Diabetes is a condition where the body either doesn’t produce enough insulin (a hormone that helps the body use sugar for energy) or can’t use it effectively. There are two main kinds:
Type I diabetes, this type often starts when someone is young. It happens because the body’s immune system, which usually fights off infections, mistakenly attacks and destroys the cells that make insulin. As a result, people with Type I diabetes need to take insulin regularly to stay healthy.
Type II diabetes,this is the more common type and usually develops in adults, although it’s increasingly seen in younger people too. Here, the body either doesn’t make enough insulin or can’t use it well. This type can often be managed with a healthy lifestyle and sometimes medication.
Shoulder capsulitis, which many people know as “frozen shoulder”, is when the shoulder becomes painful and stiff over time. Imagine the shoulder joint like a door hinge; if it gets rusty or tight, the door doesn’t swing open or close easily. Similarly, with a frozen shoulder, moving the arm can become difficult and sometimes very painful. The exact reason this happens isn’t fully understood, but it involves the shoulder capsule (the tissue surrounding the shoulder joint) becoming thicker and tighter.
Pathophysiology of Type I and Type II diabetes
Diabetes is a condition that affects how your body handles sugar in the blood. There are two main types, and they work a bit differently.
Causes and risk factors
Type I diabetes: This form is often spotted in kids and teens. It happens when the body’s defense system (the immune system) mistakenly attacks the part of the body that makes insulin, a key hormone for using sugar.
What might lead to this?
- It can run in families.
- Certain infections, like some viruses, might trigger it.
- Some think factors like food or where you live can have a role, but it’s still being studied.
Type II diabetes: This is more common and usually shows up in adults. In this case, the body either doesn’t make enough insulin or can’t use it properly.
What might lead to this?
- Being overweight, especially around the belly.
- Not being active enough.
- Eating too many sweets or processed foods.
- Having family members with the same condition.
- Aging.
- Women who had diabetes when pregnant might get it.
- Some conditions, like PCOS, and certain ethnic backgrounds might have a higher risk.
Common problems you might hear about
Type I diabetes:
- Sometimes, blood gets too acidic.
- Kidneys might have a hard time.
- Eyesight problems.
- Nerve pain.
- Heart troubles.
Type II diabetes:
- Sometimes, there’s too much sugar in blood.
- Similar problems with kidneys, eyes, and nerves as Type I.
- Greater risk of heart issues and strokes.
- Leg and foot problems.
Read More: Is Your Shoulder Pain Related to Ankylosing Spondylitis?
What is shoulder capsulitis?
Often called “frozen shoulder,” it’s when the shoulder becomes stiff and painful, making it hard to move.
Why does it happen?
- No clear reason for many people.
- Having conditions like diabetes or heart issues might make it more likely.
- If the shoulder is kept still for a long time, say after an injury.
- The body’s defenses mistakenly attacking the shoulder.
- Changes in hormones, especially in women after menopause.
What does it feel like and what might happen?
- Pain, particularly when trying to move the arm or at night.
- Stiffness, making it tough to do simple things like putting on a shirt or combing hair.
- If not taken care of, it could lead to ongoing pain or the shoulder not moving right.
Prevalence and Incidence
When we talk about health issues, there are terms like “prevalence” and “incidence” that help us understand how common a condition is. In simple terms, prevalence tells us how many people currently have a condition, and incidence tells us how many new cases pop up over a certain time.
Rate of shoulder capsulitis in the general population
“Frozen shoulder,” the more casual term for shoulder capsulitis, affects a small slice of people around the world.
What the numbers say: Studies show that out of every 100 people, about 2 to 5 people might get frozen shoulder at some point in their lives [1]. It’s more common in folks between the ages of 40 and 60 and seems to be a bit more common in women.
What might cause it: Most times, doctors aren’t sure why someone gets a frozen shoulder. But in some cases, it happens after the shoulder hasn’t been moved for a while, like after an injury or surgery. Other health conditions, like thyroid problems, can also play a role.
Rate of shoulder capsulitis in diabetic patients
Now, if you have diabetes, it seems you have a higher chance of getting a frozen shoulder.
What the numbers say: When we look at people with diabetes, out of every 100, about 10 to 36 might experience frozen shoulder [2]. That’s quite a jump compared to the general population.
