Shoulder Adhesive Capsulitis in Type 1 Diabetes Mellitus: A Cross-Sectional Study on 943 Cases in Sardinian People

Abstract

Purpose To evaluate the prevalence of adhesive capsulitis (AC) of the shoulder in patients with type 1 diabetes mellitus (T1DM) in Sardinia. Methods In this cross-sectional study, we evaluated 943 patients with T1DM attending the division of Endocrinology and Metabolism at the University Hospital in Sassari, Italy. The criteria for diagnosing AC were: pain for at least 1 month, inability to lie on the affected shoulder, and restricted active and passive shoulder joint movements in at least three planes. Age, gender, duration of DM, blood pressure, and presence of neuropathy and retinopathy were noted. Metabolic control of DM was evaluated with glycosylated hemoglobin A1c (GHbA1c) blood concentrations. Results AC was diagnosed in 331 patients (prevalence: 35.1%). Age, duration of DM, high blood pressure levels, and the presence of neuropathy and retinopathy were significantly associated with AC. No significant association was observed between gender and AC. There was no significant difference in mean levels of GHbA1c in T1DM patients with or without AC. Conclusion This study shows that AC of the shoulder is a common disorder in patients with T1DM in Sardinia. It is significantly associated with age, duration of DM, and related complications. Level of Evidence Level IV, observational cross-sectional study.

Clinical Examination and Self-Reported Upper Extremity Impairments in Patients with Long-Standing Type 1 Diabetes Mellitus

“…Larkin et al defined frozen shoulder by self-report and shoulder flexion measurement and reported a prevalence of 31% of the patients [6]. A recent Sardinian study reported adhesive capsulitis in 35% of the patients [12]. Our findings highlight shoulder impairment in diabetes and stress the importance to find patients with shoulder immobility at an early stage to possibly prevent further deterioration of pain and stiffness [30].…”

“…In the clinical examination of the shoulder, 40% of the patients showed impaired mobility, "hands against back," which is compatible but not specific for frozen shoulder as well as the observed reduced mobility in several planes [4,22]. Previous reports regarding prevalence of frozen shoulder use somewhat different diagnose criteria [6,12,23] but involve pain, stiffness, and impaired shoulder range of motion. Numerous shoulder examination techniques have been evaluated in order to diagnose shoulder conditions; however, none of the tests is considered a 100% sensitive or specific [24][25][26][27][28][29].…”

“…Pathogenesis is assumed multifactorial with risk factors such as increasing age, female gender, longer diabetes duration, higher BMI, poor glycemic control, and presence of micro-and macrovascular complications [6]. An attractive hypothesis with some support is that increased advanced glycation end products in collagen (AGEs) cause the UEI in diabetes [6,12,13]. UEIs are associated with physical disability and impaired health-related quality of life (HRQOL) [1,6,[14][15][16].…”

Upper extremity impairments in type 1 diabetes in comparison to matched controls without diabetes : associations to the IGF-system, metabolic factors, disability and quality of life

“…Adhesive capsulitis (Frozen shoulder) is a condition characterized by painful restriction in shoulder movement. Abduction and external rotation are mainly affected 44,45,63 . Frozen shoulder is a progressive condition, with a duration of 2-3 years.…”

“…Four out of ten patients were unable to perform this test, followed by the "hands to roof" test (which 20% of the patients were unable to perform). The diagnostic criteria for frozen shoulder differs; however, the common denominators of frozen shoulder are pain, stiffness, and symptoms of impaired mobility 44,63,93 . Although a variety of shoulder examination techniques have been suggested for diagnostic testing, none shows perfect specificity or sensitivity [99][100][101][102] .…”