## 4 Discussion  
Diabetic patients can develop many musculoskeletal syndromes or symptoms; these musculoskeletal disorders have been associated with the severity and duration of diabetes mellitus. Shoulder AC is a musculoskeletal disorder associated with DM, in which the patients typically present with painful glenohumeral joint limitation and abduction and flexion ROM restriction in a capsular pattern. The present study aimed to investigate the effectiveness of SWT versus intra-articular corticosteroid injection when each modality (separately) was added to the traditional physiotherapy in the management of diabetic shoulder AC patients. In addition to evaluating both techniques, we assess the side effects on blood glucose levels, thereby helping to describe the most effective and safest treatment plan for diabetic shoulder AC patients. The percent of female subjects in each group was 58.3% and 62.5% for Group A and B, respectively, with an age range from 48 to 59 years and a mean BMI of 37.63 kg/m\({}^{2}\). These patient characteristics are consistent with other studies, where AC was more common in obese women in the fifth decade of age [32; 33] and can affect daily living activities with a reduction in the quality of life due to different degrees of shoulder ROM limitation [3]. The present study's primary finding is that the SPADI scores decreased significantly in post-treatment measurement compared with pretreatment measurement in both groups. This was established in many studies that approved the corticosteroid injection effect on pain management with frozen shoulder patients [30; 34]. Additionally, the shock wave application resulted in pain reduction and the improvement of daily activities' performance, as well as quality-of-life improvement on the frozen shoulder [35; 36], in addition to the basic effect of traditional physiotherapy in the form of manual mobilization techniques, and a simple exercise program which was approved as an effective modality for pain-relief and the improvement of the range of motion and the function of the shoulder joint in frozen shoulder patients [27; 28; 29]. The present study revealed that Group B (Shock wave) had more superiority than group A (intraarticular corticosteroid injection) regarding all outcome measures after two and three months of intervention and after one month of intervention for shoulder flexion and abduction ROM. This improvement in the SWT group might be due to sound waves \begin{table}
\begin{tabular}{c c c c c c} \hline \hline  & **Baseline vs. 1 Month** & \multicolumn{2}{c}{**Baseline vs. 2 Months**} & \multicolumn{2}{c}{**Baseline vs. 3 Months**} \\ \hline
**Outcomes** & **MD (95\% CI)** & \(p\)**-Value** & **MD (95\% CI)** & \(p\)**-Value** & **MD (95\% CI)** & \(p\)**-Value** **\(\mathbf{\ast}\)** \\ \hline
**SPADI Score** & 1.88 (1.38, 2.37) & 0.0001 & 4.69 (3.95, 5.42) & 0.0001 & 6.94 (6.22, 7.66) & 0.0001 \\
**Flexion ROM (deg.)** & -0.69 & -0.68 (-127.0, 5.35) & 0.09 & -76.29 (-142.0, -10.6) & 0.01 \\
**Abduction ROM (deg.)** & -19.38 (-24.2, -14.6) & 0.0001 & -34.38 (-41.8, -27.0) & 0.0001 & -53.33 (-62.2, -44.5) & 0.0001 \\
**FBG (mg/dL)** & 4.79 (1.11,8.48) & 0.005 & 8.75 (0.58, 16.92) & 0.03 & 14.58 (1.11, 28.06) & 0.03 \\
**PPBG mg/dL** & 14.79 (7.55,22.04) & 0.0001 & 18.75 (5.32, 32.18) & 0.002 & 32.71 (14.37, 51.05) & 0.0001 \\
**HQL\%** & - & - & - & - & 0.39 (-0.11, 0.89) & 0.21 \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Pairwise Comparisons for Group B Pretreatment, after 1 Month, 2 Months and 3 Months \(\mathbf{\ast}\).