I wrote the following article on Diabetes and Frozen Shoulder for Diabetes Daily. You can see the article on their site here. This is the second piece I’ve written for them this summer, following my Diabetes and Trigger Finger article a couple of weeks ago.
Diabetes and Frozen Shoulder
Among the many complications often associated with diabetes, one of the most mystifying and painful is Frozen Shoulder. Adhesive Capsulitis, the condition’s official term, is a pathological condition of the shoulder joint which causes the gradual and painful loss of motion.
The connective tissue of the shoulder joint inflames and stiffens, limiting mobility, causing chronic pain and disturbing sleep. The associated pain varies between a dull ache to sharp stings that radiate through the bicep.
Who gets Frozen Shoulder?
Various studies have found that women are more likely to develop frozen shoulder than men, and it commonly occurs between the ages of 40 and 65.
Adhesive Capsulitis affects approximately 2 percent of the general population, but, according to a study by the American Academy of Orthopaedic Surgeons, 10 to 20 percent of people with diabetes suffer from the condition.
A 2016 study from Blackpool Victoria Hospital in the UK found that diabetics are five-times more likely to suffer from frozen shoulder than non-diabetics. This study also found there’s no significant difference in prevalence between Type-1 diabetes and Type-2.
What’s the link?
While people with diabetes make up about 30 percent of all frozen shoulder cases, there’s no definitive link between the disease and the shoulder condition. Although doctors have yet to recognize a specific cause for the condition, some studies indicate adhesive capsulitis is caused by glycosylation of the collagen in the shoulder joint.
Glycosylation occurs when sugar molecules attach to the collagen, making it sticky and restricting movement in the joint. This development can be triggered by hyperglycemia, or high-blood sugars.
In a 2017 interview, Dr. John M. Vasudevan, MD, of the Perelman School of Medicine at the University of Pennsylvania, said of frozen shoulder: “Many cases are without cause. People with diabetes may have an elevated risk, but there are so many known causes that it is definitely hard to pin the problem to diabetes itself.”
What Happens to the Shoulder?
Adhesive Capsulitis is characterized by three stages. The severity and length of the stages may vary from patient to patient.
- Stage One: “Freezing.” Typically the most painful stage of the condition, it lasts anywhere from six weeks to nine months. During this stage, there’s a slow onset of pain coinciding with a gradual reduction in the range of motion (ROM) of the shoulder. Simple movements like reaching above the head or behind the back are accompanied by tremendous pain and cramping.
- Stage Two: “Frozen.” There’s a slow lessening of pain during this stage, but stiffness remains. This adhesive stage can last four to nine months.
- Stage Three: “Thawing.” During this final stage, there’s a gradual improvement in ROM, as well as a lessening of pain and stiffness. This stage lasts anywhere from five months to two years.
What’s the Treatment?
Adhesive Capsulitis sees a wide range of treatments. Diagnosis for the condition involves a physical exam, x-ray and MRI, which is best for identifying soft tissue issues. Once diagnosed, doctors can advise a variety of approaches, including physical therapy, steroid injections, surgical manipulation, and even “supervised neglect.”
Physical therapy is the most common treatment for frozen shoulder. Therapists devise a specific exercise and stretching regimen to address the restricted motion, limited rotation, strength and pain. The regimen often employs heat and can take several weeks or even months for noticeable improvement.
Steroid injections can be used if the shoulder doesn’t respond to physical therapy, to aid in breaking up the scar tissue. But there’s a danger of elevated blood sugars for diabetics with steroid injections.
Surgical manipulation is often a last-resort when dealing with frozen shoulder. Done under general anesthesia, this procedure involves physically moving the shoulder into different positions to break up the scar tissue, forcing the joint capsule to tear or stretch. These procedures have a 70 percent success rate, but also hold a 2 percent risk of breaking the arm.
A second surgical option is arthroscopic surgery. Several small incisions are made in and around the shoulder, specifically in the capsule’s tightest portions. This restores a measure of movement and is often followed by physical therapy.
A 2004 study out of University of Groningen in the Netherlands proffered a passive option known as “supervised neglect.” The study indicated that 89 percent of patients treated with supervised neglect had normal to near-normal painless shoulder function after two years.
According to a 2011 study published by the American Family Physicians medical journal, 90-95 percent of frozen shoulder cases improve with non-surgical treatments.
What to Do with Frozen Shoulder
Frozen shoulder continues to mystify health experts, and, unfortunately, there’s no way to prevent it. Early detection and proper treatment can allow a patient with diabetes to avoid the most painful and debilitating consequences of the condition. It’s important to keep an open and honest dialogue with your doctors with this and any of the complications associated with diabetes.
Diercks, Ron & Stevens, Martin. (2004). Gentle thawing of the frozen shoulder: A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons … [et al.]. 13. 499-502.