In a lengthy letter, a reader seeks advice because she has been experiencing daily and nightly pain for 5 months due to a condition known as frozen shoulder. So far, she has received 4 injections (shoulder injections meant to reduce pain and inflammation) and has undergone physiotherapy, but without any results. She inquires whether shockwave therapy would be helpful in her case.
Frozen shoulder is a colloquial term for a condition whose cause is still unknown today. It represents an inflammatory process in the joint capsule. Once initiated, the process typically lasts between one to three years and has three phases: the inflammatory phase (when the pain is the most intense), the freezing phase (when movement restriction is the greatest), and the thawing phase. Although the condition will resolve on its own without treatment, for some patients, the pain is so intense that therapy is required, and in some cases, the process extends so much that therapy becomes necessary again. Additionally, these three phases do not necessarily alternate as described.
If pain does not subside even after multiple injections, it is worth verifying once more whether it is indeed a frozen shoulder or another condition that merely resembles it. A repeat X-ray, or preferably an MRI, is indicated. If the diagnosis is confirmed, it is very likely that physiotherapy has been trying to aggressively mobilize the shoulder, or the patient has been doing so themselves during the inflammatory phase. Studies have clearly shown that painful mobilization or repeated painful movements during the day prolong the inflammatory phase and simultaneously reduce the effectiveness of anti-inflammatory drugs and analgesics. Therefore, the first task is to avoid movements that cause pain. If necessary (in a small number of cases), the entire arm can be partially immobilized for a period. After the intense inflammatory phase concludes, an experienced and skilled physiotherapist can begin with a complex of shoulder tractions within the pain-free zone.
Shockwave therapy is CONTRAINDICATED for frozen shoulder because it works by enhancing the inflammatory process. While this role can help with calcifications and tendinopathies, it can only harm a frozen shoulder.
