Shockwave therapy may ease frozen shoulder pain, but lasting benefits remain uncertain
Extracorporeal shockwave therapy probably reduces short-term pain linked to frozen shoulder, while manipulation under anesthesia—with or without steroid injections—probably improves short-term flexion (raising the arm forward and overhead) compared with usual care, finds a review of the latest trial evidence published by The BMJ.
A recent review of 189 randomized controlled trials involving 12,988 adults with frozen shoulder found that extracorporeal shockwave therapy likely reduces short-term pain. The treatment, which uses low-energy sound waves to stimulate healing, showed a mean difference of -1.97 on a 0-10 scale compared to usual care. Additionally, manipulation under anesthesia, either with or without steroid injections, appears to improve short-term flexion (shoulder movement forward and overhead) by 33.29 degrees or 26.16 degrees, respectively, compared to usual care.
However, the evidence for these benefits is considered moderate to low certainty, with most studies at high risk of bias and lacking consistent reporting of adverse events. Most other treatments' effects and longer-term safety remain uncertain. The review concludes that while these findings may help inform treatment decisions within the first six months, they do not establish longer-term benefits or comparative effectiveness.
Treatment choices should consider factors such as invasiveness, costs, patient preferences, clinical expertise, and the persistent uncertainty surrounding longer-term benefits and harms.
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