Shock-Wave Therapy May Ease 'Frozen Shoulder' in Diabetes

Miriam E Tucker

December 08, 2016

Extracorporeal shockwave therapy (ESWT) may offer a safer alternative to steroid injections or surgery for treating "frozen shoulder" in diabetes patients, preliminary findings suggest.

Results from a small, observational, uncontrolled trial were published online November 29 in Diabetes Care by Flavia Santoboni, of Sapienza University of Rome, Italy, and colleagues.

Adhesive capsulitis of the shoulder (ACS), commonly known as "frozen shoulder," is characterized by intense shoulder pain with progressive joint mobility limitation and functional disability. It is the most common upper-extremity musculoskeletal disorder among people with diabetes.

Treatments for "frozen shoulder" include physical therapy, oral or intra-articular steroid injections, ESWT, and arthroscopic capsular release.

In diabetes patients, steroids may have a shorter duration of benefit and can significantly raise glucose levels. "Therefore, it would be preferable to avoid steroids and opt for alternative therapies in these individuals," the authors write.

ESWT May Be Viable Alternative to Steroids for Diabetics With ACS

The new study — believed to be the first ever to assess ESWT on functional outcomes in diabetes patients with ACS — included 50 consecutive patients (seven with type 1 and 43 with type 2 diabetes), with an overall mean ACS pain duration of 15.7 months.

Inclusion criteria were known diabetes, shoulder pain, >75% range of motion loss in two or more directions (abduction, flexion, external rotation, and internal rotation) for at least 3 months, and no treatment other than analgesics within the past 3 months.

All patients received ESWT once a week for 3 weeks, with 2400 shots in an anterior-to-posterior direction on the anterior shoulder joint using a low/moderate-energy flux density (0.06–0.14 mJ/mm2, depending on individual pain tolerance).

Functional improvements were significant compared with baseline at 2 months, with further amelioration at 4 and 6 months. These included an overall 3.14-fold decrease in the Visual Analog Scale, a 2.97-fold reduction in the Disabilities of the Arm, Shoulder, and Hand Score questionnaire, and a 39.7% increase in the Constant Shoulder Score.

No relevant side effects were reported throughout the study.

"Results indicate that ESWT may be effective, feasible, and well tolerated and can therefore represent a viable alternative to steroids for ACS treatment in patients with diabetes," the authors note.

However, they stress: "These findings need to be confirmed by a randomized controlled trial."

Santoboni and colleagues have no relevant financial relationships.

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Diabetes Care. Published online November 29, 2016. Article

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