Shockwave Therapy Effectiveness (ESWT_AC_DM)

Medium-energy Shockwave Therapy Effectiveness in the Treatment of Patients With Both Adhesive Capsulitis and Type 2 Diabetes Mellitus

Our hypothesis is that shock-wave therapy will reduce pain, increase the mobilization of glenohumeral joint, and will improve functionality in patients with adhesive capsulitis and type 2 diabetes mellitus.

The underlying mechanism of shock-wave therapy in individuals with both adhesive capsulitis and type 2 diabetes mellitus still remains unclear. Considering the physiological mechanism of shock-wave therapy, the effect of shock-wave therapy on pain, function, and resting muscle tone in patients with adhesive capsulitis and type 2 diabetes mellitus was evaluated. There are only two studies that evaluated the usefulness of shock-wave therapy in diabetic patients. There are no studies examining the effect of shock-wave therapy on shoulder muscle tone in individuals with adhesive capsulitis and type 2 diabetes mellitus. Therefore, the aim of this study is to investigate the treatment effects of mrESWT, in individuals with adhesive capsulitis and type 2 diabetes mellitus.

The patients received shock-wave exposure (energy flux density= 0.12 mJ/mm2, at 8 Hz), twice a week, for six weeks. Standard physiotherapy care was applied.

In the placebo group, the device applicator was positioned in the same way as the experimental shock-wave group. The previously recorded 8 Hz pulsed shock wave sounds were played, as if the actual application was being performed, however the device itself was off during the session, and its pedal was not pressed. Standard physiotherapy care was applied.

Radial Extracorporeal Shock Wave Therapy, also called radial pulse therapy. In contrast to regular focused shock wave therapy,Radial Extracorporeal Shock Wave Therapy creates a diverging pressure field, which reaches a maximal pressure already at the source, and therefore has a more superficial, but broader, effect than focused shock wave therapy. This treatment is increasingly used for calcific and non-calcific tendinopathy, probably because it is easier to apply and more affordable than focused shock wave therapy. The proposed mechanisms for the effect of Radial Extracorporeal Shock Wave Therapy include pain relief, tissue regeneration and destruction of calcification.

Evaluation of shoulder pain was performed using the Visual Analog Scale. The score is determined by measuring the distance (mm) on the 10-cm line between the "no pain" on the far left and "the most intense pain imaginable" on the far right.The patient places a mark at a point on the line corresponding to the patient's rating of pain intensity. A higher score indicates greater pain intensity.

Evaluation of shoulder pain was performed using the Visual Analog Scale. The score is determined by measuring the distance (mm) on the 10-cm line between the "no pain" on the far left and "the most intense pain imaginable" on the far right.The patient places a mark at a point on the line corresponding to the patient's rating of pain intensity. A higher score indicates greater pain intensity.

The joint movements of the affected shoulder was measured using a digital electrogoniometer. A higher score indicates greater improvement.

The joint movements of the affected shoulder was measured using a digital electrogoniometer. A higher score indicates greater improvement.

Function was assessed using the self-administered Shoulder Pain and Disability Index.The Shoulder Pain and Disability Index contains 13 items that assess two domains; a 5-item subscale that measures pain and an 8-item subscale that measures disability. Each subscale is summed and transformed to a score out of 100. A mean is taken of the two subscales to give a total score out of 100, higher score indicating greater impairment or disability.

Function was assessed using the self-administered Shoulder Pain and Disability Index.The Shoulder Pain and Disability Index contains 13 items that assess two domains; a 5-item sub-scale that measures pain and an 8-item sub-scale that measures disability. Each sub-scale is summed and transformed to a score out of 100. A mean is taken of the two sub-scales to give a total score out of 100, higher score indicating greater impairment or disability.

The muscle tone which is a biomechanical property of the shoulder muscles will be evaluated with a portable hand-held myotonometer. This myotonometer (MyotonPRO - Tallinn, Estonia) is non-invasive and provides a quantitative assessment of a muscle's biomechanical properties. The MyotonPRO applies a short-intensity mechanical impulse on the skin overlying the muscle or facia. The tissue's response then generates a signal that is recorded, and an internal software program produces an acceleration graph. To determine the feasibility of the MyotonPRO for assessing the muscle tone of forearm muscles measurements will be performed and recorded.

Inclusion Criteria: Patients aged > 18 years Unilateral adhesive capsulitis of the shoulder The symptom duration > 3 months Shoulder pain The Limited glenohumeral joint active range of motion of greater than 50% in at least three specific movements among abduction, flexion, internal rotation, and external rotation Having type 2 diabetes for at least 3 years Exclusion Criteria: Previous shoulder surgeries Massive, minor, and major rotator cuff tears Pain and muscle strength loss due to neurological causes History or presence of malignancy Osteoporosis