Why this might happen: Diabetes, particularly prolonged and uncontrolled, can lead to microvascular complications and changes in connective tissue properties. This can result in an increased susceptibility to joint conditions such as shoulder capsulitis [3].
Comparative analysis: Type I vs. Type II diabetic patients
Let’s dive a bit deeper and compare the two main types of diabetes.
Type I Diabetics: People with this type usually learn they have diabetes when they are younger. Because of this early start, they might be exposed to sugar-related issues for a longer time. The prevalence of shoulder capsulitis in Type I diabetics is notably high, with some studies suggesting rates of up to 40% [4].
Type II Diabetics: This type is more common and often starts in adulthood. Given that both older age and diabetes can increase the risk of getting a frozen shoulder, folks with Type II diabetes have a particularly higher risk. The prevalence rates are typically slightly lower than in Type I diabetics, ranging from 10% to 30% [5]. This discrepancy could be attributed to the differing pathophysiology of the two types of diabetes.
Read More: Why Do Some Lung Cancer Patients Experience Shoulder Pain
Theoretical Links between Diabetic Complications and Shoulder Capsulitis
There are other aspects of diabetes besides the sugar issue. It can affect many parts of the body, including the shoulders. Let’s try to understand how problems caused by diabetes might be linked to a shoulder issue called “shoulder capsulitis” or, more commonly, “frozen shoulder.”
Microvascular complications of diabetes
Diabetes can lead to microvascular complications, which refer to damage to the tiny blood vessels in various parts of the body. Reduced blood flow and oxygenation to the shoulder’s joint capsule and surrounding tissues can make the area prone to stiffness and fibrosis. The link between diabetes-related microvascular disease and shoulder capsulitis suggests that decreased capillary perfusion may induce hypoxia, leading to fibroblastic proliferation and collagen deposition in the joint capsule [6].
Chronic inflammation in diabetes
Patients with diabetes often have elevated levels of pro-inflammatory cytokines. Chronic hyperglycemia can activate various inflammatory pathways that exacerbate oxidative stress and inflammation [7]. Chronic inflammation can lead to thickening of the joint capsule, resulting in reduced mobility and pain. The inflammatory process in the shoulder might parallel the microvascular complications observed in other diabetic complications.
Glycation end-products and musculoskeletal complications
Here’s a tricky term: “glycation end-products.” These are sticky molecules formed when sugars attach to proteins in our blood, and they’re more common when someone has high blood sugar.
- Think of these molecules as “gum” that can build up in tissues, like our shoulder. Over time, this “gum” can make the shoulder stiff.
- This stickiness also irritates the area, adding to the problems caused by inflammation. [8].
The role of diabetic neuropathy
Another issue with diabetes is it can cause nerve damage, known as neuropathy.
- Nerve damage can change how we feel pain or even how we sense our body’s position. In the shoulder, not sensing things right might lead to strain or injury without even noticing it.
- Additionally, if the muscles around the shoulder become weak due to nerve issues, it can put more strain on the shoulder, leading to problems like frozen shoulder [3].
In simpler terms, diabetes can cause a bunch of problems that make the shoulder unhappy. From poor blood delivery and internal irritation to sticky molecules and nerve issues, all these can play a part in a diabetic person getting frozen shoulder. It’s another reason why managing diabetes well is so important!
Read More: Can Injections Trigger Frozen Shoulder? A Deep Dive into Adhesive Capsulitis
Clinical Implications
Understanding the connection between diabetes and shoulder issues, especially a condition called “shoulder capsulitis” or “frozen shoulder,” can help us take better care of our health. Here’s a breakdown of what this all means for everyday people:
Potential interventions for diabetics
Early detection and management of shoulder capsulitis:
Look Out for the Signs: Early symptoms of shoulder capsulitis include mild pain and slight restriction in movement. Recognizing these initial signs is critical, as early intervention can result in better outcomes. Diabetic patients should be educated about these symptoms given their elevated risk [9].
Using Pictures to Understand Better: Doctors can use tools like MRI scans to look inside the shoulder. This helps them see what’s going on and decide the best way to help [10].
The advantages of physical therapy:
Custom Exercises: Physical therapists, or folks who are experts in movement and exercises, can teach special exercises that help keep the shoulder moving smoothly [11].
