Frozen Shoulder and Type 2 Diabetes
Shoulder disorders and other musculoskeletal diseases including frozen shoulder are often seen in people with diabetes.1 Poor glycemic management, that’s control over blood sugar, is related to microvascular complications, resulting in an increased association between frozen shoulder and diabetes.
Frozen shoulder is characterized by progressive pain, stiffness, limited range of motion in the shoulder, especially external rotation, and pain at night causing sleeping difficulties.1
What is a frozen shoulder?
Also known as adhesive capsulitis, frozen shoulder is a painful condition characterized by a gradual decrease in range of motion. The shoulder is a ball and socket joint that comprises 3 bones, the humerus, clavicle, and scapula. The humerus is the long arm bone that goes from the elbow to the shoulder, and fits into a socket in the shoulder blade, the scapula. Connective tissue makes up the shoulder capsule surrounding the joint. The capsule, the protective sleeve of connective tissue that surrounds the joint, is lubricated by synovial fluid. It becomes frozen when the capsule adheres or gets stuck to the top of the humerus.
As the capsule gets tighter, and adhesions develop, the amount of synovial fluid decreases, and the result is the shoulder joint loses mobility. It can become nearly completely immobile. It is a reversible condition but can take 2 to 3 years to resolve.2
Frozen shoulder with diabetes
Although the specific reasons for developing frozen shoulder are unclear, it is more prevalent in people with diabetes. Prior reports have indicated a prevalence rate of 27.5% of shoulder disorders in diabetics as compared with a 5.0% rate in the general population.1 The American Academy of Orthopedic Surgeons suggests that 10-20% of people with diabetes develop frozen shoulder at some point.4 Overall frozen shoulder is most common in women between the ages of 40 and 60.2,3
When excess glucose sticks to cells, it can damage the connective tissue of the joints.2 This accumulation in the shoulder capsule means there is less empty space, resulting in joint stiffness. It is a chronic inflammatory condition, which in diabetics may be the result of sugar levels that are too high. 1
The stages of frozen shoulder
There are 3 stages of a frozen shoulder, with each one taking a variable amount of time to develop and resolve. 1,2
- Freezing is the stage where pain develops and gets worse as the shoulder loses range of motion. It can last 6 weeks to 9 months.
- Frozen is the stage where stiffness is present, getting use out of your arm may be difficult and some people may experience a reduction in pain. It can last 4-6 months.
- Thawing is the stage where shoulder motion slowly begins to return. That generally takes 6 months to 2 years.
Diagnosis and treatment for frozen shoulder
Frozen shoulder is typically diagnosed by an orthopedist who will perform a physical exam to examine your range of motion.2 People with frozen shoulder have a limited range of motion when moving their arm on their own (active) and when the doctor manipulates the shoulder (passive).
Imaging tests such as X-ray, MRI, and ultrasound can also be used to evaluate the structure of the shoulder, the presence of other conditions such as arthritis, and soft tissue damage including a torn rotator cuff.
Treatment for frozen shoulder is focused on reducing pain and restoring mobility. Physical therapy, anti-inflammatory medications, and steroid injections are the most common approaches. Physical therapists can manipulate the shoulder by using passive range of motion exercises, they also employ various therapeutic modalities including deep tissue work, heat, ice, and stim to promote stretching. Physical therapists can also help design a home exercise program which will help to restore and maintain mobility.
Non-steroidal anti-inflammatory drugs (NSAID) medications like aspirin and ibuprofen are recommended to reduce pain and swelling.2 Some people elect to receive injections of cortisone directly into the shoulder joint. This is done to try to reduce painful inflammation faster.
There are also surgical treatment options. One involves manipulating the shoulder while the person is under anesthesia. The orthopedist forces the shoulder to move which stretches or breaks up the tight tissue. Arthroscopy is also designed to loosen adhesions whereby the surgeon cuts through the thickened portion of the joint capsule followed by cleaning out the debris.2 These procedures are often performed together.
Frozen shoulder does resolve, for many, entirely and without surgical intervention. It can recur however in the same arm or in the opposite arm, which once again requires a multi-year process of recovery.
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