Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome

Abstract

ObjectiveTo investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome.MethodsIn this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed.ResultsVAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were –1.69±1.90 and –0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were –1.60±1.74 and –0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were –1.61±1.73 and –0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05).ConclusionrESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.

<p>Shock Waves as a Treatment Modality for Spasticity Reduction and Recovery Improvement in Post-Stroke Adults – Current Evidence and Qualitative Systematic Review</p>

“…This resulted in mean differences showing clinical improvement in spasticity between pre-and postinterventions at Δ=34.97%. This comparison indicates the similar clinical effect in spasticity reduction for both ESWT modalities (Δ=0.52%), though slightly better for rESWT, however statistically non-significant for M0 (p=0.153), M1 (p=0.223), and M1-M0 (p=0.525) 54,[65][66][67][68][69]74 (Figure 2 and Table 1).…”

“…This comparison determines the more beneficial effect of fESWT in the enhancement of ROM compared to rESWT (Δ=6.57%), nevertheless statistically non-significant for M0 (p=0.897), M1 (p=0. 897), and M1-M0 (p=0.897) 54,67,68 (Figure 3 and Table 1).…”

“…For purposes of the systematic review, the selected clinical outcomes were analyzed and compared between the baseline (M0) and the first measurement time point after ESWT (M1). The following outcomes were analyzed: (1) spasticity level as Δ% of grade in MAS or MMAS tools in 16 studies (nine studies in fESWT vs 7 studies in rESWT), 54,[61][62][63][64][65][66][67][68][69][70][71][72][73][74] (2) range of motion as Δ% of degree in GOM assessment of nine studies (six studies in fESWT vs three studies in rESWT), 54,63,64,67,68,70,72,75 and (3) selected electrophysiological parameters in such as MNC-V as Δ% of ms, CMAP-L as Δ% of ms, CMAP-A as Δ% of mV, FW-L as Δ% of ms, FW-A as Δ% of μV, HR-L as Δ% of ms and H/M-R as Δ% in six studies (four studies in fESWT vs two studies in rESWT), 65,67,70,73,75 It should be also noted that follow-up observations were undertaken in 12 studies within a mean period of 5.5 weeks (6.2 weeks in fESWT vs 4.7 weeks in rESWT) 54,[62][63][64][65][66]68,70,73 (Table 1).…”

“…It was found that in the ESWT groups the local anesthetic transcutaneous injections were not performed in eight studies. 61,66,[68][69][70][72][73][74] This clinically important issue was not specified in the case of nine articles 54,[62][63][64][65]67,71,75 ( Table 1). Only 11 cases of unexpected ESWT-related side effects were identified (pain n=5, lower limb muscular weakness n=2, petechiae at the treatment site n=3, and small bulla n=1).…”

“…According to the design of the study protocols, 11 of the 17 qualified studies were represented by the RCTs with the highest reliability of research data (five in fESWT vs six in rESWT), 54,[61][62][63][64][65][66][67][68][69] four were CCTs without randomized allocation (four in fESWT vs zero in rESWT), [70][71][72]75 two were PCTs without controls (one in fESWT vs one in rESWT), 73,74 and there were no CCRs ( Table 2).…”