When you have diabetes, having high blood glucose levels can lead to serious health conditions, including eye problems, foot problems and nerve damage. A lesser known but common diabetes complication is musculoskeletal disease, often causing shoulder pain.
Research suggests that shoulder disorders in diabetics is 27.5%, compared with 5% for those without diabetes. Diabetes is also one of the most common causes of adhesive capsulitis, or frozen shoulder.
As November is Diabetes Awareness Month, here we get to the root of why shoulder conditions are often experienced by patients with diabetes.
Shoulder conditions linked with diabetes
Although further research is needed into exactly how diabetes causes shoulder conditions, there are associated mechanisms of the disease. Hyperglycaemia, or high blood sugar, is linked to the formation of advanced glycosylation end‐products (AGEs). The combination of these AGEs with collagen proteins found in tendons and ligaments, affects, and compromises their structure, causing them to thicken. This thickening of the tendons makes them weaker, also causing stiffness and pain.
Another symptom of hyperglycaemia is chronic inflammation, which together with tendon stiffness in the glenohumeral joint can lead to capsular fibrosis, resulting in frozen shoulder syndrome. Also, with the formation of AGEs, alongside inflammation and impaired circulation, the rotator cuff is more susceptible to injury and the tendon is more prone to tearing.
Treating shoulder damage caused by diabetes
One of the key ways to avoid shoulder complications with diabetes is to keep it under control. Lowering your blood sugar with lifestyle changes including exercise and diet can prevent tendon problems.
Symptoms caused by a frozen shoulder can vary, but it can be extremely painful, affecting quality of life. Typically, it lasts up to nine months, but it can last the duration of diabetes – making it essential to improve and maintain control of blood sugars. Usually, treatment options are conservative and can include painkillers, anti-inflammatories, physical therapy and steroid injections for reducing the inflammation. If conservative management is unsuccessful, then surgery may be recommended. This may be an arthroscopic capsular release or manipulation of the shoulder joint.
If rotator cuff disease is diagnosed, then a similar conservative treatment approach as with frozen shoulder can be undertaken. Importantly, managing blood sugar levels can help to prevent further damage. If there is a complete tear of the tendon and surgery is needed, it is important to recognise that there can be a higher risk of complications with diabetes.
Help for your shoulder condition
If you have diabetes and are experiencing shoulder pain that is affecting your everyday life, or if your range of mobility in your shoulder is limited, then it is advisable to get a confirmed diagnosis.
During your consultation with your London Shoulder Specialist, they will discuss your medical history and can organise scans to investigate the extent of any shoulder damage. They can organise a personalised treatment plan for your shoulder condition, working alongside your diabetes management.