Effect of a Clock-Based Shoulder Exercise Program on Pain, Shoulder Movement, and Ability to Perform Daily Activities in People with Frozen Shoulder

INTERVENTION: Intervention1: hot moist pack: Temperature of hydrocollator unit: 70 75 degree Celsius Pack temperature at application: Approximately 40 45 degree Celsius (after wrapping) Layers: 6 8 layers of towels or a commercial terry cloth cover Application area: Affected shoulder (anterior, lateral, and posterior aspects) Patient position: supine with the shoulder comfortably supported Duration: 15 minutes Frequency: 5 sessions per week Total duration: 6 weeks (30 supervised sessions) Safety: Skin checked before and after application; treatment discontinued if excessive redness, burns, or patient discomfort occurs. Intervention2: Therapeutic Ultrasound: Continuous mode (100 percent duty cycle), frequency 1 MHz, intensity 1.0 Webber per cm square, applied for 8 minutes over the anterior and inferior glenohumeral capsule using a moving circular technique with coupling gel prior to manual therapy and therapeutic exercises. Ultrasound will be administered 5 sessions per week for 6 weeks. Intervention3: Mulligan mobilization with movement: Sustained pain‐free accessory glides applied to the shoulder joint during active shoulder movement. 3 sets of 10 repetitions for each movement with 30 second rest between sets for 10 to 15 minutes per session, 5 sessions per week for 6 weeks. Intervention4: Clock Based Guided Exercises: Active assisted shoulder flexion, abduction, and circumduction using clock based exercises. 3 sets of 10 repetitions in clockwise and anticlockwise directions with a 5 second hold at end range and 30 second rest between sets. 10 to 15 minutes per session. 5 sessions per week for 6 weeks. Control Intervention1: hot moist pack: Temperature of hydrocollator unit: 70 75 degree Celsius Pack temperature at application: Approximately 40 45 degree Celsius (after wrapping) Layers: 6 8 layers of towels or a commercial terry cloth cover Application area: Affected shoulder (anterior, lateral, and posterior aspects) Patient position: supine with the shoulder comfortably supported Duration: 15 minutes Frequency: 5 sessions per week Total duration: 6 weeks (30 supervised sessions) Safety: Skin checked before and after application; treatment discontinued if excessive redness, burns, or patient discomfort occurs. Control Intervention2: Therapeutic Ultrasound: Continuous mode (100 percent duty cycle), frequency 1 MHz, intensity 1.0 Webber per cm square, applied for 8 minutes over the anterior and inferior glenohumeral capsule using a moving circular technique with coupling gel prior to manual therapy and therapeutic exercises. Ultrasound will be administered 5 sessions per week for 6 weeks. Control Intervention3: Mulligan Mobilization with movement: Sustained pain‐free accessory glides applied to the shoulder joint during active shoulder movement. 3 sets of 10 repetitions for each movement with 30 second rest between sets for 10 to 15 minutes per session, 5 sessions per week for 6 weeks. Control Intervention4: Shoulder Wheel Exercises: Active assisted shoulder flexion, abduction, and circumduction using a shoulder wheel. 3 sets of 10 repetit CONDITION: Health Condition 1: M258‐ Other specified joint disorders PRIMARY OUTCOME: Visual Analogue ScaleTimepoint: start and at end of 6 weeks post treatment INCLUSION CRITERIA: diagnosed with diabetic frozen shoulder, stage 1 and 2 of frozen shoulder, Unilateral side involvement, willing to participate SECONDARY OUTCOME: Disabilities of the Arm, Shoulder and Hand scaleTimepoint: start and at end of 6 weeks post treatment Goniometry of shoulder jointTimepoint: start and at end of 6 weeks post treatment