Physiotherapy Management of Frozen Shoulder with Complex Comorbidities: A Case Report

Abstract

Background: Frozen shoulder may be more difficult to assess and manage when metabolic, neurological, and structural shoulder conditions coexist. 
Objective: To describe the physiotherapy management and clinical response of a patient with frozen shoulder, type 2 diabetes mellitus, postischemic stroke hemiparesis, and a full thickness supraspinatus tear. 
Methods: This case report followed the CARE guideline. A 52-year-old man with right frozen shoulder underwent 12 physiotherapy sessions. The first three sessions were assessed directly using SOAP documentation, whereas nine subsequent sessions were reviewed retrospectively from medical records. The primary outcome was pain measured with the Visual Analog Scale. Secondary outcomes included range of motion, Manual Muscle Testing, and selected clinical tests. 
Results: Pain at rest decreased from 8 to 5, pain on movement from 10 to 8, and tenderness from 8 to 6 over the documented treatment period. During direct assessment across the first three sessions, muscle strength remained unchanged: 5/5 for flexion, extension, and adduction, 4/5 for abduction, and 3/5 for external and internal rotation. Shoulder range of motion also remained unchanged: flexion 100°, extension 30°, abduction 100°, adduction 45°, external rotation 15°, and internal rotation 30°. Objective outcomes were not consistently documented during the subsequent nine sessions. 
Conclusion: This case documented a reduction in pain during multimodal physiotherapy, while changes in strength and range of motion could not be demonstrated within the directly assessed period. The findings should be interpreted cautiously because the contribution of individual modalities cannot be separated and long-term objective follow-up was incomplete.