New BMJ Review of 189 Trials: Shockwave Therapy Eases Frozen Shoulder Pain

Short answer: The largest review of frozen shoulder treatments ever done, published in The BMJ on November 4, 2026, compared 59 different treatments across 189 randomized trials and nearly 13,000 patients. Shockwave therapy was the only treatment with moderate-certainty evidence that it reduces frozen shoulder pain in the first three months, lowering pain by about 2 points on a 0 to 10 scale compared with usual care. A second new study, published November 1, found that patients treated with focused shockwave kept improving all the way out to 12 months. At Adisi Health Center in Hinsdale, Dr. Steve Petzel treats frozen shoulder with Storz Medical focused and radial shockwave. Call (630) 887-1900.

What is frozen shoulder?

Frozen shoulder (the medical name is adhesive capsulitis) happens when the capsule of tissue around your shoulder joint becomes inflamed, thick, and tight. It usually comes on slowly and moves through stages: first it hurts, then it stiffens, and then, often over many months, it slowly loosens up again.

According to the BMJ authors, frozen shoulder affects about 2 to 5% of people, most often between ages 40 and 60, and it’s more common in women. Typical signs include:

• Pain deep in the shoulder that is often worse at night, especially lying on that side
• Trouble reaching overhead, behind your back, or into a back seat
• Stiffness in every direction, even when someone else tries to move your arm for you
• Trouble with everyday things like fastening a bra, putting on a coat, or combing your hair

What did the new BMJ review find?

A team of sports medicine physicians, physical therapists, and orthopedic surgeons from more than a dozen countries pooled every randomized controlled trial they could find on frozen shoulder treatments, from physical therapy and laser to cortisone shots, nerve blocks, PRP, and surgery (Meng et al., BMJ, 2026; PubMed 42982479, free full text). Using a method called a network meta-analysis, they compared all 59 treatments against each other and graded how confident they could be in each result.

Here’s what stood out for shockwave:

• Shockwave stood out for pain. Across 8 trials with 464 patients, shockwave lowered pain by about 2 points on a 0 to 10 scale (1.97 on average) compared with usual care in the first three months. That’s about double the 1-point change the researchers set as the threshold for a meaningful difference to patients.
• It was the only pain result rated moderate certainty. Of all 59 treatments, shockwave was the only one with moderate-certainty evidence for short-term pain relief. Every other treatment’s pain result was rated low or very low certainty.
• Function and motion looked better, too. Shockwave was also linked with better shoulder function (about 11 points on a 0 to 100 scale), about 22 degrees more forward reach (flexion), and about 19 degrees more side reach (abduction). The reviewers rated these results with lower confidence than the pain finding.
• The benefit for function seemed to last. At three to six months, shockwave was linked with even better shoulder function (about 19 points on a 0 to 100 scale) in the trials that followed patients that long.

The only other moderate-certainty result in the whole review was for manipulation under anesthesia, a procedure where you’re put to sleep and the doctor forces the shoulder through its range of motion, which improved forward reach. Shockwave, by comparison, is done in the office with no anesthesia, no needles, and no downtime.

The authors’ own conclusion: “Extracorporeal shockwave therapy is supported most clearly for short term pain reduction.”

What did the 12-month focused shockwave study show?

A second study, published November 1, 2026 in Advances in Orthopedics, followed 77 patients in Italy (average age 57) with frozen shoulder who were treated with focused shockwave (Di Giorno et al., 2026; PubMed 42973758, free full text). Patients had a median of 6 sessions and were checked at the end of treatment and again at 2, 6, and 12 months.

• Pain dropped and function improved significantly by the end of treatment, on all three measures the researchers used.
• Patients kept improving long after treatment ended. Gains were strong at 2 months, held steady through 6 months, and then improved again by 12 months.
• Starting early helped. Patients who began focused shockwave within 3 months of their symptoms starting had better arm and shoulder function at 2 months.

The authors concluded that good results at 12 months can be expected with focused shockwave for frozen shoulder, especially when treatment starts early.

How does this fit with earlier research?

These new studies build on a steady line of positive research:

• A 2022 meta-analysis of 20 studies found that adding shockwave to other frozen shoulder treatments led to better pain relief and better early shoulder function than those treatments alone (Zhang et al., Orthopaedic Journal of Sports Medicine, 2022; PubMed 35141337).
• A 2020 trial in people with diabetes: In 103 diabetic patients with frozen shoulder, 4 weekly sessions of radial shockwave led to better function and less pain at 12 weeks than a cortisone injection into the joint (El Naggar et al., Journal of Shoulder and Elbow Surgery, 2020; PubMed 32553435). That matters because frozen shoulder is more common with diabetes, and cortisone shots can raise blood sugar.

For a full guide to symptoms, stages, and what treatment looks like, see our earlier post, Can’t Lift Your Arm? Shockwave Therapy for Frozen Shoulder in Hinsdale.

How does shockwave help a frozen shoulder?

Shockwave therapy sends strong acoustic pulses into the tight, inflamed tissue around the joint. This is thought to calm pain signals, increase blood flow, and stimulate the body’s own repair process in the capsule and surrounding tissue. Less pain also makes it easier to do the stretching and movement work that helps a frozen shoulder loosen up.

