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Assessment of the Efficacy of Extracorporeal Shock Wave Therapy in Adhesive Capsulitis: Outcomes Analysis and Predictors of Recurrence

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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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Extracorporeal Shock Waves in Metabolic Inflammation

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Review Article | Vol 4 | Issue 2 |  July-December 2024 | page: 18-25 | Cláudio Lopes Simplício, Izair Jefthe Rodrigues, Guilherme Antônio Moreira De Barros

DOI: https://doi.org/10.13107/jrs.2024.v04.i02.147

Author: Cláudio Lopes Simplício [1], Izair Jefthe Rodrigues [2], Guilherme Antônio Moreira De Barros [3]

[1] RJ Brazil Ortofisio Clinic – Instdor Clinic, São Paulo State University (UNESP), Botucatu, Brazil,
[2] Department of Neurosurgery, Regen® Institute of Reparative Medicine, Valinhos, São Paulo, Brazil.
[3] Antalgic Therapy and Palliative Care Department, Faculdade de Medicina de Botucatu, UNESP-SP, Botucatu, Brazil

Address of Correspondence
Dr. Cláudio Lopes Simplício,

São Paulo State University (UNESP), Botucatu, Brazil.

E-mail:c.simplicio@unesp.br

Abstract

Adhesive The presentation of this paper provides a comprehensive overview of the challenges associated with metabolic syndrome in clinical practice, while highlighting the innovative role of extracorporeal shock waves as a therapeutic tool to manage metabolic inflammation. A multidisciplinary approach is emphasized, suggesting that collaboration among different areas of expertise is essential to improve patient health outcomes.
Keywords: Metabolic inflammation, Oxidative stress, Extracorporeal shock waves

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How to Cite this article: Simplício CL, Rodrigues IJ, De Barros GA. Extracorporeal Shock Waves in Metabolic Inflammation. | Journal of Regenerative Science | July-December 2024; 4(2): 18-25.

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Extracorporeal Shock Waves and Ultrasound: A Combined Approach in the Treatment of Musculoskeletal Injuries

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Original Article | Vol 4 | Issue 2 |  July-December 2024 | page: 26-31 | Cláudio Lopes Simplício, Everaldo Gregio-Junior, Guilherme Antônio Moreira de Barros, Izair Jefthe Rodrigues

DOI: https://doi.org/10.13107/jrs.2024.v04.i02.149

Author: Cláudio Lopes Simplício [1], Everaldo Gregio-Junior [2], Guilherme Antônio Moreira de Barros [3], Izair Jefthe Rodrigues [4]

[1] Orthopedics – Physiatrist – Antalgic Therapy, RJ Brazil Ortofisio Clinic – Instdor Clinic- São Paulo State, University (UNESP) Botucatu – São Paulo, Brazil,
[2] Department of Medical Imaging, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil; Professor of the Ultrasonography course at Cetrus School, São Paulo, Brazil,
[3] Department of Antalgic Therapy and Palliative Care, Antalgic Therapy and Palliative Care, Faculdade de Medicina de Botucatu, UNESP, São Paulo, Brazil,
[4] Department of Neurosurgery, Regen® Institute of Reparative Medicine, Valinhos, São Paulo, Brazil

Address of Correspondence
Dr. Cláudio Lopes Simplício,

Orthopedics – Physiatrist – Antalgic Therapy, RJ Brazil Ortofisio Clinic – Instdor Clinic- São Paulo State, University (UNESP) Botucatu – São Paulo, Brazil.

Email: c.simplicio@unesp.br

Abstract

The combination of extracorporeal shock wave therapy (ESWT) and ultrasound (US) emerges as an innovative and effective approach in the treatment of musculoskeletal injuries. This integration provides significant benefits in both diagnosis and treatment, resulting in better clinical outcomes and faster recovery for patients. US stands out as a non-invasive diagnostic tool that offers real-time imaging, and is widely used in the assessment of various musculoskeletal conditions, including injuries to the shoulder, elbow, wrist, knee, and ankle.
ESWT is an effective method that has expanded to treat a variety of musculoskeletal pathologies through the application of acoustic waves. The interaction between US and shock waves is crucial in ensuring precision in interventions, allowing for more targeted and effective treatment.
In addition to enhancing the accuracy of injections and therapeutic interventions, US also plays a critical role in monitoring clinical progress and the early detection of complications. Studies show that the combination of these approaches results in significant pain relief and improved functionality for patients. Therefore, the integrated use of US and shock wave therapy represents a valuable strategy in the management of musculoskeletal injuries, broadening its application in clinical practices.
Keywords: Ultrasound, Musculoskeletal injuries, Extracorporeal shock waves

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How to Cite this article: Simplício CL, Junior EG, Barros GAMD, Rodrigues IJ | Extracorporeal Shock Waves and Ultrasound: A Combined Approach in the Treatment of Musculoskeletal Injuries. | Journal of Regenerative Science | July-December 2024; 4(2): 00-00.

 

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