Introduction: Prolonged posture related soft tissue pain are common among desk work nature of job. Pain and reduction in use of arm can give rise to diminished daily activities and quality of life aims and objectives of this subject with adhesive capsultis (Right) Shoulder was to analyse the combined effect of manual therapy and CKC exercises.

Aims & Objective of this original case study was a) To Evaluate the efficacy of manual therapy and closed kinematic chain exercises, using shoulder functional index.

Materials & Methodology: Geriatric type II diabetic with hba₁c of 8.2% was treated with specific manual therapy closed and kinematic chain exercises for right shoulder pain and restricted usage of the arm. In 6 sessions pain and improved usage of (Shoulder) right arm was recorded and analysed using due statistical means

Results: Shoulder functional index was improved with P<.05   

Conclusion: Selection of suitable means of therapy should be time conserving, effective and evidenced. Posture related soft tissue tightness of shoulder where advanced exercises modalities were more productive than symptom based therapy with electrotherapy.  

Keywords: PNF, Shoulder Functional Index, Adhesive Capsulitis, CKC, hba₁c.

1. Mavrikakis ME, Drimis S, Kontoyannis DA, Rasidakis A, Moulopoulou ES, Kontoyannis S. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Ann Rheum Dis. 1989 Mar;48(3):211–214. 
2. Figueroa A, Baynard T, Fernhall B, Carhart R, Kanaley JA: Endurance training improves post-exercise cardiac autonomic modulation in obese women with and without type 2 diabetes. Eur J Appl Physiol2007;100(4):437–44 
3. Wyatt, Ferrance. The musculoskeletal effects of diabetes mellitus. J Can Chiropr Assoc 2006; 50(1): 43-50
4. Hawk C, Long C, Boulanger K. Prevalence of nonmusculoskeletal complaints in chiropractic practice: report from a practice-based research program. JMPT 2001; 24(3):157–169.
5. Smith, S P Burnet, J D McNeil. Musculoskeletal manifestations of diabetes mellitus. Br. J. Sports Med. 2003;37;30-35
6. Joslin EO, Root EF, White P. The treatment of diabetes mellitus. Philadelphia: Lea & Febiger 1959.
7. Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med.1993 Sep 30;329(14):977-86.
8. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. 2001 Sep 12; 286(10):1218-27.
9. Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med.2010 Nov;38(11):2346-56. doi: 10.1177/0363546509348048. Epub 2010 Jan 28.
10. Andersen LØ, Husted H, Kristensen BB,  Otte KS, Gaarn-Larsen L, Kehlet H. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty. 2010 Sep;65(9): 904-12. doi: 10.1111/j.1365-2044.2010.06389.x.
11. Garcilazo C, Cavallasca JA, Musuruana JL. Shoulder manifestations of diabetes melli-tus. Curr DiabetesRev.2010Sep;6(5):334-40.
12. Casteels K. Rhabdomyolysis in diabetic ketoscidosis. Pediatr Diabetes. 2003;4 (1):29–31.
13. Levine W. N., et al. Nonoperative manage-ment of idiopathic adhesive capsulitis. J Shoulder Elbow Surg. 2007; 16:569–573 
14. Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975; 4:193–196 
15. Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg [Am] 2000;82:1398–407
16. Balci N, Balci MK, Tuzuner S. Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications. J Diabetes Complications 1999;13:135–40
17. Arkkila PE, Kantola IM, Viikari JS, et al. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis 1996;55:907–14
18. Bottorff M, Hansten P. Long-term safety of hepatic hydroxymethyl glutaryl coenzyme A reductase inhibitors: the role of metabolism-monograph for physicians. Arch Intern Med. 2000; 160:2273–2280.
19. Teasdall R, Smith B, Koman L. Complex regional pain syndrome (reflex sympathetic dystrophy) Clin Sports Med. 2004;23:145–155. 
20. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis1998;57: 649-55.
21. Winters JC, Sobel JS, Groenier KH, Arendzen JH, Meyboom-de Jong B. The long-term course of shoulder complaints: a prospective study in general practice.  Rheumatology1999;38: 160-3.
22. Jürgens H, Haass W, Castañeda TR,  Schürmann A, Koebnick C, Dombrowski F, Otto B, Nawrocki AR, Scherer PE, Spranger J, Ristow M, Joost HG, Havel PJ, Tschöp MH. Consuming fructose-sweetened beverages increases body adiposity in mice. Obes Res.2005 Jul;13(7):1146-56.
23. Sokka T, Kautiainen H, Toloza S, Mäkinen H, Verstappen SM, Lund Hetland M,  Naranjo A, Baecklund E, Herborn G, Rau R, Cazzato M, Gossec L, Skakic V, Gogus F, Sierakowski S, Bresnihan B, Taylor P, McClinton C, Pincus T; QUEST-RA Group. QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis.2007 Nov;66(11):1491-6. Epub 2007 Apr 5.
24. Rizk TE, Christopher RP, Pinals RS, Higgins C and Frix R (983), Adhesive capsulitis (Frozen shoulder), Anew approach to its management, Archives ofPhysical Medicine and Rehabilitita.. lion, 62, 29-33
25. Leung MS, Cheing GL. Effects of deep and superficial heating in the management of frozen shoulder. J Rehabil Med.2008 Feb;40(2):145-50. doi: 10.2340/16501977-0146.
26. Jewell D, Moore J, Goldstein M. Delivering the Physical Therapy Value Proposition: A Call to Action. Physical Therapy. 2013;93 (1):104–114. 
27. Johnson A, Godges J, Zimmerman G, Ounanian L. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. J Orthop Sports Phys Ther. 2007;37:88–99.
28. Vermeulen H, Rozing P, Obermann W, et al. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: Randomized controlled trial. Phys Ther. 2006;86:355–368.

Dr S.S.Subramanian

M.P.T (Orthopaedics), M.S (Education), M. Phil (Education), Ph.D (Physiotherapy)

The Principal, Sree Balaji College of physiotherapy, Chennai – 100

Affiliated To (Bharath) University, BIHER Chennai – 73

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., This email address is being protected from spambots. You need JavaScript enabled to view it.

Phone: 99400 47137