Effectiveness of Shortwave Diathermy for Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection: A Double-Blinded, Randomized, Placebo-Controlled Trial

The Efficacy of Electromagnetic Diathermy for the Treatment of Musculoskeletal Disorders: A Systematic Review with Meta-Analysis

OBJECTIVE

This study aims to establish the effect of electromagnetic diathermy therapies (e.g., shortwave, microwave, capacitive resistive electric transfer) on pain, function, and quality of life in treating musculoskeletal disorders.

METHODS

We conducted a systematic review according to the PRISMA statement and Cochrane Handbook 6.3. The protocol has been registered in PROSPERO: CRD42021239466. The search was conducted in PubMed, PEDro, CENTRAL, EMBASE, and CINAHL.

RESULTS

We retrieved 13,323 records; 68 studies were included. Many pathologies were treated with diathermy against placebo, as a standalone intervention or alongside other therapies. Most of the pooled studies did not show significant improvements in the primary outcomes. While the analysis of single studies shows several significant results in favour of diathermy, all comparisons considered had a GRADE quality of evidence between low and very low.

CONCLUSIONS

The included studies show controversial results. Most of the pooled studies present very low quality of evidence and no significant results, while single studies have significant results with a slightly higher quality of evidence (low), highlighting a critical lack of evidence in the field. The results did not support the adoption of diathermy in a clinical context, preferring therapies supported by evidence.

Physical Therapy Combined With Subacromial Cortisone Injection Is a First-Line Treatment Whereas Acromioplasty With Physical Therapy Is Best if Nonoperative Interventions Fail for the Management of Subacromial Impingement: A Systematic Review and Network Meta-Analysis

PURPOSE

To construct an algorithm to optimize clinical outcomes in subacromial impingement based on current, high-level evidence.

METHODS

A systematic review of all clinical trials on subacromial impingement published from 1999 to 2020 was performed. Demographic, clinical, range of motion (ROM), and patient-reported outcome measure (PROM) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model and treatments ranked via surface under the cumulative ranking curves with respect to 3 domains: pain, PROMs, and ROM.

RESULTS

A total of 35 studies comprising 3,643 shoulders (42% female, age 50 ± 5 years) were included. Arthroscopic decompression with acromioplasty ranked much greater than arthroscopic decompression alone for pain relief and PROM improvement, but the difference in absolute PROMs was not statistically significant. Corticosteroid injection (CSI) alone demonstrated inferior outcomes across all 3 domains (pain, PROMs, and ROM) with low cumulative rankings. Physical therapy (PT) with CSI demonstrated moderate-to-excellent clinical improvement across all 3 domains whereas PT alone demonstrated excellent ROM and low-moderate outcomes in pain and PROM domains. PT with nonsteroidal anti-inflammatory drugs or alternative therapies ranked highly for PROM outcomes and moderate for pain and ROM domains. Finally, platelet-rich plasma injections demonstrated moderate outcomes for pain, forward flexion, and abduction with very low-ranking outcomes for PROMs and external rotation.

CONCLUSIONS

Arthroscopic decompression with acromioplasty and PT demonstrated superior outcomes whereas CSI demonstrated poor outcomes in all 3 domains (pain, PROMs, and ROM). For patients with significant symptoms, the authors recommend PT with CSI as a first-line treatment, followed by acromioplasty and PT if conservative treatment fails. For patients with symptoms limited to 1 to 2 domains, the authors recommend a shared decision-making approach focusing on treatment rankings within domains pertinent to individual patient symptomatology.

LEVEL OF EVIDENCE

I, systematic review and network meta-analysis of Level I studies.

Effects of High-Energy Extracorporeal Shockwave Therapy on Pain, Functional Disability, Quality of Life, and Ultrasonographic Changes in Patients with Calcified Rotator Cuff Tendinopathy

Objective

The current trial was designed to evaluate the effects of high-energy shockwave therapy on objective and subjective outcomes among participants with calcified rotator cuff tendinopathy.

Methods

This parallel-group, randomized trial consists of 42 patients affected by calcific tendinopathies divided into two groups of 21 participants. Patients having calcified tendinopathy aged between 30 and 65 years with type A or B calcification were selected in the trial after signing the written consent form. Participants in the ESWT+RPT group received eight sessions of shockwaves, while the RPT group was treated by routine physical therapy. About 2000 shockwaves of 0.32 mJ/mm², 120 Hz per treatment, were given as 12 sessions for the first six weeks (2 sessions/week). Pain intensity and shoulder functional ability, ultrasonographic changes, and quality of life were assessed with the numeric pain rating scale (NPRS), Constant-Murley score (CMS), ultrasonography, and Western Ontario rotator cuff index (WORC).

Results

There were significant differences regarding NPRS and CMS between the two groups, at baseline and 6th and 12th weeks after intervention (p < 0.05). Within-group differences also showed statistically significant results after treatment (all p < 0.05). Significant results were seen in the WORC and ultrasonographic results pre- and posttreatment; more significant findings were found in the experimental group as compared to others.

Conclusion

High-energy shockwave therapy has been proved to be effective and thus strongly recommended for the management of calcified rotator cuff tendinopathy, improving the pain, functionality, and quality of life of these participants and decreasing the size of calcified deposits. Shockwave therapy is proved to be superior to routine physiotherapy.

Effects of deep friction massage and dry needling therapy on night pain and shoulder internal rotation in subacromial pain syndrome: 1-year follow up of a randomised controlled trial

Background/Aims

Shoulder problems are common in the general population. The aim of this research was to compare the short and long-term effects of trigger point deep friction massage and trigger point dry needling therapy on rest, activity, and the intensity of night shoulder pain and shoulder internal rotation in Subacromial Pain Syndrome.

