Extracorporeal shockwave therapy (ESWT) effectively reduces short-term pain in patients with adhesive capsulitis, or “frozen shoulder,” but its benefits beyond three months remain unclear. A large-scale systematic review and network meta-analysis published in the international journal The BMJ evaluated 189 randomized controlled trials involving 12,988 patients with an average age of 54. The study, as reported by imaeil.com, found that shockwave therapy—which uses low-energy sound waves to stimulate blood flow and tissue recovery—reduced short-term pain by an average of 1.97 points on a 10-point scale compared to standard care. While the data suggested potential improvements in shoulder function and range of motion, the researchers noted that the level of evidence for these outcomes was low and highlighted inconsistencies across the datasets.
Short-Term Efficacy of Manipulation Under Anesthesia
The systematic review also examined manipulation under anesthesia (MUA), a procedure where a physician moves the shoulder joint to increase range of motion while the patient is sedated. When combined with steroid injections, MUA improved short-term shoulder flexion (the angle of lifting the arm forward) by an average of 33.29 degrees compared to standard care. Even when performed without steroid injections, MUA yielded a 26.16-degree improvement in flexion.
These findings position MUA and shockwave therapy as notable options for short-term symptom management. However, the researchers emphasized that the evidence for most other therapeutic approaches—particularly concerning long-term effects beyond three months and comparative safety profiles—remains significantly more uncertain.
Challenges in Safety Reporting and Long-Term Data
A primary limitation identified by the study team is the lack of complete, consistent reporting regarding side effects across the analyzed trials. Because adverse events were inconsistently documented, the researchers could not definitively compare the safety risks associated with various treatments.
Adhesive capsulitis, which affects approximately 2% to 5% of the general population, involves the thickening and tightening of the connective tissue surrounding the shoulder joint, leading to inflammation, pain, and restricted movement. The condition is most prevalent in individuals aged 50 to 60. Given the current uncertainty regarding long-term outcomes, the study authors advise that patients consult closely with their medical providers to weigh the risks and benefits of these interventions when determining an initial treatment plan.
Common Questions Regarding Frozen Shoulder Treatment
How long do the benefits of shockwave therapy last for frozen shoulder?
The current evidence indicates that while shockwave therapy provides measurable pain relief in the short term, the data regarding its efficacy beyond the three-month mark is insufficient and unclear.
Is manipulation under anesthesia considered a standard treatment?
Manipulation under anesthesia is a recognized procedure for improving range of motion in patients with adhesive capsulitis, often performed in conjunction with other interventions like steroid injections to maximize short-term functional gains.
Why is there uncertainty regarding the safety of these treatments?
The systematic review identified that clinical trials in this field have frequently failed to report side effects in a complete or consistent manner, making it difficult for researchers to establish a clear safety profile for the various therapies analyzed.