The Therapeutic Effects of Extracorporeal Shock Wave Therapy (ESWT) on the Rotator Cuff Lesions with Shoulder Stiffness: A Prospective Randomized Study.

Jih-Yang Ko,Shu-Jui Kuo,Kai-Kit Siu,Chung-Cheng Huang,Feng-Sheng Wang,Ching-Jen Wang,Wen-Yi Chou

doi:10.1155/2020/6501714

Abstract

Aim We wish to investigate the therapeutic potential of a single-session high-energy extracorporeal shock wave therapy (ESWT) on the rotator cuff lesions with shoulder stiffness. Patients and Methods. Thirty-seven patients afflicted with rotator cuff lesions with shoulder stiffness were randomized to receive either shockwave or sham treatment based on statistical randomization. In the shockwave group, we used Orthospec™ Extracorporeal Shock Wave Therapy 3000 impulse 24 kV (0.32 mJ/mm2) focused at two points as one session. The sham intervention entailed the use of the device in which the silicone pad was removed from the stand-off device. The visual analogue scale (VAS), muscle power of the shoulder, Constant and Murley score (CMS), and range of motion (ROM) of the shoulder were assessed for all patients. Ten milliliters of peripheral venous blood was obtained from every participant for the measurements of markers for inflammation, tissue regeneration, angiogenesis, and substance P before and at 1 week and 4 weeks after intervention. Results The ESWT group has significantly better VAS, muscle power, CMS, and ROM at 6 and 12 months after intervention. No between-group differences were observed before as well as 1 and 4 weeks after intervention in the selected biomarkers. Conclusion ESWT may be a good adjuvant for the treatment of rotator cuff lesions with shoulder stiffness.

Highlights

Shoulder stiffness is characterized by pain and loss of shoulder motion
Increased expression of IL-1β and myofibroblast recruitment in the subacromial bursa in rotator cuff lesions could be observed in shoulder stiffness, suggesting that rotator cuff lesions with shoulder stiffness are an inflammatory disease [5]
Ten milliliters of peripheral venous blood was obtained from every participant for the measurements of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin 1-beta (IL-1β), transforming growth factor-beta 1 (TGF-β1) for inflammation, insulin-like growth factor-1 (IGF-1), dickkopf-related protein 1 (DKK-1) for tissue regeneration, vascular endothelial growth factor (VEGF) for angiogenesis, and substance P for pain threshold before and at 1 week and 4 weeks after intervention

Summary

Introduction

Shoulder stiffness is characterized by pain and loss of shoulder motion. Some patients have no identifiable cause (socalled “idiopathic adhesive capsulitis”), and others are caused by underlying diseases, especially rotator cuff lesions [1]. Rotator cuff lesions are the common shoulder disorder manifested by pain, limited motion, weakness, and functional disability. Outlet impingement, and inflammatory process are the important mechanisms underlying the pathogenesis of the rotator cuff lesions [2,3,4,5]. Increased expression of IL-1β and myofibroblast recruitment in the subacromial bursa in rotator cuff lesions could be observed in shoulder stiffness, suggesting that rotator cuff lesions with shoulder stiffness are an inflammatory disease [5]. Treatment options for shoulder stiffness include physical therapy, intra-articular corticosteroid injection, closed manipulation, and open or arthroscopic release [1, 6,7,8,9,10]

Methods

Results

Conclusion