Causes of Shoulder Dysfunction in Diabetic Patients: A Review of Literature

Abstract

Objective: Understanding the underlying mechanisms behind shoulder dysfunctions in patients with diabetes mellitus. Study Design: Systematic qualitative literature review. Participants: Patients with shoulder dysfunctions and diagnosed with impaired glucose tolerance or diabetes mellitus. Intervention: Published scientific literature containing evidence about the mechanisms of shoulder dysfunctions in the diabetic population. Articles were selected based on criteria containing diabetic population, shoulder dysfunction, methodological quality ≥ 6/9 and >20 subjects. Main Outcome measures: range of motion; questionnaires (QoL, UCLA-m, SPADI, DASH); blood glucose, blood HbA1C; calculated capsular stiffness (Kcap); calcification shoulder joint; shoulder dysfunction in patients with glucose metabolism disorders and diabetes mellitus. Results: We found 17 published articles with level 2 and 3 evidence. Multiple factors such as age, duration of diabetes mellitus (DM), glycated hemoglobin (HbA1c), advanced glycation end products (AGE), vascular endothelial growth factor (VEGF), interleukin-1ß (IL-1ß) were shown to be associated with tendon changes and increased capsular stiffness (Kcap) conceivably leading to limited range of motion (ROM) or frozen shoulder. Decreased ROM and frozen shoulder have a significantly higher prevalence in DM than in non-DM. Conclusions: Based on the current literature we confirm a high prevalence of shoulder dysfunctions in patients with diabetes mellitus. The cause of the shoulder complications is unknown, and more research is mandatory to shed more light on the complex interplay between the multifactorial causes of shoulder dysfunction in diabetes mellitus.

A Novel Method for Establishing a Rabbit Model of Diabetic Periarthritis: The Combination of Alloxan and a Continuous Strain with Ice Compression

“…It is likely related to factors such as the deposition of advanced glycation end products (AGEs) in the shoulder joint, leading to alterations in the microstructure of collagen bers, increased production of diabetes-related in ammatory factors and proin ammatory mediators, microcirculatory disturbances associated with diabetes, and lipid metabolism disorders(Date and Rahman, n.d.). These factors can induce in ammatory responses and brotic changes in the joint capsule surrounding the shoulder joint, resulting in shoulder dysfunction (Struyf et al, 2022). Under hyperglycemic conditions, excessive sugar and protein combine to form AGEs, which accumulate within the body.…”

Factors associated with frozen shoulder in adults: a retrospective study

“…Additionally, it has been confirmed that the incidence of complications and frozen shoulder ranges from 10 to 35%, and these patients have more severe stiffness, which should be actively managed [ 30 , 31 ]. There was evidence that poor long-term blood sugar control in diabetes patients was associated with an increased incidence of periarthritis, whereas there was no association between the hemoglobin A1c levels of diabetes patients and the incidence of periarthritis [ 32 ].…”

Decreased Expression of Leptin among Patients with Shoulder Stiffness

“…Leptin has been shown to modulate the fibroblastic and inflammatory processes of hepatic cholestasis, hepatic fibrosis, and chronic allergic airway disease [ 26 , 27 , 28 ]. Type II diabetic patients have been shown to have a lower serum leptin level and are prone to suffer from SS [ 14 , 15 , 29 ]. The recognized role of leptin in mediating the fibroblastic and inflammatory processes as well as the known diabetes-leptin/diabetes-SS linkages inspired us to investigate the role of leptin in the pathogenesis of SS.…”