Limitation of Joint Mobility and Shoulder Capsulitis in Insulin- And Non-Insulin-Dependent Diabetes Mellitus

Abstract

Limited joint mobility and shoulder capsulitis were evaluated in 109 consecutive diabetic patients attending an out-patient diabetic clinic. Forty-nine had insulin-dependent diabetes mellitus (IDDM) and 60 had non-insulin-dependent diabetes mellitus (NIDDM). Seventy-five normal subjects were also examined. Limitation of joint mobility was detected in 24 (49%) patients with IDDM and in 31 (52%) patients with NIDDM but in only 17 (20%) normal subjects (p less than 0.001). There were no significant differences between diabetic patients with and without joint limitation with regard to age, sex, type of DM, mean daily insulin dosage and overall diabetic control as assessed by estimation of glycosylated haemoglobin concentration. However, patients with impaired joint mobility had a longer duration of diabetes (p = 0.01) and a significantly increased frequency of retinopathy compared to patients without joint limitation (p less than 0.05). Normal subjects with restricted joint mobility were older than those without restriction (p = 0.05). Shoulder capsulitis was present in 19% of patients with diabetes mellitus and 5% of normal subjects. However, there was no significant association between limited joint mobility and shoulder capsulitis in the diabetics.

Frozen Shoulder: Evidence and a Proposed Model Guiding Rehabilitation

“…For instance, individuals with secondary frozen shoulder related to insulin-dependent diabetes are more likely to have a more protracted and difficult clinical course. 85,86,88 We also propose another classification system based on the patient's irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention ( ). Irritability is determined based on pain, range of motion (ROM), and extent of disability.…”

“…Frozen shoulder is reported to affect 2% to 5% of the general population, 4,13,64,88 increasing to 10% to 38% in patients with diabetes and thyroid disease. 4,5,13,64,71,88 Individuals with primary frozen shoulder are commonly between 40 and 65 years old, 79,82,83 and the incidence appears higher in females than males.…”

“…Frozen shoulder is reported to affect 2% to 5% of the general population, 4,13,64,88 increasing to 10% to 38% in patients with diabetes and thyroid disease. 4,5,13,64,71,88 Individuals with primary frozen shoulder are commonly between 40 and 65 years old, 79,82,83 and the incidence appears higher in females than males. 4,9,43,64,71,109 The occurrence of frozen shoulder in 1 shoulder increases the risk of contralateral shoulder involvement by 5% to history, clinical presentation, and recovery.…”

“…Systemic secondary frozen shoulder is more common among these patients, due to the related underlying systemic connective tissue disease processes. 13,14,88 Extrinsic secondary frozen shoulder includes patients whose pathology is not directly related to the shoulder, and intrinsic secondary frozen shoulder describes patients with a known pathology of the glenohumeral joint soft tissues or structures. Specific causes of secondary frozen shoulder may influence prognosis.…”

A quantitative assessment of limited joint mobility in patients with diabetes

“…Limitation of motion may also occur secondary to microangiopathy or neuropathy (13). The reported prevalence of limited joint mobility ranges from 11% to 55% in patients with insulin-dependent diabetes mellitus (IDDM) (3-5, [14][15][16][17][18][19][20][21][22][23][24], from 30% to 70% in patients with non-insulindependent diabetes mellitus (18,21,23-25), and from 1% to 20% in nondiabetic subjects (3,17,19,21,23,24). These wide ranges in reported prevalence are due to differences among the studies in terms of population selection, assessment methodology, and definition of limited joint mobility.…”