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Extracorporeal shockwave therapy probably reduces short-term pain linked to frozen shoulder, while manipulation under anesthesia—with or without steroid injections—probably improves short-term flexion (raising the arm forward and overhead) compared with usual care, finds a review of the latest trial evidence published by The BMJ.

Most other treatment effects remain uncertain due to low-certainty evidence and inconsistent data, and comparative safety and longer-term effects are not well established.

Frozen shoulder (adhesive capsulitis) occurs when the strong connective tissue surrounding the shoulder joint becomes thick, stiff and inflamed, causing pain and restricted movement. It's more common in people aged 40–60 years, and among women than men.

Many treatments are available, including drugs, steroid injections and surgery, but their comparative benefits and harms remain uncertain.

To address this, researchers analyzed the results of 189 randomized controlled trials involving 12,988 adults (average age 54 years) with adhesive capsulitis comparing active treatments with another intervention, placebo or usual care on pain, function, range of motion and adverse events.

Moderate-certainty evidence showed that extracorporeal shockwave therapy (low-energy sound waves delivered to damaged tissue to stimulate blood flow and healing) probably reduced short-term pain compared with usual care (mean difference -1.97 on a 0–10 scale).

There was some indication that extracorporeal shockwave therapy may also improve short-term function, flexion and abduction, but the researchers say these apparent benefits are less certain because they are based on low-certainty evidence and inconsistencies in the data.

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