Our shoulder is made up of three bones: The shoulder blade, the collarbone, and the upper arm bone or humerus.  The shoulder has a ball-and-socket joint.  The round head of the upper arm bone fits into the socket.  Connective tissue (shoulder capsule) surrounds the shoulder joint.  It is the synovial fluid that reduces the friction in the joint and makes the joint mobile.

Though it is often overlooked, musculoskeletal diseases are one of the most common side effects in patients with diabetes.  Musculoskeletal ailments associated with diabetes are strong enough to inflict both physical and psychological harm.  Frozen shoulder (also referred to as adhesive capsulitis) occurs when the ligaments around the shoulder joint swell and become stiff.  The affected shoulder joint gradually loses mobility over a period of time, until the joint becomes stiff or “frozen”.  Due to inflammation and swelling present in the shoulder, normal healing becomes hard and leads to shoulder getting stiff.  As a result of inflammation and stiffness, it would be painful to carryout activities of daily living.  Seemingly simple tasks such as buttoning the shirt and reaching into an overhead bin can be difficult.  Among the various musculoskeletal conditions associated with diabetes, frozen shoulder is one of the most common complaints.

Frozen shoulder is a very painful condition.  Stiffness that comes with frozen shoulder can increase in intensity after around nine months.  With time, symptoms intensify and adversely affect movements, eventually leading to decreased quality of life and disability in daily activities.

The exact cause of frozen shoulder is not fully understood, though it has been noted that the incidence of getting frozen shoulder is directly proportional to diabetes.  Apart from diabetes, there are a number of causes that are believed to increase the risk of developing frozen shoulder, including:

Health conditions:  Heart disease, stroke, overactive and underactive thyroid

Recent surgery or injury:  The risk of getting frozen shoulder increases after a shoulder or arm injury or surgery.  This could be due to keeping the shoulder immobile for a prolonged period of time during the recovery period.

Age and gender:  Frozen shoulder generally affects people aged between 40 and 60.  Women are more likely to get the condition than men.

Altered arm mobility:  Participating in activities that involve arm rotation, weight lifting and sudden stress via injury can lead to frozen shoulder.

Shoulder conditions:  Calcific tendonitis and rotator cuff tear can also cause frozen shoulder.

Connection with diabetes:

Medical research has shown that people suffering from diabetes are up to twice as likely to suffer from frozen shoulder.  This is due to the effects on collagen in the shoulder, which holds the bones together in a joint.  Collagen gets triggered by the presence of high blood sugars.  Interestingly, collagen gets sticky when sugar molecules become attached, leading to restricted movements and shoulder starting to stiffen.

Poorly-controlled diabetes can obviously lead to muscular and skeletal problems and consistently raised sugar levels in the blood increases risk of complications of frozen shoulder.  Long-term complications of diabetes and its impact on connective tissue have been well documented in the medical literature.  Excess glucose can get on to the cells, impairing the connective tissue which makes up the joint.  Frozen shoulder, being a pathological condition of the shoulder, causes gradual loss of motion, usually in just one shoulder.

Though the prevalence of frozen shoulder is only 2% in general population, when it comes to people suffering from diabetes it is 10 to 29%.  It has been observed that in diabetes patients symptoms of frozen shoulder can be severe.   Dupuytren’s Contracture of the palms and fingers of the hand is another example of contracture syndrome related to abnormally high glucose levels in the blood.  It is sometimes referred to as stiff-man syndrome, although it occurs in both sexes.

Stages of frozen shoulder:

Symptoms of frozen shoulder are classified into three stages as they worsen gradually.

Freezing or painful stage:  Pain increases gradually, making motion of the shoulder harder and harder.  The affected person can experience more pain at night.  This stage normally lasts from six weeks to nine months.

Frozen:  There is no worsening of pain at this stage and it may actually decrease.  Stiffness grips the shoulder.  It can last from four to six months, making movements restricted.

Thawing:  Movements of the shoulder may be possible and may eventually return to normal.  There may be intermittent pain.  However this takes between six months and two years.

