What You Need To Know About Frozen Shoulder And Diabetes

Adhesive capsulitis or periarthritis, which is more commonly known as frozen shoulder, is characterised by a gradual development of restricted motion typically at the shoulder joint, with radiographic findings that are nonspecific.

Individuals with frozen shoulder have complaints of acute shoulder pain, with an inability to successfully sleep on the affected side, with the progression of the disease.

There are three, primary clinical stages of frozen shoulder: (1) freezing stage, (2) frozen stage, and (3) thawing stage. The freezing stage typically lasts from 2-9 months, with moderate-to-severe shoulder pain and stiffness. As individuals advance to the frozen stage, there is an increase in stiffness. This stage lasts for an average of anywhere between 4 and 14 months, with a reduction in the component of pain. Lastly, the thawing stage continues for around 5-24 months, wherein there is a gradual relief from symptoms and full recovery of range of motion.

Frozen shoulder primarily affects the elderly population, predominantly women. Those individuals with prolonged shoulder immobility (such as minor upper limb trauma, surgery, overuse injury, and/or neurosurgery) as well as those with systemic diseases (such as diabetes, osteoporosis, thyroid disorders, stroke, cardiovascular disease, or Dupuytren’s contracture) are at a higher risk.

Frozen Shoulder And Diabetes

The association between frozen shoulder and diabetes is well-documented. The incidence of the former is 2-4 times higher in those with diabetes in comparison with the general population. Individuals with diabetes are at a much higher risk of frozen shoulder, with an incidence of 10-20%. Moreover, those who are dependent on insulin have a much higher incidence, which is around 36%.

The condition has been described as one of the most severely disabling musculoskeletal manifestations of diabetes mellitus.

The incidence of diabetes and life expectancy of those with diabetes have increased, thus resulting in an increase in the overall prevalence of musculoskeletal problems. Early diagnosis and successful management of diabetes reduce the risk of microvascular complications and overall manifestations of organ involvement.

The overall prevalence of diabetes in those with frozen shoulder is not adequately addressed. This condition affects your ability to move your shoulder and generally has unilateral involvement. That said, frozen shoulder can additionally involve the other shoulder in around 1 in every 5 patients.

Frozen shoulder is highly uncommon among younger individuals, and it is primarily seen in those aged between 40 and 60 years. According to a longitudinal study, women have a greater tendency to develop this condition, with 1.6 times higher risk.

Pathophysiology Of Frozen Shoulder

The pathophysiology of frozen shoulder in those with diabetes is still a matter of debate. One theory involves collagen, which is a primary building block of tendons, ligaments, and cartilage that hold the bones together in a joint. As an exceeding number of glucose molecules bind with collagen in those with diabetes, it eventually leads to highly abnormal collagen deposits in the tendons and cartilage of the shoulder. This build-up then results in the stiffening of the shoulder. Moreover, inflammation and fibrosis, too, play a key role in the development of the disease. The total prevalence of diabetes mellitus in those with frozen shoulder is 71.5%.

In overall statistics, frozen shoulder affects around 11-30% of those with diabetes in comparison to 2-10% of individuals without diabetes. Individuals who sustain an injury to the shoulder or who have undergone shoulder surgery can also develop frozen shoulder. When the injury is further followed by joint immobilisation, the risks of developing a frozen shoulder are the highest. These were some of the frozen shoulder causes.

When it comes to frozen shoulder exercises, gentle abduction, external rotation, and/or internal rotation at the shoulder joint level, within the pain limits, have been recommended for overall long-term care in those with frozen shoulder.

Regarding frozen shoulder treatment, physiotherapy is known to have benefits, and most patients tend to recover sans any complications. When it comes to short-term control of symptoms, oral or injection steroid therapy is considered more effective.

On A Final Note

Frozen shoulder is formally known as adhesive capsulitis or periarteritis. Those with frozen shoulder experience acute shoulder pain, with an inability to sleep on the affected side as the disease progresses. The three clinical stages of the disorder include the freezing stage, frozen stage, and thawing stage. Frozen shoulder primarily affects the elderly population, with an increased incidence among women. Frozen shoulder is one of the most severely disabling musculoskeletal manifestations of diabetes.