Management of limited joint mobility in diabetic patients

Abstract

Several rheumatologic manifestations are more pronounced in subjects with diabetes, ie, frozen shoulder, rotator cuff tears, Dupuytren’s contracture, trigger finger, cheiroarthropathy in the upper limb, and Achilles tendinopathy and plantar fasciitis in the lower limb. These conditions can limit the range of motion of the affected joint, thereby impairing function and ability to perform activities of daily living. This review provides a short description of diabetes-related joint diseases, the specific pathogenetic mechanisms involved, and the role of inflammation, overuse, and genetics, each of which activates a complex sequence of biochemical alterations. Diabetes is a causative factor in tendon diseases and amplifies the damage induced by other agents as well. According to an accepted hypothesis, damaged joint tissue in diabetes is caused by an excess of advanced glycation end products, which forms covalent cross-links within collagen fibers and alters their structure and function. Moreover, they interact with a variety of cell surface receptors, activating a number of effects, including pro-oxidant and proinflammatory events. Adiposity and advanced age, commonly associated with type 2 diabetes mellitus, are further pathogenetic factors. Prevention and strict control of this metabolic disorder is essential, because it has been demonstrated that limited joint motion is related to duration of the disease and hyperglycemia. Several treatments are used in clinical practice, but their mechanisms of action are not completely understood, and their efficacy is also debated.

Achilles tendons in people with type 2 diabetes show mildly compromised structure: an ultrasound tissue characterisation study

“…Also, other factors like pentosidine concentration or altered gait might play a role. Abate et al 17 concluded in their review that many complex pathogenetic mechanisms are involved in rheumatological manifestations of diabetes.…”

“…Hyperglycaemia itself may also increase expression of matrix metalloproteinase-9 and metalloproteinase-13 in tendon cells and impair collagen synthesis 16. Nevertheless, the pathomechanics behind tendon degeneration in either type 1 or type 2 diabetes is most likely multifactorial and still largely unknown 12 17…”

Primary ulnar superficial slip resection in complicated trigger finger

“…Satisfaction rate was high and disability returned to normal after surgery. The patients with diabetes, a known metabolic disturbance quite often leading to therapy resisting tendinosis, all recovered as well after surgery as the idiopathic forms [9,10].…”

Changes in Gene Expression in Responders and Nonresponders to a Low-Intensity Walking Intervention

“…Factors such as compliance (11) and exercise responsiveness (12,13) complicate the development and implementation of clear physical activity recommendations and/or guidelines for people with IGT or overt type 2 diabetes. Furthermore, older individuals may be restricted or limited in their exercise modality because of prior illness, reduced mobility, or other complications (14). In addition, controlled, supervised exercise trials do not necessarily reflect the actual adherence to an exercise prescription offered by many primary care professionals.…”