Transfer Energy Capacitive and Resistive (TECAR) therapy is a heat therapy method that increases blood circulation at the microscopic level by generating heat in the upper and lower layers of your tissues, reduces inflammation and supports tissue regeneration. In this study, we aimed to evaluate whether this treatment reduces pain and improves functioning in patients with frozen shoulder disease.
Adhesive capsulitis (AC), commonly known as "frozen shoulder," is a prevalent and painful condition resulting from the contracture of the glenohumeral capsule, which significantly impacts individuals' quality of life. While AC is self-limiting in many cases, some patients may experience long-term functional limitations if not treated promptly. One promising intervention is transfer energy capacitive and resistive (TECAR) therapy, which has gained attention for its potential to enhance tissue regeneration, reduce inflammation, and improve pain management by generating heat in superficial and deep tissues. This study aimed to evaluate the effects of TECAR therapy on pain and functional outcomes in patients with adhesive capsulitis (AC). This prospective, randomized controlled clinical trial included 60 patients \[TECAR group: 30, (50.37 ± 13.90 years); control group: 30, (55.27 ± 10.44 years)\]. Both groups completed a 2-week tailored therapeutic exercise program, with 30-minute hot pack application and Transcutaneous Electrical Nerve Stimulation. The TECAR group also received three TECAR therapy sessions per week, for a total of six sessions. Pain was measured using the Visual Analog Scale (VAS), functional status with the Shoulder Pain and Disability Index (SPADI), and supraspinatus tendon thickness and bicipital effusion were assessed via ultrasonography. Evaluations were conducted at baseline, 1 and 3 months post-treatment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
All patients were administered a therapeutic exercise program that included passive, active-assisted, and active range of motion exercises, stretching, strengthening, and mobilization exercises based on their level of movement restriction and pain intensity for 5 sessions per week for 2 weeks under the supervision of an experienced physiotherapist.
As part of the treatment protocol, a hot pack was applied to the affected shoulder area for 30 minutes prior to any other therapeutic interventions. This initial application of heat was intended to promote muscle relaxation, increase local blood circulation, and reduce joint stiffness, effectively preparing the shoulder for the subsequent treatments, including therapeutic exercise, TENS and TECAR therapy. The hot pack was maintained at a temperature between 40-45°C, which is considered optimal for achieving therapeutic heat without causing discomfort or skin irritation.
Ankara Bilkent City Hospital, Physical Medicine and Rehabilitation Hospital
Çankaya, Ankara, Turkey (Türkiye)
Visual Analogue Scale (VAS) for pain
The Visual Analog Scale (VAS) was employed to evaluate pain intensity in patients. This scale features a 10 cm horizontal line, where one end represents "no pain" (0) and the other represents "worst imaginable pain" (10). Patients were instructed to place a mark on the line that best reflected their current pain level. The distance from the "no pain" end to the patient's mark was measured in centimeters and recorded as the VAS score, providing a numeric representation of their pain intensity
Time frame: VAS for pain was applied to the patients before the procedure and at the 4th week and the 12th week after the procedure.
Shoulder Pain and Disability Index (SPADI)
The Shoulder Pain and Disability Index (SPADI) was used to evaluate both pain and functional limitations related to shoulder disorders. SPADI is a patient-reported outcome measure consisting of 13 items, divided into two subscales: pain (5 items) and disability (8 items). Each item is rated on a numerical rating scale (0:no pain or difficulty to 10:worst pain imaginable or extreme difficulty). The scores for each subscale are averaged to create a total score, expressed as a percentage, with higher scores reflecting greater pain and disability. SPADI is widely recognized and validated for assessing shoulder-related pain and functional impairment in both clinical practice and research
Time frame: SPADI) was applied to the patients before the procedure and at the 4th week and 12th week after the procedure.
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TECAR therapy was administered using the BTL-6000 TR-Therapy PRO device which emitted energy at a frequency of approximately 500 kHz and used three types of electrodes: active, neutral, and static application electrodes. Each patient was seated in a comfortable position with the affected shoulder exposed, ensuring adequate support and stability throughout the treatment session. The affected shoulder was prepared with a conductive gel to enhance energy transfer. During the session, the capacitive electrode was initially applied, targeting the superficial muscles and tendons around the shoulder joint using circular or linear movements for 5 min. Following this, the resistive electrode was employed to target deeper structures, focusing on the joint capsule and rotator cuff muscles for 10 min. The output power was adjusted based on the patient's tolerance, ensuring a comfortable warm sensation without causing discomfort or burning feeling or pain.
TENS was employed as a non-invasive pain management technique in this study, utilizing the Intellect Advanced device manufactured by Chattanooga Group. Electrodes were strategically placed over the affected shoulder, ensuring coverage of the most painful areas as well as relevant nerve pathways to maximize the analgesic effect. A symmetric biphasic waveform was selected, with a frequency of 100 Hz and a pulse duration of 100 microseconds. The intensity of the stimulation was adjusted according to the patient's tolerance, typically aiming for a strong, yet comfortable tingling sensation.