Effectiveness of Ultrasound Therapy Combined with Shoulder Glides and Range of Motion Exercises for Adhesive Capsulitis Among Diabetic Population

Background: Adhesive capsulitis is a common and disabling shoulder condition that occurs with increased frequency and severity in individuals with diabetes mellitus, where capsular fibrosis and stiffness cause pain, sleep disturbance, and functional limitation. Combining physical agent modalities with manual therapy or exercise is widely practised, but comparative evidence in diabetic frozen shoulder remains limited. Objective: To compare the effectiveness of therapeutic ultrasound combined with Kaltenborn shoulder glides versus therapeutic ultrasound combined with range of motion (ROM) exercises in improving pain, disability, and shoulder ROM in diabetic patients with adhesive capsulitis. Methods: In this randomized controlled trial, 38 diabetic adults with idiopathic adhesive capsulitis were allocated to either ultrasound plus Kaltenborn glides (n=19) or ultrasound plus ROM exercises (n=19). Interventions were delivered in government hospital physiotherapy departments. Shoulder pain and disability were assessed using the Shoulder Pain and Disability Index (SPADI), and active abduction and external rotation were measured with a goniometer at baseline and post-treatment. Data were analysed using paired and independent-samples t-tests with p<0.05 considered significant. Results: Both groups showed significant within-group improvements in SPADI pain and disability items and in shoulder abduction and external rotation. However, reductions in pain and disability were consistently greater in the Kaltenborn glides group, while ROM gains were large and comparable between groups. No treatment-related adverse events were observed. Conclusion: In diabetic adhesive capsulitis, ultrasound-based rehabilitation is effective when combined with either Kaltenborn mobilization or ROM exercises, but adding joint glides to ultrasound yields superior improvements in pain and disability without compromising ROM recovery.