Case Study: Frozen Shoulder in a Diabetic Patient

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Clinical Experience (2010–2012)

Presenting Complaint:

A 53-year-old female patient presented to the physiotherapy outpatient department with complaints of pain and stiffness in her right shoulder. She reported difficulty performing daily activities such as combing her hair, dressing, and reaching overhead. The symptoms had progressively worsened over a few weeks. The primary concern was the inability to externally rotate her right shoulder, accompanied by pain at end range.

History and Background:

The patient was a housewife with a known history of type 2 diabetes mellitus, moderately controlled with medication. There was no history of trauma or previous shoulder injury. Her lifestyle involved repetitive use of the upper limbs for household work.

Assessment:

On physical examination:

• Observation: No visible swelling or deformity

• Palpation: Mild tenderness over the anterior shoulder joint

• Active Range of Motion (AROM):

- Flexion: Limited

- Abduction: Limited

- External Rotation: Severely restricted (~10°)

• Passive Range of Motion (PROM):

- External rotation limited with capsular end-feel

• Strength Testing: Generally preserved, but limited due to pain

• Special Tests: Pain reproduced on external rotation and abduction; no signs of instability

Based on clinical findings and patient history, a diagnosis of adhesive capsulitis (frozen shoulder) – Stage II was made.

Treatment Plan:

The patient was treated in a clinical setting over 9 consecutive sessions. My hands-on intervention included:

1. Therapeutic Ultrasound – Applied locally over the anterior shoulder joint capsule for 7–8 minutes, to improve tissue extensibility and reduce inflammation.

2. Passive Mobilization Techniques – Grade I-II glenohumeral joint mobilizations, focusing on anterior and inferior glides to improve capsular mobility.

3. Range of Motion Exercises – Initiated with pendulum exercises and progressed to wand-assisted and pulley-assisted exercises.

4. Isometric Shoulder Strengthening – Focused on deltoid and rotator cuff muscles, started as pain allowed.

5. Home Exercise Program – Patient was educated and encouraged to perform ROM exercises thrice daily, with emphasis on external rotation.

Outcome Measures:

• Range of Motion: External rotation improved from 10° to approximately 60°

• Pain Levels: Reduced from 7/10 to 2/10 on the Visual Analogue Scale

• Functional Improvement: Reported ease in grooming, reaching kitchen shelves, and dressing

Prognosis:

After 9 sessions, the patient showed around 80% functional recovery. She was discharged with a structured home exercise program and was advised regular follow-up. Given the positive response and her motivation, the long-term prognosis was considered favorable, with emphasis on glycemic control to avoid recurrence.

“This case reinforced the importance of patient education, consistent mobilization, and tailored interventions, especially in patients with systemic conditions like diabetes. My hands-on involvement throughout the sessions helped me better understand the subtle progression of frozen shoulder and the value of early physiotherapy in achieving optimal outcomes.”


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