Shoulder Manifestations of Diabetes Mellitus

Abstract

The musculoskeletal system can be affected by diabetes in a number of ways. The shoulder is one of the frequently affected sites. One of the rheumatic conditions caused by diabetes is frozen shoulder (adhesive capsulitis), which is characterized by pain and severe limited active and passive range of motion of the glenohumeral joint, particularly external rotation. This disorder has a clinical diagnosis and the treatment is based on physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections and, in refractory cases, surgical resolution. As with adhesive capsulitis, calcific periarthritis of the shoulder causes pain and limited joint mobility, although usually it has a better prognosis than frozen shoulder. Reflex sympathetic dystrophy, also known as shoulder-hand syndrome, is a painful syndrome associated with vasomotor and sudomotor changes in the affected member. Diabetic amyotrophy usually affects the peripheral nerves of lower limbs. However, when symptoms involve the shoulder girdle, it must be considered in the differential diagnosis of shoulder painful conditions. Osteoarthritis is the most common rheumatic condition. There are many risk factors for shoulder osteoarthritis including age, genetics, sex, weight, joint infection, history of shoulder dislocation, and previous injury, in older age patients, diabetes is a risk factor for shoulder OA. Treatment options include acetaminophen, NSAIDs, short term opiate, glucosamine and chondroitin. Corticosteroid injections and/or injections of hyaluronans could also be considered. Patients with continued disabling pain that is not responsive to conservative measures may require surgical referral. The present review will focus on practice points of view about shoulder manifestations in patients with diabetes.

Synergistic Interaction between Metformin and Sulfonylureas on Diclofenac‐Induced Antinociception Measured Using the Formalin Test in Rats

“…Therefore, if diclofenac, metformin and a sulfonylurea are administered simultaneously in patients with diabetes, it is possible that this triple combination may affect the effect of diclofenac. Diabetes mellitus affects structural macromolecules of the extracellular matrix in vessels and connective tissues in multiple ways and causes different alterations in periarticular, muscular and skeletal systems (41)(42)(43)(44)(45)(46)(47)(48). Musculoskeletal disorders of the upper extremity, such as shoulder adhesive capsulitis, Dupuytren disease, carpal tunnel syndrome and stenosing flexor tenosynovitis (trigger finger), are widely associated with diabetes mellitus (45)(46)(47)(48).…”

Musculoskeletal manifestations in diabetic versus prediabetic patients

“…Early diagnosis of musculoskeletal complications in diabetic patients can prevent early onset of long‐term morbidities. A few investigators demonstrated age and DM duration as risk factors for musculoskeletal manifestations . For instance, Hoff et al .…”

“…A few investigators demonstrated age and DM duration as risk factors for musculoskeletal manifestations. [6][7][8][9][10] For instance, Hoff et al 8 demonstrated an odds ratio (OR) of 1.6 for patients aged < 60 with DM versus subjects aged < 60 with no DM, whereas for those aged ≥ 60 years, the OR was only 1.1. Similarly, Mathew et al 6 showed an OR of about 1.5 for DM duration as a significant risk factor for musculoskeletal manifestations.…”

The stiff shoulder in diabetic patients

“…The search retrieved 135 citations: 47 were excluded after reviewing the title, three were excluded after reviewing the abstract, 16 articles after full text review and finally 68 were included in this review. There were 14 review articles in which references were searched for relevant quotes …”