Effectiveness of Shock Wave Therapy versus Intra-Articular Corticosteroid Injection in Diabetic Frozen Shoulder Patients’ Management: Randomized Controlled Trial

Ahmed Ebrahim Elerian,Mahmoud S El Fakharany,Hend Adel Dorgham,David Rodriguez-Sanz,Dina Mohamed Ali Al-Hamaky,Mahmoud Ewidea,Abdelaziz Abdelaziz Elsherif

doi:10.3390/app11083721

Ahmed Ebrahim Elerian, Mahmoud S El Fakharany + Show 5 more

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https://doi.org/10.3390/app11083721

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Abstract

Frozen shoulder is a major musculoskeletal illness in diabetic patients. This study aimed to compare the effectiveness of shock wave and corticosteroid injection in the management of diabetic frozen shoulder patients. Fifty subjects with diabetic frozen shoulder were divided randomly into group A (the intra-articular corticosteroid injection group) and group B that received 12 sessions of shock wave therapy, while each patient in both groups received the traditional physiotherapy program. The level of pain and disability, the range of motion, as well as the glucose triad were evaluated before patient assignment to each group, during the study and at the end of the study. Compared to the pretreatment evaluations there were significant improvements of shoulder pain and disability and in shoulder flexion and abduction range of motion in both groups (p < 0.05). The shock wave group revealed a more significant improvement the intra-articular corticosteroid injection group, where p was 0.001 for shoulder pain and disability and shoulder flexion and abduction. Regarding the effect of both interventions on the glucose triad, there were significant improvements in glucose control with group B, where p was 0.001. Shock waves provide a more effective and safer treatment modality for diabetic frozen shoulder treatment than corticosteroid intra-articular injection.

Highlights

Many painful musculoskeletal conditions that interfere with regular daily activity, including trigger finger, carpal tunnel syndrome, osteoarthritis, and frozen shoulder, are associated with diabetes mellitus (DM) [1]
Many studies had approved positive effects of oral nonsteroidal anti-inflammatory agents and oral glucocorticoids on pain management and the improvement of the range of motion in diabetic frozen shoulder patient, but without any longer effect than a few weeks [6]; hydro-dilatation accompanied with manipulation under anesthesia is considered an effective method for resolving the condition of Adhesive capsulitis (AC), but with the risk of anesthesia complications [6], while several studies approved many physiotherapy modalities such as ultrasound therapy, stretching exercises, manual mobilization and strengthening exercises as well-established conservative management techniques [7,8]
After 2 and 3 months of treatment, Group A and Group B showed a significant difference in Shoulder Pain and Disability Index (SPADI) score, shoulder flexion range of motion (ROM), shoulder abduction ROM, FBG, and PPBG, as well as for Hemoglobin A1c (HbA1c) after 3 months of treatment (

Summary

Introduction

Many painful musculoskeletal conditions that interfere with regular daily activity, including trigger finger, carpal tunnel syndrome, osteoarthritis, and frozen shoulder, are associated with diabetes mellitus (DM) [1]. Many studies had approved positive effects of oral nonsteroidal anti-inflammatory agents and oral glucocorticoids on pain management and the improvement of the range of motion in diabetic frozen shoulder patient, but without any longer effect than a few weeks [6]; hydro-dilatation accompanied with manipulation under anesthesia is considered an effective method for resolving the condition of AC, but with the risk of anesthesia complications [6], while several studies approved many physiotherapy modalities such as ultrasound therapy, stretching exercises, manual mobilization and strengthening exercises as well-established conservative management techniques [7,8]. Multiple studies have reported the short-term benefits of corticosteroid injections, including the improvement of the range of motion (ROM) in the shoulder and pain reduction [9,10], through the reduction of the synovial inflammation by decreasing the capsular fibrosis, thereby improving joint movements and providing pain relief [11]. It would be better to avoid steroids and search for alternative therapies [12,13]

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