A frozen shoulder normally recovers, but the time period is pretty long, around three years!  That being the case, getting timely medical treatment is a key factor in recovery of frozen shoulder.  Doctors most likely diagnose frozen shoulder based on signs and symptoms, and physical exam.  In order to find out the severity of the condition, doctors do a basic test in which certain parts of the arms and shoulder are pressed and moved.

Prevention of frozen shoulder in patients with diabetes:

Since people with diabetes are prone to developing frozen shoulder, they can keep off the condition by ensuring that blood glucose levels are as close to normal as possible.  Regular exercises such as yoga, tai chi or other exercises that provide motion and flexibility of shoulder joint can also help keep the joints strong and flexible.

Early detection, proper staging, and appropriate treatment can allow the patients with diabetes to avoid the painful and disabling consequences of frozen shoulder.

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Q&As on Diabetes and Frozen Shoulder

1)  What should you not do if you have a frozen shoulder?

Certain things might seem like good ideas, but in reality, they can make your frozen shoulder even worse. Here are they

  • Never use a shoulder sling: It might feel tempting to use a shoulder sling to keep your arms and shoulders in a fixed position and decrease pain, but it is vital to use your arm and not limit its range of motion.
  • Do not stop using your arm completely: Even if it might be painful, using your arm slowly helps in the process of healing. However, remain careful and do not lift anything heavy.
  • Do not look for a magic cure: Frozen shoulder is a condition that will take time to get better. Several websites will try to sell some quick methods of cures using medications and other exercise programs. But very few of them work, and many of them can be harmful.

2) What is the link between frozen shoulder and diabetes?

It’s a common belief that frozen shoulder occurs because of the collagen in the shoulder capsule that becomes sticky as sugar molecules attach to it. Collagen is considered one of the primary components in the ligaments and the tendons that connect the muscles to the bones and the bones to the bones. Therefore, any change in the collagen can cause a restriction of movement. This is mainly because of the process known as glycosylation, where the glucose molecules will get attached to the protein molecules. In addition, it has been seen that people with diabetes are more likely to develop frozen shoulders when compared with non-diabetic people. This is because high blood sugar levels can impact other body areas.

3) Who gets a frozen shoulder?

Every year a lot of people are getting diagnosed with frozen shoulder. It is widespread in between 40 and 60 ages and mainly among women. So it is not surprising that people with diabetes are more likely to get frozen shoulder than anybody else. This is why researchers are calling for screening people with diabetes diagnosed with a frozen shoulder.

Other than diabetes, what are some other risk factors for frozen shoulders?

While many people get frozen shoulders, some are at high risk of getting this condition. These risk factors are

  • Age: Frozen shoulder mainly impacts adults between the ages of 40 and 60, and the peak age is 56.
  • Ender: Frozen shoulder mainly affects women more than men.
  • Injury: An injury that decreases shoulder movement contributes to the development of this condition. One such example is a rotator cuff tear.
  • Any surgery: Like a recent injury, any surgery that makes your shoulder joint immovable contributes to the development of FS.
  • Any existing health conditions: An underactive or an overactive thyroid gland, heart disease, or Parkinson’s disease also increases the chance of a frozen shoulder.

4) How is frozen shoulder diagnosed?

If you are having consistent pain in your shoulder, then you have to consult your doctor. If your doctor suspects a frozen shoulder, then they will

  • See your symptoms
  • Please go through the medical history, including diabetes or any risk factors involved.
  • Do a physical exam that includes checking motion range
  • Order an x-ray of your shoulder to find out if there are other conditions such as arthritis, calcium deposits, etc.

Other than that, you can also do a preliminary test for a frozen shoulder at your home like

  • Stretch your arms in front of you and put them overhead. You are most likely to feel pain if you have FS, which prohibits you from lifting the arm completely.
  • Lift your arm to one side. If your shoulder is moving up towards your ear and you are feeling pain, you might have a frozen shoulder.
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