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Brindisino F, Girardi G, Crestani M, Fiore A, Giovannico G, Garzonio F, Venturin D, Struyf F. Effectiveness of electrophysical agents in subjects with frozen shoulder: a systematic review and meta-analysis. Disabil Rehabil 2023:1-22. [PMID: 37667875 DOI: 10.1080/09638288.2023.2251880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE This systematic review with meta-analysis aimed to assess the effectiveness of electrophysical agents in improving pain, function, disability, range of motion, quality of life, perceived stiffness, and time to recovery in subjects with frozen shoulder (FS). METHODS A thorough search of MEDLINE, Cochrane Library, PEDro, and EMBASE yielded 1143 articles, of which 23 randomized controlled trials were included. Risk of bias (RoB) was assessed through Cochrane Risk of Bias 2 tool. The certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS The analysis included a total of 1073 subjects. None of the studies were judged as low RoB. Potentially clinically significant differences were observed in pain at 6 weeks and 5 months after extracorporeal shockwave therapy (ESWT), and in disability up to 3 months with laser therapy, albeit with uncertain results due to the high RoB and to the study heterogeneity. Ultrasound (US) therapy did not yield significant differences in any outcomes. The certainty of evidence was very low. CONCLUSIONS Based on the high heterogeneity and low quality and certainty of evidence, ESWT, laser, and US cannot be recommended for FS treatment. Caution should be exercised in interpreting the findings.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Giuseppe Girardi
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Mauro Crestani
- Rehabilitation Unit, Azienda ULSS n.9 Scaligera, Verona, Italy
| | | | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Fabiola Garzonio
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Davide Venturin
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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Abstract
Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.
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Saldiran TÇ, Yazgan P, Akgöl AC, Mutluay FK. Radial shock-wave therapy for frozen shoulder patients with type 2 diabetes mellitus: a pilot trial comparing two different energy levels. Eur J Phys Rehabil Med 2022; 58:412-422. [PMID: 35191654 PMCID: PMC9980541 DOI: 10.23736/s1973-9087.22.07087-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Extracorporeal shock-wave therapy (ESWT) is highly recommended for the management of orthopedic shoulder pathologies. Yet, the clinical relevance of the dose difference effect of radial ESWT approaches in the management of frozen shoulder patients with type 2 diabetes mellitus remains uncertain. AIM The aim was to examine the short-term effects of medium-and high-energy levels of radial ESWT (rESWT) in the treatment of frozen shoulder patients with type 2 diabetes mellitus. DESIGN Prospective clinical pilot study. SETTING This study was conducted in an outpatient clinic. POPULATION Thirty-nine patients who had frozen shoulder untreated for at least 3 months, diagnosed with type 2 diabetes mellitus for ≥3 years were included. METHODS The patients were randomly allocated to receive either high-energy rESWT (hrESWT), or medium-energy rESWT (mrESWT) or placebo at 8 Hz twice a week for six weeks. The primary outcome measure was pain, evaluated by the Visual Analog Scale (VAS) Score. Secondary outcome measures were function evaluated by the Shoulder Pain and Disability Index (SPADI) Score, and shoulder active range of motion (AROM). The mechanical properties of the deltoid and trapezius muscles were assessed using the MyotonPRO (Myoton AS, Tallinn, Estonia). RESULTS The mrESWT resulted in statistically significant reductions in night pain at 6 weeks (η<inf>p</inf>2=0.27, P=0.003). Significantly improved function (SPADI scores: -35.42±21.29 vs.-29.59±22.60; η<inf>p</inf>2=0.39, P˂0.001) was found in both hrESWT and mrESWT group by 6 weeks. Significantly higher mean shoulder AROM values were recorded for external rotation (η<inf>p</inf>2=0.53, P<0.001), and internal rotation (η<inf>p</inf>2=0.21, P=0.020), in the hrESWT group at the 6th week. A significantly improved resting tone (η<inf>p</inf>2=0.58) and stiffness of deltoid muscle (η<inf>p</inf>2=0.62) were found in the mrESWT group (P<0.001). The trapezius muscle resting tone reduced with hrESWT (η<inf>p</inf>2=0.17, P=0.033). CONCLUSIONS Regardless of the energy levels, rESWT appears to be an effective therapeutic intervention for frozen shoulder patients with type 2 diabetes mellitus in the short-term results. CLINICAL REHABILITATION IMPACT Our results suggest that this rESWT can be a useful strategy for the rehabilitation of frozen shoulder patients with type 2 diabetes mellitus. This is the first study on dose difference effectiveness in terms of the clinical significance of rESWT which is key to transfer research evidence into practice.
