Treatment For Chronic Shoulder Pain: Better Results With Exercise Than Shockwave Treatment
Shoulder pain is the fourth most frequent type of musculoskeletal pain reported to general practitioners and physiotherapists. Physiotherapy, non-steroidal anti-inflammatory drugs, and steroid injections are often part of the treatment. Physiotherapy can consist of shockwave treatment, ultrasound, exercises and acupuncture.
Although quite a few studies have suggested that shockwave treatment may not be effective, it continues to be used extensively.
In order to find out more, a team of researchers based in Oslo, Norway studied the effectiveness of radial extracorporeal shockwave treatment using low to medium energy impulses delivered into the tissue. They compared it with supervised exercises in patients with shoulder pain.
The study involved a total of 104 men and women aged between 18 and 70 years. They were all attending the outpatient clinic at Ullevaal University Hospital in Oslo. All had shoulder pain lasting at least three months.
Participants were randomized to receive either radial extracorporeal shockwave treatment including one session weekly for four to six weeks or supervised exercises including two 45 minute sessions weekly for up to twelve weeks.
At the start of the study, both groups were identical with regard to age, education, dominant arm affected and pain duration.
All patients were advised not to have any extra treatment except analgesics (including anti-inflammatory drugs) during the follow-up period. They were monitored at six, twelve and eighteen weeks. Using a recognized scoring index, pain and disability were measured.
After eighteen weeks, 64 percent of patients (32 individuals) in the exercise group achieved a reduction in shoulder pain and disability scores. This compared with 36 percent (18 individuals) in the shockwave treatment group.
In the exercise group more patients returned to work. On the other hand, more patients in the shockwave treatment group had additional treatment after twelve weeks. This suggests that they were less satisfied.
These findings corroborate results from earlier trials recommending exercise therapy. The authors say: "results do not strengthen the evidence for extracorporeal shockwave treatment."
They write in conclusion: "Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain."
"Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study"
Kaia Engebretsen, physiotherapist, Margreth Grotle, research leader, Erik Bautz-Holter, professor, Leiv Sandvik, professor, Niels G Juel, MD consultant, Ole Marius Ekeberg, Research fellow, Jens Ivar Brox, MD consultant
BMJ 2009; 339:b3360
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