These findings underscore the importance of careful patient selection, pre-procedural screening, and counseling. Larger prospective studies are needed to better define this risk.