The effectiveness of extracorporeal shockwave therapy for frozen shoulder in patients with diabetes: randomized control trial.
Ramprasad Muthukrishnan, Ayesha Abdul Rashid, Fatma Al-Alkharji
PMID 31417208WHAT IT FOUND
For type 2 diabetic frozen shoulder, shockwave therapy plus mobilization and exercises gave more pain relief at 4 weeks than ultrasound, hot packs, mobilization and exercises.
Disability, motion and 12-week outcomes were similar, and both groups improved.
Key findings
01Between-group comparison at 4 weeks found a significant difference only in pain scores, favoring the shockwave group.
02At 12-week follow-up, no significant difference was found between the control and shockwave groups.
03Both groups showed significant within-group improvement after 4 weeks in pain, disability, overall change and active shoulder motion.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 20 participants were randomized, and the paper says one control participant withdrew before intervention while the reported analyses include 10 per group, so the analysed sample is unclear. The authors state the small sample was constrained by economic and logistical reasons, so the results should be viewed cautiously. Both groups received joint mobilization and therapeutic exercises; the control group also received hot packs and ultrasound, and the ESWT group received shockwaves, so the contribution of any single component cannot be separated. The between-group benefit was limited to pain at 4 weeks; disability, motion, overall change and 12-week outcomes did not differ significantly. The ESWT group received once-weekly treatment and the control group received three sessions a week, so treatment dose and frequency differed. Participants self-monitored blood glucose control during the trial, and its effect on outcomes could not be separated from the treatment effects.
Declared interests
The study was supported by a research grant from Gulf Medical University. No other conflicts are reported.
The easy way to misread this
Do not read this as proof that ESWT alone treats diabetic frozen shoulder. Both groups received mobilization and exercises, the control group also received hot packs and ultrasound, and the only between-group difference at 4 weeks was pain, with no difference at 12 weeks. The study was also too small to make this a firm treatment choice.