Methods

Out of 73 outpatients diagnosed with Subacromial Pain Syndrome, 40 were selected according to agreed criteria and were randomly assigned to two groups. A total of 19 patients received trigger point deep friction massage and 21 received trigger point dry needling therapy. The trigger point deep friction massage group received treatment over 3 weeks and the trigger point dry needling therapy group received treatments over 4 weeks. Both groups received six treatment sessions and a programme of post-treatment exercises. The shoulder internal rotation angle was measured using a goniometer, and pain intensities were measured using a visual analogue scale before the first session, after six sessions and after 1 year.

Results

According to both the short- and long-term data, significant improvements were seen in both groups for all parameters. However, when the groups were compared, no significant difference was found between the two interventions, although the trigger point deep friction massage intervention showed earlier improvements as the treatments could be carried out in 3 weeks, rather than the 4 weeks required for the trigger point dry needling therapy sessions.

Conclusions

Both trigger point deep friction massage and trigger point dry needling therapy are effective in improving pain and shoulder internal rotation. Both groups maintained significant clinical improvement throughout the year. Although both interventions produced good results, trigger point deep friction massage treatments were completed in a shorter time and so demonstrated earlier improvements. Therefore, Trigger point deep friction massage may be regarded as the preferred option, particularly as no equipment is needed and is a non-invasive method of treatment.

The effectiveness of routine physiotherapy with and without neuromobilization on pain and functional disability in patients with shoulder impingement syndrome; a randomized control clinical trial

Background

The objective of the study was to compare the effects of neuromobilization (NM) techniques and routine physiotherapy on pain and functional disability in patients having shoulder impingement syndrome (SIS). Present study was aimed to discover evidence based conservative and cost effective remedy on pain and functional disability.

Study design

Single blinded randomized control clinical trial.

Methods

A total of 80 patients with SIS were randomly assigned into care and experimental groups (40 in each group). After the baseline assessment routine physiotherapy was executed on both groups, while NM was applied additionally to experimental group. Pain and functional disability score were evaluated by Visual Analogue Scale and University of California at Los Angeles rating score at baseline, 5th and 11th week. Differences in outcome between groups were evaluated with clinical improvement.

Results

The experimental group compared with care group at 11th week had lower mean pain score 2.15(1.66–2.64) vs 4.90(4.41–5.40); between group difference, 1.82; 95% (CI), − 2.38 to − 1.25; P < 0.001 and Partial ƞ² = 0.33, similarly functional disability score 28.58(27.32–29.83) vs 20.10(18.84–21.36); between group difference,5.62; 95%CI, (4.32–6.92); P< 0.001 and Partial ƞ² = 0.49 respectively. In experimental group NM was a more effective technique to reduce the pain severity and disability in SIS patients as compare to care group.

Conclusion

Neuromobilization techniques in addition to routine physiotherapy were significantly effective for the treatment of SIS.

Trial registration

IRCT20190121042445N1, Registered 19 February 2019.

Thermophysiological responses to capacitive resistive monopolar radiofrequency electromagnetic radiation in patients with osteoarthritis of the knee joint: A randomised controlled experimental study

This study investigated the effect of 448 kHz capacitive resistive monopolar radiofrequency (CRMRF) on the superficial and deep physiological responses of patients with osteoarthritis (OA) of the knee(s). Forty-five patients diagnosed with OA in their knee(s) were enrolled into a three-group randomised controlled study, from the waiting list of a local hospital. They received localized treatment with either CRMRF, CRMRF placebo or a control (no treatment) to the knee for 15 minutes. Pre, post, and 20 min follow-up measurements of skin temperature (SKT) and skin blood flow (SBF) were obtained from the knee using the FlexComp Infiniti (SA7550) physiological measurement system. Pre and post-treatment deep blood flow were recorded using Doppler ultrasound. Core temperature, blood pressure (BP) and pulse rate (PR) were concurrently monitored. Group data were compared using the ANOVA model. Statistical significance was set at p ≤ 0.05, 0.8 power, and 95% CI. Significant increases and sustenance of SKT and SBF, and significant increases in volume and intensity of deep blood flow were demonstrated with CRMRF over the placebo and control interventions in all comparisons (p< .001). No meaningful changes in blood flow velocity, core temperature, BP, or PR were noted for any condition. The findings were markedly more pronounced than those previously reported in asymptomatic adults. However, the patients had received a higher average dose of CRMRF (mean (SD): 46.87 (4.08) W) compared to the asymptomatic sample (mean (SD): 42.37 (4.64) W); therefore, further research is needed to better understand the differences in physiological responses between patients and asymptomatic people.

Effects of capacitive and resistive electric transfer therapy in patients with painful shoulder impingement syndrome: a comparative study

Objective

Capacitive and resistive electric transfer therapy (CARE) reduces pain and improves quality of life for many orthopaedic degenerative and inflammatory disorders. The research aim was to determine the effects of CARE on painful shoulder. The outcomes were pain reduction and recovery of shoulder function.

Methods

A retrospective, observational case-control study was conducted. Participants were 46 patients (22 in the CARE group and 24 in the SHAM group). Clinical data, pain (visual analogic scale, VAS) and functional scale scores (Disabilities of the Arm, Shoulder and Hand scale, and Constant–Murley Scale) were measured at baseline T0 (before treatment), T1 (after treatment) and follow-up T2 (2 months after the end of the treatment).

Results

VAS scores in the CARE group improved from 7.23 ± 1.11 at baseline to 2.68 ± 0.99 at follow-up. The SHAM group did not experience any improvement. Similarly, functional scale scores improved in the CARE group compared with the SHAM group.

Conclusion

Considering the small number of sessions needed, low cost and long-term benefits, CARE could be a useful therapeutic option for the conservative management of shoulder pain to restore pain-free and powerful movement to the shoulder joint.