High-dose extracorporeal shockwave therapy restores shoulder motion in adhesive capsulitis after a single session

Extracorporeal shockwave therapy (ESWT) is widely applied to manage musculoskeletal disorders, including shoulder pathologies. However, the optimal therapeutic dosage for adhesive capsulitis (AC) remains unclear. This study aimed to evaluate the dose-response relationship of ESWT in patients with AC.

In this randomized controlled trial, 48 patients with AC refractory to conservative management were assigned to receive a single session of either basic-dose (3,000 pulses) or high-dose (6,000 pulses) ESWT. Shoulder range of motion was assessed at baseline, immediately after treatment, and at 1, 2, 4, 8, and 12 weeks. Functional outcomes were evaluated at 12 weeks using the Constant Murley score. Subgroup analysis was performed based on baseline abduction (cutoff: 90°).

At 12 weeks, the high-dose group demonstrated significantly greater improvements than the basic-dose group in forward flexion (P < .001), abduction (P < .001), external rotation (P = .004), and internal rotation (P = .001). The largest changes occurred immediately after treatment. Subgroup analysis showed that high-dose ESWT resulted in superior gains in forward flexion, abduction, and internal rotation across baseline abduction strata, whereas no significant between-group difference was observed for external rotation.

High-dose ESWT provided significantly enhanced recovery of shoulder range of motion and function compared with a basic-dose protocol in patients with AC. These findings support a dose-response relationship; however, results should be interpreted as short-term outcomes given the 12-week follow-up and absence of a control group.