Assessment of the Efficacy of Extracorporeal Shock Wave Therapy in Adhesive Capsulitis: Outcomes Analysis and Predictors of Recurrence
Original Article | Vol 5 | Issue 1 | January-June 2025 | page: 23-30 | Paul Teran, Anabel Lozada, Francisco Endara, Luis Guzman
DOI: https://doi.org/10.13107/jrs.2025.v05.i01.165
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 26 April 2025, Review Date: 15 May 2025, Accepted Date: May 2025 & Published: 30 Jun 2025
Author: Paul Teran [1, 2], Anabel Lozada [1], Francisco Endara [1], Luis Guzman [3]
[1] Orthopedic Surgeon, Orthopedic Specialties Center (CEO), Quito-Ecuador,
[2] Department of Traumatology and Orthopedics, Metropolitan Hospital, Quito – Ecuador,
[3] Physician, Orthopedic Specialties Center (CEO), Quito-Ecuador.
Address of Correspondence
Dr. Paul Germán Terán Vela,
Orthopaedic Surgeon, Orthopedic Specialties Center (CEO), Quito-Ecuador.
E-mail: paulteranmd@gmail.com
Abstract
Background: Adhesive capsulitis of the shoulder is a condition characterized by pain and progressive restriction of the range of motion. Its management remains a clinical challenge due to variability in therapeutic response. Extracorporeal shock wave therapy (ESWT) has emerged as a non-invasive alternative with potential antifibrotic and analgesic effects. However, evidence regarding its efficacy and the factors associated with recurrence is limited.
Objectives: To assess the effectiveness of ESWT in functional improvement and pain reduction in patients with adhesive capsulitis and to analyze clinical factors associated with recurrence.
Study Design: A retrospective observational study conducted in a cohort of patients with adhesive capsulitis treated with ESWT. The study adhered to strengthening the reporting of observational studies in epidemiology guidelines for observational research.
Materials and Methods: Nineteen patients with a clinical and image-based diagnosis of adhesive capsulitis in the inflammatory or adhesive stage, treated with ESWT at a specialized center, were included. Patients with prior shoulder surgery, inflammatory arthritis, joint infection, or full-thickness rotator cuff tear were excluded. Demographic, clinical, and therapeutic variables were analyzed.
Measured Outcomes:
• Functionality: Disabilities of the arm, shoulder, and hand (DASH) score, pre- and post-treatment
• Pain: Visual analog scale (VAS)
• Recurrence: Reappearance of symptoms requiring additional intervention within a 1-year period.
Multivariable logistic regression with Lasso regularization was used to identify predictors of recurrence.
Outcomes: Following ESWT treatment, there was a significant reduction in DASH scores (62.4 ± 11.2 pre-treatment vs. 35.6 ± 9.8 post-treatment, P < 0.001) and in VAS scores (mean reduction of 3.8 points, P < 0.001). The 1-year recurrence rate was 26.3%. The following clinical factors were associated with an increased risk of recurrence:
• Advanced age (Odds ratio [OR] = 1.08, confidence interval [IC] 95%: 1.01–1.15, P = 0.02)
• Longer duration from symptom onset to the initiation of ESWT (OR = 1.23, IC 95%: 1.06–1.41, P = 0.004)
• Treatment cost as a mild protective factor (OR = 0.92, IC 95%: 0.85–0.99, P = 0.048).
No significant association was found between the number of ESWT sessions and functional improvement (r = 0.12, P = 0.34).
Conclusion: ESWT has demonstrated significant efficacy in improving functional outcomes and reducing pain in patients with adhesive capsulitis. Nevertheless, advanced age and delayed initiation of therapy have been identified as factors associated with an increased risk of recurrence. Early intervention is therefore recommended to optimize therapeutic outcomes. Further prospective studies with larger sample sizes and appropriate control groups are warranted to validate these findings.
Keywords: Adhesive capsulitis, Frozen shoulder, Extracorporeal shock waves, Extracorporeal shock wave therapy, Capsular fibrosis, Rehabilitation, Recurrence factors
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How to Cite this article: Terán P, Lozada A, Endara F, Guzmán L | Assessment of the efficacy of extracorporeal shock wave therapy in adhesive capsulitis: Outcomes analysis and predictors of recurrence. | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 23-30.
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