Cool and Warm Treatments: Using heat or cold, and sometimes even small electric currents (it’s painless!), can help reduce pain and swelling in the shoulder. The contrast of temperatures can be beneficial for pain management and healing acceleration.
Learning at Home: Physical therapists can also teach you exercises and techniques to use at home, so you can continue to help your shoulder feel better. This consistent practice can accelerate recovery and reduce the risk of reoccurrence [12].
Importance of diabetic management in preventing musculoskeletal complications
Keeping diabetes under control is like making sure your car has a regular service. It runs smoother and prevents bigger problems down the road.
Keeping Track: Regular monitoring of blood sugar levels can help in keeping diabetes under control, subsequently reducing the risk of complications, including musculoskeletal disorders like shoulder capsulitis [9].
Understanding the Big Picture: Effective diabetes management isn’t just about monitoring blood sugar. It involves understanding the potential complications, including those affecting muscles and joints, and adopting preventative strategies [3].
Working Together: Collaborative care involving endocrinologists, primary care physicians, physical therapists, and possibly orthopedic specialists can ensure a comprehensive approach to preventing and managing musculoskeletal complications in diabetic patients [13].
Read More: Coping with Overactive Bladder (OAB), Whether You Have Urinary Incontinence (UI) or Not
Conclusion
Think of diabetes like a tree with many branches. While we often focus on the main trunk (high blood sugar levels), the branches represent various health problems that can sprout because of diabetes. One such branch leads to “shoulder capsulitis,” or what some people call “frozen shoulder.” We’ve learned that when diabetes isn’t managed well, it can cause a range of problems. Some of these problems might be directly linked to issues in the shoulder, making it stiff and painful. While we know a bit about how diabetes affects the shoulder, there’s still much to learn.
By continuing to study this topic, we hope to find better ways to help those suffering from shoulder problems due to diabetes. By understanding these links better, we can come up with improved treatments, prevention strategies, and maybe even find ways to reverse some of these issues. Doctors, nurses, therapists, and other healthcare providers should always be on the lookout for signs of shoulder problems in their diabetic patients. If you or someone you know has diabetes, it’s crucial to have regular check-ups.
These check-ups can catch potential issues early, making them easier to manage. Health experts should take the time to explain these connections to patients. When patients know what to look out for, they can get help faster. In short, diabetes is more than just about sugar levels. It’s a condition that can touch various parts of our health. By understanding, researching, and being proactive, we can ensure better health outcomes for everyone. Remember, knowledge is power, and taking steps based on that knowledge makes all the difference!
FAQ’s
What is shoulder capsulitis?
Shoulder capsulitis, commonly known as “frozen shoulder,” is a condition characterized by pain and stiffness in the shoulder joint, limiting its range of motion. Over time, the shoulder becomes very hard to move.
How does diabetes increase the risk of developing shoulder capsulitis?
Diabetic patients, especially those with long-standing disease or poor blood sugar control, are at a higher risk due to factors such as microvascular complications, chronic inflammation, the accumulation of advanced glycation end-products (AGEs), and neuropathy.
Is there a difference in risk between Type I and Type II diabetics?
Both Type I and Type II diabetics are at an increased risk, but the prevalence and associated risks can vary based on factors like the duration of diabetes, level of glycemic control, and presence of other complications.
Can managing my diabetes help in preventing shoulder capsulitis?
Yes, effective management of diabetes, including maintaining stable blood sugar levels, can reduce the risk of various complications, including musculoskeletal disorders like shoulder capsulitis.
What are the early signs of shoulder capsulitis in diabetic patients?
Early signs include mild pain during movement, slight restriction in raising the arm, and discomfort when sleeping on the affected side. Diabetics should be vigilant and seek medical advice if they notice these symptoms.
How is shoulder capsulitis treated in diabetics?
Treatment includes pain management, physical therapy, and exercises to restore movement. In some cases, injections or surgery may be recommended. Good glycemic control can also aid in faster recovery.
Are there other musculoskeletal problems associated with diabetes?
Yes, diabetes can also lead to conditions like carpal tunnel syndrome, tendinopathy, and Charcot joints due to its effects on blood vessels, nerves, and connective tissues.
Can shoulder capsulitis recur in diabetic patients?
While anyone can experience a recurrence of shoulder capsulitis, diabetics may have a slightly elevated risk due to the underlying factors that predispose them to the condition.
