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
References:
1. Moya D. Myths, truths, doubts and confusions about shockwave therapy and its role in musculoskeletal pathology. Rev Asoc Argent Ortop Traumatol 2024;89:199-209.
2. Ogden JA, Tóth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthop Relat Res 2001;387:8-17.
3. Ramon S, Español A, Yebra M, Morillas JM, Unzurrunzaga R, Freitag K, et al. Ondas de choque. Evidencias y recomendaciones SETOC (sociedad española de tratamientos con ondas de choque). Rehabilitacion (Madr) 2021;55:291-300.
4. Speed CA. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. Bone Joint J 2004;86-B:165-71.
5. Ge R, Zhu Q, Liu D, Zhang Q, Jiang S, Yu X, et al. Quantitative proteomics reveals potential anti-inflammatory protein targets of radial extracorporeal shock wave therapy in TNF-α-induced model of acute inflammation in primary human tenocytes. Heliyon 2022;8:e1200800.
6. Simplicio CL, Purita J, Murrell W, Santos GS, Dos Santos RG, Lana JF. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma 2020;11 Suppl 3:S309-18.
7. Inanmaz ME, Uslu M, Isik C, Kaya E, Tas T, Bayram R. Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant-related chronic osteomyelitis: Experimental study in a rat model. J Orthop Res 2014;32:752-6.
8. Chow DH, Suen PK, Huang L, Cheung WH, Leung KS, Ng C, et al. Extracorporeal shockwave enhanced regeneration of fibrocartilage in a delayed tendon-bone insertion repair model. J Orthop Res 2014;32:507-14.
9. Moya D, Loske AM, Hobrough P, Moya C. History of shock waves and radial pressure waves from newton to our times. J Regen Sci 2023;3:9-14.
10. Huang C, Holfeld J, Schaden W, Orgill D, Ogawa R. Mechanotherapy: Revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends Mol Med 2013;19:555-64.
11. Wang CJ, Ko JY, Chan YS, Weng LH, Hsu SL. Extracorporeal shockwave for chronic patellar tendinopathy. Am J Sports Med 2007;35:972-8.
12. Loske AM, Moya D. Shock waves and radial pressure waves: Time to put a clear nomenclature into practice. J Regen Sci 2021;1:4-8.
13. Helbig K, Herbert C, Schostok T, Brown M, Thiele R. Correlations between the duration of pain and the success of shock wave therapy. Clin Orthop Relat Res 2001;387:68-71.
14. Wang CJ, Huang HY, Pai CH. Shock wave-enhanced neovascularization at the tendon-bone junction: An experiment in dogs. J Foot Ankle Surg 2002;41:16-22.
15. Gerdesmeyer L, Von Eiff C, Horn C, Henne M, Roessner M, Diehl P, et al. Antibacterial effects of extracorporeal shock waves. Ultrasound Med Biol 2005;31:115-9.
16. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Joint Surg Am 2018;100:251-63.
17. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 2012;7:11.
18. Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res 2001;387:90-4.
19. Rompe JD, Buch M, Gerdesmeyer L, Haake M, Loew M, Maier M, et al. Musculoskeletal shock wave therapy–current database of clinical research. Z Orthop Ihre Grenzgeb 2002;140:267-74.
20. Gollwitzer H, Roessner M, Langer R, Gloeck T, Diehl P, Horn C, et al. Safety and effectiveness of extracorporeal shockwave therapy: Results of a rabbit model of chronic osteomyelitis. Ultrasound Med Biol 2009;35:595-602.
21. Carulli C, Tonelli F, Innocenti M, Gambardella B, Muncibì F, Innocenti M. Effectiveness of extracorporeal shockwave therapy in three major tendon diseases. J Orthop Traumatol 2016;17:15-20.
22. Ogden JA, Alvarez RG, Levitt R, Marlow M. Shock wave therapy (Orthotripsy) in musculoskeletal disorders. Clin Orthop Relat Res 2001;387:22-40.
23. Stania M, Juras G, Chmielewska D, Polak A, Kucio C, Król P. Extracorporeal shock wave therapy for achilles tendinopathy. Biomed Res Int 2019;2019:3086910.
24. Sems A, Dimeff R, Iannotti JP. Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg 2006;14:195-204.
25. Haake M, König IR, Decker T, Riedel C, Buch M, Müller HH. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: A randomized multicenter trial. J Bone Joint Surg Am 2002;84:1982-91.
26. Rompe JD, Decking J, Schoellner C, Nafe B. Shock wave application for chronic plantar fasciitis in running athletes. A prospective, randomized, placebo-controlled trial. Am J Sports Med 2003;31:268-75.
27. Krischek O, Hopf C, Nafe B, Rompe JD. Shock-wave therapy for tennis and golfer’s elbow — 1 year follow-up. Arch Orthop Trauma Surg 1999;119:62-6.
28. Perlick L, Luring C, Bathis H, Perlick C, Kraft C, Diedrich O. Efficacy of extracorporal shock-wave treatment for calcific tendinitis of the shoulder: Experimental and clinical results. J Orthop Sci 2003;8:777-83.
29. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res 2003;21:984-9.
30. Elster EA, Stojadinovic A, Forsberg J, Shawen S, Andersen RC, Schaden W. Extracorporeal shock wave therapy for nonunion of the tibia. J Orthop Trauma 2010;24:133-41.
31. Huang SS, Chen SF, Tsay SL, Chia WT, Chien TW. Nurse practitioner applies extracorporeal shock wave therapy for patients with frozen shoulder: A randomized controlled trial. J Am Assoc Nurse Pract 2025;???:???.
32. Farhat MA, Butt M, Saeed A, Waseem A, Shah SM. Effects of extracorporeal shockwave therapy in long term functional outcomes of shoulder adhesive capsulitis. Ann Med Health Sci Res 2021;11:67-70.
33. Chen CY, Hu CC, Weng PW, Huang YM, Chiang CJ, Chen CH, et al. Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis. J Shoulder Elbow Surg 2014;23:1843-51.
| 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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