Short Wave Diathermy (SWD) Therapy in Patients with Adhesive Capsulitis of Shoulder

Research Article

Phys Med Rehabil Int. 2022; 9(2): 1203.

Short Wave Diathermy (SWD) Therapy in Patients with Adhesive Capsulitis of Shoulder

Haque A¹ and Khan ZI²*

1Department of Physical Medicine and Rehabilitation, Cox’sbazar Medical College Hospital, Bangladesh

2Department of Biological and Biomedical Sciences, Glasgow Caledonian University, UK

*Corresponding author: Zahidul Islam Khan, Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK

Received: July 01, 2022; Accepted: August 04, 2022; Published: August 11, 2022


Introduction: There are several options for the management of adhesive capsulitis. Short Wave Diathermy (SWD) is also an important option for adhesive capsulitis management, but very few data are available to support SWD use in adhesive capsulitis. Therefore, we studied the effectiveness of SWD to improve the pain and range of motions in frozen shoulder.

Methods: A total 56 patients with adhesive capsulitis were selected in this randomized controlled trial for a study period of 6 months. The subjects were divided into two intervention groups; one group with conventional treatment plan plus SWD and second group with conventional treatment alone. Visual Analogue Scale (VAS) with Tenderness Grading (TG) and Shoulder Pain And Disability Index scoring (SPADI) were used to measure the pain and disability, The SPSS (version 20) was used for the statistical analysis; differences between the intervention groups were determined by independent t-test.

Results: Among 56 patients, male and female gender were matched (p>0.05) and male to female ratio was 1.66: 1. Only one patient had both shoulders involvement, 48.2% of subjects had right sided and 50.0% had left sided involvement. There were 92.7% of patients who had localized pain and only 7.3% had radiating pain. About 56.4% of the patients had evening time of onset of the pain and 43.6% at night. Most of the patients in both groups had constant and intermittent type of pain, 47.5% and 45.5% respectively, and other types were sharp and dull. Significant differences were observed in VAS, TG and SPADI analysis in between Group A and Group B at week 2, 4 and 6 (P<0.05), whereas initial follow-up was non-significant in VAS and TG analysis (p>0.05).

Conclusion: We conclude that when SWD is combined with conventional management of adhesive capsulitis, it gives better reduction in shoulder pain and disability.

Keywords: Adhesive capsulitis; Short wave diathermy; stretching exercise; NSAIDs


Adhesive capsulitis is a clinical condition, which is characterized by painful and restricted active and passive shoulder motion [1]. The prevalence of adhesive capsulitis is about 2-5% in the normal population, whereas, in patients with diabetes it is increased to 10% in type IDM and 22% in type IIDM. Adhesive capsulitis is commonly occurred in the ages of 40 to 60 years [2-4]. Higher incidence of this condition has been reported in women compared to men. Approximately, 70% of adhesive capsulitis patients are women [5].

Although the etiology of adhesive capsulitis remains unclear yet, this condition is basically classified into two different etiological categories such as, idiopathic and secondary. Idiopathic or primary adhesive capsulitis, which is not linked to any systemic disease or injury [1]. Most common etiology of secondary adhesive capsulitis is diabetes mellitus. It may also be linked to other conditions such as parkinson’s disease, pulmonary disease hyperthyroidism, hypothyroidism, and hypoadrenalism, cardiac disease, and stroke [6].

Adhesive capsulitis has been staged in 3 stages [7].

1. Stage I: this is a painful stage and usually lasts for 2-9 months.

2. Stage II / frozen stage: pain subsides at this stage but stiffness is marked that lasts for 4-12 months.

3. Stage III / thawing phase: shoulder motion improves and pain appears to resolve

Diagnosis of adhesive capsulitis is made by clinical observation [8]. There are many treatment options for treating adhesive capsulitis, but only few have high level of evidence to support them [9]. The effective adhesive capsulitis treatment is undefined yet. Nonsurgical treatments for this condition are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), short-term oral corticosteroids, intra-articular corticosteroid injections, hydro-dilation, physiotherapy, and acupuncture [10]. Physical therapy has been shown to play a principal role in the treatment of many painful shoulder conditions including adhesive capsulitis [11]. Clinical studies fail to demonstrate any clear effect of specific treatment; this may be affected by the placebo effects and the patient characteristics and methodological weaknesses of the trials evaluated [12].

SWD is a treatment modality, which yields deep heat by changing electromagnetic energy into thermal energy. High frequency magnetic and electrical fields oscillation produces rotation of polar molecules, and distortion of nonpolar molecules, and movement of ions with subsequent heat generation [13,14]. Industrial, scientific and medical uses are limited to 13.56MHz, 27.12MHz and 40.68MHz by the federal communications commission [15]. The most commonly used frequency is 27.12MHz14. Short Wave Diathermy (SWD) is commonly used as an adjuvant therapy to exercise for helping the patient to regain ROM and restore function of the affected shoulder. Alteration of the viscoelastic properties of connective tissues by heating is the basis to attain the therapeutic goals. Studies have shown that tensile stress is significantly dropped with a rise of temperature of soft tissues in between 40°C and 45°C compared to that recorded at room temperature (25°C) [16]. Findings also suggest that deep heating (using SWD) is more effective than the stretching or superficial heating (using hot packs) alone for improving shoulder pain and function in stage II adhesive capsulitis [16]. Although many people in the community have been suffering from adhesive capsulitis in our country (Bangladesh), not many studies have done in this field. A paucity of information exists in our country regarding the exact role of SWD and Exercise therapy in the management of adhesive capsulitis. In this study, an attempt has been made to see the effects of SWD in the management of adhesive capsulitis and its outcome.

Materials and Methods

A randomized controlled clinical trial was carried out among 56 patients at the Department of Physical Medicine & Rehabilitation, Coxsbazar medical college, Coxsbazar, Bangladesh, for 6 months. Study populations were the patients, who attended the outpatient department of Physical Medicine & Rehabilitation. Purposive sampling was used for this trial.

A sample size calculation was performed based on assumptions that 65% can respond to treatment group & 95% to control group. Sample size was calculated as follows: [17]