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Affiliation(s)
- Tülay Ç Saldiran
- School of Health Sciences, Department of Physiotherapy and Rehabilitation, Bitlis Eren University, Bitlis, Turkey -
| | - Pelin Yazgan
- Department of Physical Therapy and Medicine, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Ahmet C Akgöl
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Okan University, Istanbul, Turkey
| | - Fatma K Mutluay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Zhang R, Wang Z, Liu R, Zhang N, Guo J, Huang Y. Extracorporeal Shockwave Therapy as an Adjunctive Therapy for Frozen Shoulder: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671211062222. [PMID: 35141337 PMCID: PMC8819773 DOI: 10.1177/23259671211062222] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The best nonsurgical treatment for frozen shoulder is still unclear.
Extracorporeal shockwave therapy (ESWT) is an innovative adjunctive
treatment for frozen shoulder, but its effect is still unclear. Purpose: To evaluate the published literature regarding the potential of ESWT as an
adjunctive therapy for frozen shoulder. Study Design: Systematic review; Level of evidence, 1. Methods: Searches were conducted in the PubMed, EMBASE, Cochrane Library, China
National Knowledge Infrastructure (CNKI), and VIP Information databases for
relevant studies between inception and November 2020. Included were
randomized controlled trials (RCTs) for frozen shoulder that compared ESWT
with routine treatments to controls. There were no restrictions on the
treatment period, type of ESWT, or severity of symptoms. At least 1 of the
following outcome indices was assessed: visual analog scale (VAS) for pain,
Constant-Murley score (CMS) for shoulder function assessment, or external
rotation range of movement (ER ROM). RevMan 5.3 software was used to
evaluate the bias and quality of the included studies. For continuous
variables, the mean difference (MD) or standardized MD (SMD) with the 95% CI
was extracted. For dichotomous data, event ratios and sample sizes were
extracted. Results: Overall, 20 studies were included. The ESWT used as an adjunct to other
interventions had better outcomes compared with control groups regarding
immediate and short-term analgesic effects (immediate: MD, –1.10 [95% CI,
–1.27 to –0.92], P < .00001; short-term: MD, –0.72 [95%
CI, –0.94 to –0.50], P < .00001) as well as immediate
function (SMD, 1.54 [95% CI, 1.19 to 1.89], P < .00001],
I2 = 0%). There was significant heterogeneity between studies for
long-term analgesia (MD, –0.90 [95% CI, –1.40 to –0.41], P
< .00001, I2 = 89%) and ER ROM (MD, 10.31 [95% CI, 3.46 to 17.17],
P < .003, I2 = 93%). Conclusion: ESWT seems to be beneficial to patients with frozen shoulder by alleviating
pain and improving function. ESWT could be used as an adjunct therapy to
routine treatments, although the quality of the included RCTs was hampered
by significant heterogeneity regarding long-term analgesia and joint
ROM.
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Affiliation(s)
- Ruihan Zhang
- Department of Rehabilitation Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Zhenyu Wang
- Department of Rehabilitation Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Ruishu Liu
- Department of Dermatology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Nan Zhang
- Department of Rehabilitation Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Jiaxun Guo
- Department of Rehabilitation Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Yunxia Huang
- Department of Rehabilitation Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
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Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. J Back Musculoskelet Rehabil 2021; 34:195-205. [PMID: 33185587 DOI: 10.3233/bmr-200186] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adhesive capsulitis is a debilitating condition which causes the capsule of the gleno-humeral joint to thicken and contract progressively. The effectiveness of various non-operative methods has been demonstrated to improve the pain, range of motion (ROM) and functional status of patients with adhesive capsulitis. OBJECTIVE This study aims to review recent evidence on the efficacy of physiotherapy interventions in the treatment of adhesive capsulitis. METHODS PubMed, Physiotherapy Evidence Database (PEDro), Science Direct and Cochrane databases were searched for studies published since 2013. The search terms included: Frozen shoulder, adhesive capsulitis, physical therapy, rehabilitation, manual therapy, mobilization, exercise, education, and electrotherapy. The search was limited to studies published in English and studies that used human subjects. RESULTS Quality scores of 33 articles were reviewed according to the Sackett's critical appraisal criteria and the grades of recommendation were determined for physiotherapy interventions used in the studies. CONCLUSION The empirical evidence suggests that certain physical therapy techniques and modalities are strongly recommended for pain relief, improvement of ROM, and functional status in patients with adhesive capsulitis, while others are either moderately or mildly recommended. However, the efficacy of one treatment modality over another is uncertain. The poor methodological rigors demonstrated in most of the reviewed studies emphasize the urgent need of properly conducted, adequately sampled randomized controlled trials with adequate follow up to determine the superior combination of treatment.
