Diabetes-induced adhesive capsulitis: the role of radial extracorporeal shock wave therapy on pain and the shoulder muscles strength

Abstract

Background and Aims: The study aimed to determine thechanges in the shoulder pain and muscle strength in patients with diabetes-induced adhesive capsulitis (DIAC) when the differentdose of Radial Extracorporeal Shock Wave Therapies (rESWT)applied.Methods: This double-blind randomized clinical trial conductedat Okan University Research Hospital (Istanbul) with patients referredfrom multiple centers. Participants were ‡45years (mean53.49 – 5.81 years), had T2D for ‡3years (meanduration9.92–5.70years), had DIAC, had HbA1c£ 9.0% (mean 7.38 – 0.76%); werebeing treated with inadequately basal insulin (20.5%) and oral antidiabeticdrugs (79.5%) were enrolled. The rESWT was appliedwith Enraf Nonius Endoplus device with a 25mm applicator, at 8Hz,and with 2000 beats. The participants were randomly assigned tothree groups as follows: high dose rESWT (hrESWT, n = 13),moderate dose rESWT(mrESWT, n =13) or placebo rESWT group(prESWT, n = 13). The primary outcomes were Visual Analog Scale(VAS) for pain and dynamometer evaluations for shoulder musclestrength for over the 4th and 6th week of the trial.Results: Without the group differences (p>0.05) pain decreasedin 4th and 6th week in all three treatment groups(p < 0.001). Increased strength of shoulder flexor, extensor androtator muscles were observed in both groups receiving activerESWT(p < 0.05). Strength of abductor’s muscles did not changein all three groups (p>0.05). There was no increase in the strengthof the evaluated muscles of the prESWT group (p>0.05).Conclusions: Different doses of rESWT were effective inimproving muscle strength in the diabetes-induced adhesivecapsulitis. In pain reduction, rESWT was effective without beingdifferent from placebo application.