Pilot Trial of Extracorporeal Shock Wave Therapy Combined with Chuna Manual Therapy for Adhesive Capsulitis (Frozen Shoulder)

INTERVENTION: Medical Device, Procedure/Surgery : The intervention will be administered once weekly for 4 weeks (4 sessions in total). The experimental group will receive focused extracorporeal shock wave therapy (ESWT) combined with Chuna manual therapy (CMT), whereas the control group will receive sham ESWT combined with the identical CMT protocol. Focused ESWT will be delivered using the Ulforce Blue Plus device at an energy flu Xdensity of 0.08–0.15 mJ/mm², 10 Hz, and 2,000 impulses per session, applied to the anterior, lateral, and posterior aspects of the affected shoulder. CMT will be administered for approximately 20 minutes, including Maitland Grade III–IV glenohumeral joint mobilization, soft tissue release of the rotator cuff and surrounding muscles, correction of scapulohumeral rhythm, and passive range‐of‐motion exercises. Sham ESWT will be performed using the same device and treatment procedure, with energy transmission blocked by inserting a polyethylene foil between the probe and the silicone pad while operating the device at the minimum output setting. CONDITION: Diseases of the musculoskeletal system and connective tissue PRIMARY OUTCOME: Shoulder pain and disability index (SPADI) SECONDARY OUTCOME: 100mm pain VAS for pain intensity Adverse events EuroQol 5‐dimension 5 levels Passive ROM of Shoulder Shoulder pain and disability inde X(SPADI) Treatment Satisfaction INCLUSION CRITERIA: 1) Adult men and women between the ages of 25 and 65 years 2) Unilateral shoulder pain for more than 6 weeks and less than 12 months 3) Significant pain of 50–100 mm on a 100‐mm pain visual analogue scale (VAS) during activity (daily life movement or light exercise) 4) Restriction of passive ROM of more than 25% in two or more motions compared with the unaffected side 5) Diagnosis of Adhesive capsulitis by excluding fracture, dislocation, osteoarthritis, and calcific tendinitis on plain shoulder radiography 6) Ability to communicate sufficiently with the researcher and to complete questionnaires 7) Voluntary agreement to participate in this trial with written informed consent