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Affiliation(s)
- Piumi Nakandala
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indumathie Nanayakkara
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Surangika Wadugodapitiya
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Zhang J, Zhong S, Tan T, Li J, Liu S, Cheng R, Tian L, Zhang L, Wang Y, Liu F, Zhou P, Ye X. Comparative Efficacy and Patient-Specific Moderating Factors of Nonsurgical Treatment Strategies for Frozen Shoulder: An Updated Systematic Review and Network Meta-analysis. Am J Sports Med 2021; 49:1669-1679. [PMID: 32941053 DOI: 10.1177/0363546520956293] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators. PURPOSE To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder. STUDY DESIGN Systematic review and network meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion. RESULTS Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional improvement (3.66 [1.65-5.67]). Subgroup analyses by disease stages revealed that steroid injection combined with physical therapy provided more benefits during the freezing phase, whereas joint manipulation provided more benefits in the adhesive phase. Adjunctive therapies, female sex, and diabetes were also identified as moderators of effectiveness. CONCLUSION Capsular distension is a highly recommended choice for treatment of frozen shoulder, contributing greatly to pain relief and functional improvement; steroid injection is also a prevailing effective intervention. Among new options, extracorporeal shockwave therapy and laser therapy show potential benefits for multiple outcomes. Individualized optimal intervention should be considered, given that treatment effect is moderated by factors including the disease stage, time of assessment, adjunctive therapies, female sex, and diabetes.
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Affiliation(s)
- Jie Zhang
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shuchang Zhong
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Tongcai Tan
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Juebao Li
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shuang Liu
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ruidong Cheng
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Liang Tian
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Li Zhang
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuanjiao Wang
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Fei Liu
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Panpan Zhou
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangming Ye
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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El Naggar TEDM, Maaty AIE, Mohamed AE. Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain, function, and range of motion in diabetic patients with shoulder adhesive capsulitis. J Shoulder Elbow Surg 2020; 29:1300-1309. [PMID: 32553435 DOI: 10.1016/j.jse.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
UNLABELLED To compare the efficacy of radial extracorporeal shock-wave therapy (rESWT) vs. an ultrasound-guided low-dose intra-articular steroid injection in pain reduction and functional improvement in diabetic patients with shoulder adhesive capsulitis (AC). METHODS This was a 2-parallel-group, active-control, assessor-blinded, randomized trial. We randomized 103 diabetic patients with shoulder AC to receive either 4 sessions of rESWT, 1 week apart (rESWT group, n = 52), or a single ultrasound-guided low-dose intra-articular steroid injection of 20 mg of triamcinolone acetonide (steroid group, n = 51). The primary outcome measure was functional improvement evaluated by the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) score. Secondary outcome measures were pain evaluated by the visual analog scale score and shoulder range of motion (ROM). An assessor who was blinded to treatment assignment assessed both groups at baseline and at 4, 8, and 12 weeks thereafter. RESULTS By 12 weeks, both groups demonstrated a significant reduction in the qDASH score and pain severity, as well as improvement in ROM. However, significantly improved function (qDASH score, 40.4 ± 12.9 vs. 50.5 ± 13.3; P < .001) and shoulder pain reduction (visual analog scale score, 1.6 ± 1.2 vs. 2.8 ± 1.7; P < .001) were found in the rESWT group vs. the steroid group. Similar improvement in shoulder ROM was observed in both groups. CONCLUSION At short-term follow-up, rESWT was superior to a low-dose intra-articular steroid injection in improving function and pain in diabetic patients with shoulder AC. Therefore, rESWT might be considered a safe alternative to steroid injections in diabetic patients with shoulder AC.
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Affiliation(s)
| | - Ahmed Ibrahim Elsayed Maaty
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Aly Elsayed Mohamed
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
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Zhou Y, Yang K. Prevention of arthrofibrosis during knee repair by extracorporeal shock wave therapy: Preliminary study in rabbits. Injury 2019; 50:633-638. [PMID: 30739764 DOI: 10.1016/j.injury.2019.01.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgery or trauma may induce extensive arthrofibrosis around joints and tendon for the restrictive range of motion. Although some approaches were proposed, this problem is not solved satisfactorily. Extracorporeal shock wave therapy (ESWT) has been used for orthopedic, musculoskeletal, and fibrotic disorders. Whether it could prevent the formation of arthrofibrosis during the joint repair is unknown. METHODS Intra-articular adhesions were created in the right knee of the rabbit by cortical bone shaving and subsequent cast immobilization. Arthrofibrosis in the control and ESWT group was evaluated and compared at week 4. RESULTS Macroscopic score of arthrofibrosis and contracture angle of the control group are significantly higher. Histologically, the apparent gap between patella and tibia, loose connective tissue, and much less density of the blood vessel are found in the ESWT group. CONCLUSIONS ESWT could noninvasively, effectively, and safely prevent the formation of arthrofibrosis during the knee repair.
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Affiliation(s)
- Yufeng Zhou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
| | - Kai Yang
- SG Med International Pte Ltd, Singapore
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