Should I consult a physiotherapist if I’m diabetic and suspect I have shoulder capsulitis?
Absolutely. Physiotherapists can provide exercises and interventions to improve shoulder mobility and reduce pain. Collaborative care with your endocrinologist or primary care physician is also crucial.
Are there preventive exercises for shoulder capsulitis recommended for diabetics?
Engaging in regular shoulder stretching and strengthening exercises can help maintain joint flexibility and reduce the risk. Consultation with a physiotherapist can provide guidance on specific exercises tailored to individual needs.
References
1. Reeves, B., 1975. The natural history of the frozen shoulder syndrome. Scandinavian journal of rheumatology, 4(4), pp.193-196. https://www.tandfonline.com/doi/abs/10.3109/03009747509165255
2. Thomas, S.J., McDougall, C., Brown, I.D., Jaberoo, M.C., Stearns, A., Ashraf, R., Fisher, M. and Kelly, I.G., 2007. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. Journal of shoulder and elbow surgery, 16(6), pp.748-751.
https://www.sciencedirect.com/science/article/pii/S105827460700359X
3. Arkkila, P.E., Kantola, I.M., Viikari, J.S. and Rönnemaa, T., 1996. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Annals of the rheumatic diseases, 55(12), pp.907-914.
https://ard.bmj.com/content/55/12/907.short
4. Zreik, N.H., Malik, R.A. and Charalambous, C.P., 2016. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles, ligaments and tendons journal, 6(1), p.26.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915459/
5. Mavrikakis, M.E., Drimis, S., Kontoyannis, D.A., Rasidakis, A., Moulopoulou, E.S. and Kontoyannis, S., 1989. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Annals of the rheumatic diseases, 48(3), pp.211-214.
https://ard.bmj.com/content/48/3/211.short
6. Tighe, C.B. and Oakley Jr, W.S., 2008. The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. Southern medical journal, 101(6), pp.591-595.
https://europepmc.org/article/med/18475240
7. Dandona, P., Aljada, A. and Bandyopadhyay, A., 2004. Inflammation: the link between insulin resistance, obesity and diabetes. Trends in immunology, 25(1), pp.4-7.
https://www.cell.com/trends/immunology/fulltext/S1471-4906(03)00336-3?_returnURL=http://linkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1471490603003363%3Fshowall%3Dtrue&cc=y%3D
8. Abate, M., Schiavone, C., Salini, V. and Andia, I., 2013. Occurrence of tendon pathologies in metabolic disorders. Rheumatology, 52(4), pp.599-608.
https://academic.oup.com/rheumatology/article-abstract/52/4/599/1796925
9. Hand, C., Clipsham, K., Rees, J.L. and Carr, A.J., 2008. Long-term outcome of frozen shoulder. Journal of shoulder and elbow surgery, 17(2), pp.231-236.
https://www.sciencedirect.com/science/article/pii/S1058274607004867
10. Kim, H.A., Kim, S.H. and Seo, Y.I., 2007. Ultrasonographic findings of the shoulder in patients with rheumatoid arthritis and comparison with physical examination. Journal of Korean medical science, 22(4), pp.660-666.
https://synapse.koreamed.org/articles/1020479
11. Page, M.J., Green, S., Kramer, S., Johnston, R.V., McBain, B., Chau, M., Buchbinder, R. and Cochrane Musculoskeletal Group, 1996. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews, 2014(8).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011275/abstract
12. Kelley, M.J., Shaffer, M.A., Kuhn, J.E., Michener, L.A., Seitz, A.L., Uhl, T.L., Godges, J.J., McClure, P.W., Altman, R.D., Davenport, T. and Davies, G.J., 2013. Shoulder pain and mobility deficits: adhesive capsulitis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. Journal of orthopaedic & sports physical therapy, 43(5), pp.A1-A31.
https://www.jospt.org/doi/abs/10.2519/jospt.2013.0302
13. Abate, M., Schiavone, C., Pelotti, P. and Salini, V., 2010. Limited joint mobility in diabetes and ageing: recent advances in pathogenesis and therapy. International journal of immunopathology and pharmacology, 23(4), pp.997-1003.
https://journals.sagepub.com/doi/abs/10.1177/039463201002300404
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd
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