Diabetes is literally a tough burden to shoulder for some people. Apart from its regular manifestations, uncontrolled diabetes could also lead to multiple musculoskeletal complications, says Dr Abhijit Bhograj, consultant, Diabetes and Endocrinology, Manipal Hospital, Bengaluru. These complications occur in our joints and one of the most common conditions is frozen shoulder (also called adhesive capsulitis).
Link between diabetes and joint problems
Dr Prashant Tejwani, senior consultant, Orthopaedics, Narayana Health City, Bengaluru, explains that when blood sugar levels are high, blood supply to the shoulder joint gets drastically reduced. This results in a condition called hypoxia (decreased oxygen supply to the tissues) which causes stiffening of the tissues, thereby restricting shoulder joint mobility.
Dr Bhograj says that excess glucose in our blood reacts with collagen fibres in our muscles, tendons and ligaments. This causes excessive cellular crosslinking and leads to increased stiffness, pain and reduced movement in our shoulders.
What is frozen shoulder?
Frozen shoulder, as the name suggests, is a condition where shoulder movement becomes severely restricted and painful. It is triggered due to inflammation of the connective tissues in the shoulder joint. According to the American Academy of Orthopaedic Surgeons (AAOS), frozen shoulder is caused due to thickening of the shoulder capsule as thick bands of tissue (called adhesions) develop over it. The AAOS also points out that the condition is quite commonly seen in people with diabetes. A research article published in Journal of Diabetes Investigation cites that the prevalence rate of shoulder disorders is higher among diabetics (27.5 percent) compared to that in non-diabetic people (five percent).
Dr Tejwani points out that frozen shoulder manifests in three different stages (freezing, frozen and thawing). A slow growing pain in the shoulder marks the onset of the first phase and it slowly aggravates and starts restricting our shoulder movements. The pain then slowly subsides but stiffness remains. Both these stages might last for a couple of months. In the final stage, there will be no pain and shoulder movement will start returning to normal.
Frozen shoulder generally tends to subside on its own after a couple of months. However, medical intervention and even surgery could also be sometimes required in severe cases which are accompanied by conditions like diabetes
Initial symptoms of frozen shoulder
Most people realise they have a frozen shoulder after experiencing shoulder ache while trying to comb their hair or stretch their back, says Dr Tejwani.
Dr Tejwani also adds that diabetics who overexert their shoulder joints are also at higher risk for developing conditions like frozen shoulder.
According to Rajeesh Kumar, a Kerala-based health coach and certified diabetes and exercise specialist, frozen shoulder is a common condition that he encounters while training his clients with diabetes. He attributed it to the inflammation of connective tissue which gets aggravated in people due to excess blood sugar.
“The range of motion in their shoulder joint will be limited and they are asked to start with low-intensity exercises initially to avoid any chances of injury. Some of these exercises will be similar to those done during physiotherapy sessions to loosen the joints,” he adds. He also points out that controlling blood sugar plays an integral part in recovery and it will take some time for people with frozen shoulder to regain mobility.
“Apart from people with diabetes, this condition is also seen in older people and if they are also diabetic, then it could manifest in a severe form,” he adds.
Diabetes and other forms of tendon damage
Multiple studies also attribute diabetes as a catalyst for tendon damage and few other conditions including rotator cuff tendinopathy and trigger finger. In case of rotator cuff tendinopathy induced by diabetes, excess blood glucose interacts with collagen and hardens the connective tissues resulting in tendon injury.
Managing diabetes-related shoulder disorders
Experts point out that frozen shoulder could be prevented by managing diabetes and performing activities which do not over-engage the shoulders. They suggest some ways to manage diabetes associated shoulder pain:
- Following a diabetes-friendly diet to maintain healthy blood sugar levels.
- Adopting an active lifestyle and exercising on a daily basis.
- Incorporating calcium-rich foods like milk and vegetables in your daily diet for better bone health.
- Avoiding unnecessary stress to the shoulder joint if possible.
- Seeking medical advice if you are diabetic and have nagging shoulder pain.
Takeaways
- People with diabetes are at a higher risk for developing shoulder-related musculoskeletal conditions like frozen shoulder.
- Excess blood sugar levels often lead to inflammation and hardening of the connective tissues in our shoulder joint which could be painful, thereby restricting shoulder mobility.
- Such conditions could be managed through lifestyle alterations and better diabetes management.
