Physical Therapist–Patient Dialogue: Adhesive Capsulitis Management
Physical Therapist (PT): Good morning, Mrs. Johnson. I've reviewed your chart—you're a 52-year-old woman with type 2 diabetes and hypertension, and you've had right shoulder pain and stiffness for about 4 months now. Tell me what's been going on with your shoulder.
Patient: Well, it started gradually. At first, I just had some pain when I reached overhead, but now I can barely lift my arm. It hurts at night, and I can't even reach behind my back to fasten my bra. It's really affecting my daily life.
PT: I understand how frustrating that must be. Based on your symptoms and the fact that you have diabetes, you're at significantly higher risk for frozen shoulder—studies show that up to 27% of diabetic patients develop this condition, compared to only 2–4% of the general population 1, 2, 3. Let me examine your shoulder to confirm the diagnosis and see exactly which movements are most limited.
(PT performs examination)
PT: Your examination confirms adhesive capsulitis—what we call "frozen shoulder." Both your active movement and passive movement are equally restricted, which is the hallmark of this condition 4. Your external rotation is the most severely limited, followed by abduction, and your internal rotation is least affected—this creates what we call the "capsular pattern" 4. The good news is that we can treat this effectively with the right approach.
Patient: What causes this? Is it because of my diabetes?
PT: Yes, diabetes is a major factor. Your chronic high blood sugar causes cross-links to form between collagen molecules in your shoulder capsule, leading to excessive collagen buildup and thickening 5. This thickening, especially in an area called the axillary recess, directly correlates with your loss of motion—the thicker it gets, the more restricted your movement becomes 6. That's why controlling your blood sugar is so important, not just for your overall health but specifically for your shoulder recovery.
Patient: So what do we do about it?
PT: We need to start stretching and mobilization exercises immediately—the most important thing is that we focus on external rotation and abduction, because external rotation is the single most critical factor in preventing and treating shoulder pain 7, 8. Delaying treatment will only lead to more motion loss and potentially permanent dysfunction 7, 8.
Patient: What kind of exercises will I be doing?
PT: Let me walk you through your home program. You'll perform these exercises daily, holding each stretch for 10–30 seconds while breathing continuously 7. Do them when your pain is lowest—many patients find before bedtime works best 7.
Here are your specific exercises:
External rotation stretch: Stand in a doorway with your elbow bent at 90 degrees. Gently rotate your body away from your affected arm, feeling the stretch in the front of your shoulder. This is your most important exercise 7, 8.
Abduction stretch: Lie on your back and use your good arm to gently lift your affected arm out to the side and overhead, only going as far as you can tolerate 7.
Internal rotation stretch: Reach behind your back with your affected arm, using your good arm to gently pull it higher 7.
Start with a 5–10 minute warm-up of gentle pendulum exercises, then progress to 30–60 minutes of stretching as you're able, and finish with a 5-minute cool-down 7.
Patient: That sounds like a lot. What if it hurts?
PT: Great question. You should only experience mild stretching discomfort—if you feel sharp pain, stop immediately 7. Never exercise during an acute flare-up when your shoulder is very inflamed 7. The goal is gradual improvement, not pushing through severe pain.
Patient: Are there any exercises I should avoid?
PT: Absolutely. Never use overhead pulleys—this single exercise carries the highest risk of worsening your shoulder pain and is the most important thing to avoid 7, 8. Also avoid explosive or high-impact movements 7. And don't use a sling or wrap to immobilize your shoulder, as that will make the frozen shoulder worse 8.
Patient: What about pain medication? The pain keeps me up at night.
PT: You should take ibuprofen or acetaminophen as your first-line pain medication to control pain and allow you to participate in therapy 7. Take it about 30–45 minutes before your exercise session. If oral medications aren't providing adequate relief after 2–3 weeks of consistent therapy, we'll discuss with your doctor about an intra-articular triamcinolone injection into your shoulder joint—this provides significant pain relief, especially in your stage of frozen shoulder, and works better than oral NSAIDs for acute pain 7, 4.
Patient: How long will this take to get better?
PT: Recovery typically takes several months with consistent daily exercise. If you don't achieve full shoulder function within 6–8 weeks, we'll need to intensify your formal physical therapy to prevent permanent dysfunction 8. That's why your home program compliance is so critical.
Patient: What else can help besides exercises and medication?
PT: You can use ice, heat, or soft-tissue massage as adjunctive pain relief 7. Some patients also benefit from acupuncture combined with exercise 4. If your pain remains severe despite these measures, your doctor might consider a suprascapular nerve block as an additional option 7.
Patient: My friend had frozen shoulder and her doctor told her to just wait it out. Should I do that?
PT: No. That's a critical mistake—delaying treatment leads to further motion loss and potentially permanent shoulder dysfunction 7, 8. The window for effective intervention is narrow, and frozen shoulder develops rapidly once restriction begins 8. Starting treatment now gives you the best chance for full recovery.
Patient: Okay, I'm ready to start. When should I come back?
PT: I'll see you in 2 weeks to assess your progress and advance your exercises. Between now and then, perform your stretching program daily, take your pain medication as needed, and remember—external rotation exercises are your priority 7, 8. If your pain becomes unmanageable or you develop new symptoms, call us immediately. Do you have any other questions?
Patient: No, I think I understand. Thank you for explaining everything so clearly.
PT: You're welcome. Remember, the key to success is daily exercise focusing on external rotation and abduction, avoiding overhead pulleys, and not immobilizing your shoulder 7, 8. I'll send you home with written instructions and diagrams. Let's get your shoulder moving again.