Musculoskeletal disease is one of the most common complications in patients with Diabetes, and yet it receives relatively little attention. The severity and the risks of musculoskeletal complications might not be well recognized as cardiovascular complications; however, the associated ailments certainly affect both Physical and Psychological health of people with Diabetes. Among the various musculoskeletal diseases, shoulder pain is one of the most common complaints. 

In general, it is characterized by pain and restricted range of motion of one or both shoulders due to which activities of daily living are affected thus hampering overall quality of life.

Let us understand causes, signs & symptoms, impairments and management of Frozen Shoulder:


1. Excessive cross linkage of collagen, in capsule and capsular thickening of shoulder joint. This is result of glycosylation in patients with consistently high blood sugar levels.

2. Impaired microvascular circulation in patients with long standing diabetes or consistently high blood sugar levels. This causes tissue hypoxia and increased free radicals.

Signs and Symptoms:

They highly depend whether patient is in acute, sub acute or chronic conditions. Commonly seen are mentioned below:

1. Pain in shoulder and muscle guarding limiting motion, usually external rotation and abduction.

2.  Atrophy of Deltoid, Rotator cuff, Biceps and Triceps occur in later stages

3.  There is significant capsular restriction within ability to reach over head, outward or behind back.


1. Night pain and disturbed sleep

2. Decreased range of motion limiting external rotation and abduction and elevation in flexion

3. Postural compensation with rounded shoulders

4. Substitute movements

5. Muscles weakness of shoulder girdle muscles with over use of scapular muscles 


Physiotherapy treatment depending on the stage of Frozen shoulder, below mentioned guidelines can be followed:

1.     Electro-therapy for pain relief 

2.     Passive range of motion in pain free ranges which can be progressed to active assisted with use of wall, table to assist the movement.

3.     Passive glides in pain free motion.

4.     Pendulum exercises where effect of gravity is used to caused distraction and oscillatory movements provide motion of joint structure and synovial fluid.

5.     Muscle setting exercises

6.     In case of swelling arm to be elevated above the heart level

7.     Range of motion exercises assisted or active in pain free range.