At Adisi Health Center, we have both types of Storz Medical shockwave:

• Focused shockwave concentrates energy at a precise depth, which is the type used in the new 12-month study.
• Radial shockwave spreads energy over a wider area, which works well for the tight muscles around the shoulder blade and upper arm that often tense up to protect a frozen shoulder.

Many frozen shoulder patients benefit from both. Learn more about shockwave therapy in Hinsdale.

What does treatment look like at Adisi Health Center?

Most patients see significant improvement after 6 sessions, each about 20 minutes and spaced about a week apart, and many notice a difference by sessions 3 or 4. That lines up closely with the new 12-month study, where patients had a median of 6 sessions.

Your plan starts with a full exam so Dr. Petzel can confirm it’s frozen shoulder and not a rotator cuff problem, calcific tendinitis, or pain coming from your neck, since those are treated differently. Shockwave is combined with simple home stretches and movement work so you keep the motion you gain.

If you’ve had a cortisone shot in your shoulder, you’ll need to wait at least 6 weeks after your last shot before starting shockwave.

Who might be a good fit?

Shockwave may be worth discussing if you:

• Have shoulder pain and stiffness that has lasted weeks or months
• Can’t sleep on your shoulder or reach overhead without pain
• Want to avoid more cortisone shots, or have diabetes and want to avoid blood sugar spikes
• Want to try a non-surgical, in-office option before manipulation under anesthesia or surgery
• Are early in the course of frozen shoulder, since the new research suggests starting sooner may help

When should I get help right away?

Get medical care promptly if your shoulder pain started after a fall or injury and you can’t lift your arm at all, if the shoulder looks deformed, if you have fever, redness, or warmth around the joint, or if shoulder or arm pain comes with chest pain, shortness of breath, or sweating, which can be a sign of a heart problem.

Frequently asked questions

What is the best treatment for frozen shoulder pain?
In the largest review to date, published in The BMJ in November 2026, shockwave therapy was the only one of 59 treatments with moderate-certainty evidence for reducing frozen shoulder pain in the first three months, lowering pain by about 2 points on a 0 to 10 scale compared with usual care.

Does shockwave therapy work for frozen shoulder?
Yes, the research is encouraging. Along with the 2026 BMJ review of 189 trials, a November 2026 study of 77 patients found focused shockwave improved pain and function, with patients still improving at 12 months.

How many shockwave sessions does frozen shoulder need?
At Adisi Health Center, most patients see significant improvement after 6 sessions, each about 20 minutes and spaced about a week apart. Patients in the new 12-month study had a median of 6 sessions.

How long do the results of shockwave for frozen shoulder last?
In the November 2026 focused shockwave study, patients improved by the end of treatment, held their gains through 6 months, and improved again by 12 months.

Is it better to start shockwave early for frozen shoulder?
The new research suggests so. Patients who started focused shockwave within 3 months of their symptoms beginning had better shoulder function at 2 months.

Is shockwave better than a cortisone shot for frozen shoulder?
In a 2020 trial of 103 people with diabetes and frozen shoulder, 4 weekly shockwave sessions led to better function and less pain at 12 weeks than a single cortisone injection. If you’ve already had a cortisone shot, you must wait at least 6 weeks after your last shot before starting shockwave.

Does shockwave for frozen shoulder hurt?
Most people feel only mild discomfort, often described as a strong tapping. There are no needles, no anesthesia, and no downtime, and we recommend avoiding high-impact activity for 24 to 48 hours after each session.

Do I need a referral?
No. You can book directly, and same-week openings are often available.

Do you treat patients from outside Hinsdale?
Yes. Patients come to our office at 534 Chestnut Street, Suite 240 in downtown Hinsdale from Oak Brook, Burr Ridge, Clarendon Hills, Western Springs, Downers Grove, Westmont, La Grange, and nearby towns.

Related reading: Can’t lift your arm? Shockwave for frozen shoulder, rotator cuff tendinitis and overhead shoulder pain, calcific tendinitis of the shoulder, is shockwave therapy safe?, and does shockwave therapy hurt?

Ready to get your shoulder moving again?

If a stiff, painful shoulder is keeping you up at night or stopping you from reaching overhead, we’d be glad to help. Book a visit, call Adisi Health Center at (630) 887-1900, or email DrPetzel@AdisiHealth.com.

References

1. Meng J, Liu P, Gomes NS, et al. Interventions for adhesive capsulitis: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2026;395:e101057. doi:10.1136/bmj-2026-101057. PubMed 42982479 | Free full text
2. Di Giorno A, Carlisi G, Sanzo V, et al. Effectiveness of focal extracorporeal shockwave therapy for idiopathic frozen shoulder at 12-month follow-up. Adv Orthop. 2026;2026:9822934. doi:10.1155/aort/9822934. PubMed 42973758 | Free full text
3. Zhang R, Wang Z, Liu R, Zhang N, Guo J, Huang Y. Extracorporeal shockwave therapy as an adjunctive therapy for frozen shoulder: a systematic review and meta-analysis. Orthop J Sports Med. 2022;10(2):23259671211062222. PubMed 35141337
4. El Naggar TEDM, Maaty AIE, Mohamed AE. Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain, function, and range of motion in diabetic patients with shoulder adhesive capsulitis. J Shoulder Elbow Surg. 2020;29(7):1300-1309. PubMed 32553435

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This article is for education only and is not medical advice. Results vary.