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_Article_  
**Effectiveness of Shock Wave Therapy versus Intra-Articular Corticosteroid Injection in Diabetic Frozen Shoulder Patients' Management: Randomized Controlled Trial**  
**[PERSON] 1,*, [PERSON] 2, [PERSON] 3, [PERSON] 4, [PERSON] 5, [PERSON] 6 and [PERSON] 7,*  
Footnote 1: [[https://www.mdpi.com/journal/applsci](https://www.mdpi.com/journal/applsci)]([https://www.mdpi.com/journal/applsci](https://www.mdpi.com/journal/applsci))  
Footnote 2: [[https://www.mdpi.com/journals/article/pdf/1](https://www.mdpi.com/journals/article/pdf/1)]([https://www.mdpi.com/journals/article/pdf/1](https://www.mdpi.com/journals/article/pdf/1))  
associated with diabetes mellitus (DM) [1]. Adhesive capsulitis (AC) (also referred to as frozen shoulder) is characterized by severe shoulder pain [2] with advanced limitation of the joint range of motion associated with functional disability [3], that negatively affects life quality and care costs [4]. AC is caused by inflammation and results in tissue fibrosis, which might lead to joint capsule tightness [5].  
Many studies had approved positive effects of oral nonsteroidal anti-inflammatory agents and oral glucocorticoids on pain management and the improvement of the range of motion in diabetic frozen shoulder patient, but without any longer effect than a few weeks [6]; hydro-dilatation accompanied with manipulation under anesthesia is also considered an effective method for resolving the condition of AC, but with the risk of anesthesia complications [6], while several studies approved many physiotherapy modalities such as ultrasound therapy, stretching exercises, manual mobilization and strengthening exercises as well-established conservative management techniques [7; 8].  
Multiple studies have reported the short-term benefits of corticosteroid injections, including the improvement of the range of motion (ROM) in the shoulder and pain reduction [9; 10], through the reduction of the synovial inflammation by decreasing the capsular fibrosis, thereby improving joint movements and providing pain relief [11]. Corticosteroid injections are also associated with complications, such as fat atrophy, skin color changes, infected arthritis, post injection symptom flare/synovitis, allergic reaction, and steroid chondro-calcific arthroplasty, as well as increasing the blood glucose level, which is one of the most dangerous side effects among diabetic patients. Therefore, it would be better to avoid steroids and search for alternative therapies [12; 13].  
Shock wave therapy (SWT) is a physical therapy modality that consists of very short energy waves; the waves are faster than the speed of sound and it is considered a novel treatment in a wide variety of musculoskeletal dysfunction and illness [14; 15; 16]. Shock wave application has been reported to result in good clinical satisfaction in patients with many conditions that include pain and disability associated with ligament or muscle injuries, joint arthritis, tendon entrapment, or inflammation [17; 18; 19].  
Therefore, the current study's principal aim was to investigate the effectiveness of SWT versus intra-articular corticosteroid injection when each modality was separately added to traditional physiotherapy in the management of diabetic shoulder AC patients. Additionally, evaluating both techniques' side effects on blood glucose levels helps identify the most appropriate treatment plan for diabetic shoulder AC patients.