ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2022 June;58(3):412-22

DOI: 10.23736/S1973-9087.22.07087-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Radial shock-wave therapy for frozen shoulder patients with type 2 diabetes mellitus: a pilot trial comparing two different energy levels

Tülay Ç. SALDIRAN ¹ ✉, Pelin YAZGAN ², Ahmet C. AKGÖL ³, Fatma K. MUTLUAY ⁴

¹ School of Health Sciences, Department of Physiotherapy and Rehabilitation, Bitlis Eren University, Bitlis, Turkey; ² Department of Physical Therapy and Medicine, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey; ³ Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Okan University, Istanbul, Turkey; ⁴ Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey

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 (ηp²=0.27, P=0.003). Significantly improved function (SPADI scores: -35.42±21.29 vs.-29.59±22.60; ηp²=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 (ηp²=0.53, P<0.001), and internal rotation (ηp²=0.21, P=0.020), in the hrESWT group at the 6^th week. A significantly improved resting tone (ηp²=0.58) and stiffness of deltoid muscle (ηp²=0.62) were found in the mrESWT group (P<0.001). The trapezius muscle resting tone reduced with hrESWT (ηp²=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.

KEY WORDS: Diabetes mellitus; Muscle tonus; Pain