Ultrasound Deep Heat Therapy for Adhesive Capsulitis: Does it really work?

TOPLINE

Adhesive capsulitis is caused by the abnormal process of synovial inflammation and capsular fibrosis in the glenohumeral joint. It leads to dysfunction of daily activities with pain and stiffness in the shoulder. Various physical therapy modalities are known to alleviate symptoms such as therapeutic ultrasound, hot-packs, interferential currents, transcutaneous electrical stimulation, etc. 

Thermo-therapy modalities like ultrasound therapy (UST) are commonly used for ACS treatment. UST is known to create molecular vibration which forms cavitation and microstreaming by inducing cell membrane permeability and soft tissue healing. 1 MHz UST is used to target deeper tissues typically between 2.5 – 5 cms and 3 MHz UST is used to target tissues at the depth of 0.8 -1.6 cms. 

METHODOLOGY

As per the guidelines of the PRISMA, (Preferred Reporting Items for Systematic Review and Meta-Analyses) the authors searched clinical trails from the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PEDro, Web of Science, and Google scholar. Studies that met all the following inclusion criteria were selected:

• The studies that enrolled patients with ACS for any duration.
• The studies that compared thermal ultrasound therapy alone or in combination with any other intervention.
• The goal of treatment was to improve pain, mobility, or functional disability for which outcome measures were attained in pain score, range of motion, and disability score, respectively.

Only 7 out of 3055 relevant studies were finally selected after exclusion of other studies due to irrelevant titles/abstracts, ineligible clinical conditions, ineligible intervention, and the quality assessment not meeting inclusion criteria.

The authors also used a modified Downs and Black checklist consisting of a total of 27 scoring items to assess the and quality of the 7 selected trails. A total of 409 participants’ data from the seven trials published between January 2006 and November 2018 were included for the analysis. All trials included, had the main intervention as UST comparing it with either sham (3 trials), shock-wave therapy (2 trials), corticosteroid injection/platelet-rich plasma injection (1 trial) and cryotherapy (1 trial). All studies included co-interventions such as exercises and/or mobilizations.

Outcome measurements included the following instruments: 

• For pain, visual analogue pain scores during activity or random were included in data for analysis. 
• For mobility, shoulder range of abduction, flexion internal and external rotation measured with goniometer were included. 
• For disability, the Shoulder Pain and Disability Index (SPADI) consisting of 5 pain questions and 8 disability questions were included. 

RESULT

(Key: PSWT – piezoelectric shockwave therapy, UST – ultrasound therapy, CTP – cryotherapy, VAS – visual analogue scale, SPADI - Shoulder Pain and Disability Index, PRP – plasma-rich platelet injection, CS – corticosteroid injection, ABD - abduction; FL - flexion; IR - internal rotation; ER - external rotation; EX – extension, DASH - disabilities of the arm, shoulder, and hand score, UCLA - University of California and Los Angeles shoulder scale, SDQ - shoulder disability questionnaire)  

TAKE-AWAY

This research was aimed to determine the effectiveness of deep heat ultrasound therapy by way of systematic review and meta-analysis. 

• Researchers concluded that UST accompanied by co-interventions is useful to participants with ACS to reduce overall pain. 
• Range of movement improvements were seen in 4 clinical trials where UST was compared with PSWT, ESWT, plasma-rich platelet, and corticosteroid injection. However, whether UST was a superior modality when compared with others was inconclusive. 
•  There was no significant difference in disability scores of participants treated with UST versus placebo, corticosteroid injection, or platelet-rich plasma injection.  

SOURCE 

The study was led by Jung-Ha Sung from the department of Sports medicine & science, Kyung Hee University, Yongin-si, Korea. The study was published in the International Journal of Environmental Research and public health in February 2022. LINK - https://pmc.ncbi.nlm.nih.gov/articles/PMC8835494/#sec4-ijerph-19-01859 

LIMITATIONS 

According to the authors, “whether there are additional benefits of the UST when carried out with other therapeutic interventions is still ambiguous”. 

More research is needed to determine the sole effect of UST over other modalities. When using various types of interventions and comparing them with UST, a larger number of data syntheses may help determine the effectiveness of each modality.