Efficacy of Extracorporeal Shockwave Therapy versus Ultrasound Therapy in Adhesive Capsulitis of Shoulder Complex: A Systematic Review and Meta-analysis

Physiotherapy treatment of adhesive capsulitis comprises various exercise and electrotherapeutic interventions including Codman’s regime, diathermy, ultrasound therapy, and shockwave. However, there is no existing meta-analytic research comparing the efficacy of shockwave and ultrasound. In this review article the databases of PubMed, Embase, Web of Science, Cochrane Central Register, and Google Scholar were searched for clinical trials. Quality assessment of included studies was done as per the method described in the Cochran’s Handbook of Systematic Reviews. Continuous data for pain, range of motion (ROM), and function were expressed in terms of mean ± standard deviation and dichotomous data as n (%). Standard mean difference between the experimental and treatment arm was calculated with 95% confidence interval (CI). We obtained Eight-hundred and twenty-six studies, out of which only 4 were incorporated after in-depth exploration. Statistical comparisons were made for Visual Analog Scale present (pooled mean difference: −0.93; 95% CI: −1.86, 0.00), ROM in terms of flexion (pooled mean difference: −14.58; 95% CI: −20.86, −8.30), abduction (pooled mean difference: −6.66; 95% CI: −15.04, 1.72), and rotations (pooled mean difference: −3.36; 95% CI: −3.03, −0.33), Patient-Specific Functional Scale (pooled mean difference: −2.30; 95% CI: −3.06, −1.54), Disabilities of the Arm, Shoulder, and Hand (pooled mean difference: −9.70; 95% CI: −14.47, −4.93). Among the 4 included studies, the results showed shockwave to be superior in terms of reducing pain, increasing ROM and improving function. Our meta-analysis concluded that the shockwave is more efficient than ultrasound therapy. However, the improvements were only clinically significant in terms of flexion ROM.