Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain, function, and range of motion in diabetic patients with shoulder adhesive capsulitis.

Abstract

To compare the efficacy of radial extracorporeal shock-wave therapy (rESWT) vs. an ultrasound-guided low-dose intra-articular steroid injection in pain reduction and functional improvement in diabetic patients with shoulder adhesive capsulitis (AC).

METHODS:

This was a 2-parallel-group, active-control, assessor-blinded, randomized trial. We randomized 103 diabetic patients with shoulder AC to receive either 4 sessions of rESWT, 1 week apart (rESWT group, n = 52), or a single ultrasound-guided low-dose intra-articular steroid injection of 20 mg of triamcinolone acetonide (steroid group, n = 51). The primary outcome measure was functional improvement evaluated by the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) score. Secondary outcome measures were pain evaluated by the visual analog scale score and shoulder range of motion (ROM). An assessor who was blinded to treatment assignment assessed both groups at baseline and at 4, 8, and 12 weeks thereafter.

RESULTS:

By 12 weeks, both groups demonstrated a significant reduction in the qDASH score and pain severity, as well as improvement in ROM. However, significantly improved function (qDASH score, 40.4 ± 12.9 vs. 50.5 ± 13.3; P < .001) and shoulder pain reduction (visual analog scale score, 1.6 ± 1.2 vs. 2.8 ± 1.7; P < .001) were found in the rESWT group vs. the steroid group. Similar improvement in shoulder ROM was observed in both groups.

CONCLUSION:

At short-term follow-up, rESWT was superior to a low-dose intra-articular steroid injection in improving function and pain in diabetic patients with shoulder AC. Therefore, rESWT might be considered a safe alternative to steroid injections in diabetic patients with shoulder AC.

• Authors: Tasneem El Desouky Mohammed El Naggar, Ahmed Ibrahim Elsayed Maaty, Aly Elsayed Mohamed
• Journal: Journal of shoulder and elbow surgery (J Shoulder Elbow Surg) Vol. 29 Issue 7 Pg. 1300-1309 (Jul 2020) ISSN: 1532-6500 [Electronic] United States
• PMID: 32553435 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Inflammatory Agents
• Triamcinolone Acetonide

Topics

• Aged
• Anti-Inflammatory Agents (administration & dosage, therapeutic use)
• Bursitis (complications, physiopathology, therapy)
• Diabetes Mellitus, Type 2 (complications)
• Extracorporeal Shockwave Therapy
• Female
• Humans
• Injections, Intra-Articular
• Male
• Middle Aged
• Pain Measurement
• Range of Motion, Articular
• Shoulder Joint (physiopathology)
• Shoulder Pain (etiology, therapy)
• Single-Blind Method
• Treatment Outcome
• Triamcinolone Acetonide (administration & dosage, therapeutic use)
• Ultrasonography, Interventional