What Is the Diagnosis in Patients with Type 2 Diabetes Who Have a Painful Shoulder? Results from a Prospective Cross-Sectional Study

Abstract

Background: Patients with diabetes mellitus have higher risk of developing shoulder pathology. However, only adhesive capsulitis is addressed in shoulder pain guidelines as a disorder associated with diabetes. Yet, patients with diabetes are at risk of having several other shoulder disorders, including focal neuropathy. Our aim was to quantify the presence of shoulder disorders using physical examination and ultrasound imaging in patients with type 2 diabetes (T2DM) suffering from shoulder pain in general practice. Methods: In this prospective cross-sectional study, patients with T2DM who had had a painful shoulder for at least four weeks were included. Patients filled out a questionnaire and underwent a physical examination of the shoulders and feet and ultrasound imaging of the shoulder. Results: A total of 66 patients were included, of whom 40.9% (n = 27) had bilateral complaints resulting in 93 symptomatic shoulders. Subacromial pain syndrome was most frequently diagnosed by physical examination (66.6%, 95% CI 51.6–72.0%; p < 0.0001), while ultrasound imaging showed that subacromial disorders were statistically significantly the most prevalent (90.3%, 95% CI 81.9–95.2%). Only two patients (3%) were diagnosed with neuropathic shoulder pain. Conclusion: When choosing treatment, general practitioners should be aware that in patients with T2DM the subacromial region is most frequently affected.

Risk factors for shoulder pain after stroke: A clinical study

“…In Alabdali' s study, a total of 66 patients with type 2 diabetes were included, in which 40.9% of patients were found to have bilateral complaints of symptomatic shoulders, demonstrating a higher prevalence of shoulder pain in diabetes patients. 12 Kidwai' study concluded a similar conclusion. 13 Although the exact mechanism for the increased prevalence of shoulder disorders in diabetes patients remains unclear, some authors advocated that connective tissue damage based on the advanced glycosylation end-products, and peripheral or autonomic neuropathy may play an important role in the occurrence of shoulder pain in patients with diabetes.…”

“… 13 Although the exact mechanism for the increased prevalence of shoulder disorders in diabetes patients remains unclear, some authors advocated that connective tissue damage based on the advanced glycosylation end-products, and peripheral or autonomic neuropathy may play an important role in the occurrence of shoulder pain in patients with diabetes. 12 In addition, Alabdali found in their study that subacromial pain syndrome was the most prevalent shoulder disorder. Similarly, in the shoulder pain group of the current study, there were 73 cases suffering from rotator cuff injury, 88 cases suffering from tendon inflammation, 77 cases frozen shoulder, and 38 cases shoulder hand syndrome, most of these diseases also belong to subacromial pain syndrome, indicating these two studies demonstrate a similar trend.…”

“…13 Although the exact mechanism for the increased prevalence of shoulder disorders in diabetes patients remains unclear, some authors advocated that connective tissue damage based on the advanced glycosylation end-products, and peripheral or autonomic neuropathy may play an important role in the occurrence of shoulder pain in patients with diabetes. 12 In addition, Alabdali found in their study that subacromial pain syndrome was the most prevalent shoulder disorder. Similarly, in the shoulder pain group of the current study, there…”

Upper extremity musculoskeletal disorders in patients with type 2 diabetes in general practice

“…However, only adhesive capsulitis is addressed in shoulder pain guidelines for GPs as a disorder associated with DM even though patients with T2DM are at risk of having several other shoulder disorders, including focal neuropathy. Therefore, in chapter 4, a cross-sectional study was conducted, which included 66 patients with T2DM suffering from shoulder pain who were enrolled in the questionnaire study of chapter 3, to quantify the presence of shoulder disorders using physical exam and musculoskeletal ultrasound (US) imaging [3]. Subacromial pain syndrome was most frequently diagnosed by physical exam (66.6%, 95% CI 51.6-72.0%; p < 0.0001), while US imaging showed that subacromial disorders were statistically significantly most prevalent (90.3%, 95% CI 81.9-95.2%), with calcific tendinopathy most commonly observed (80.6%, 95% CI 70.8-87.8%).…”

“…Also, patients with T2DM tend to have abnormally high z-scores (≥ 2) more frequently compared to patients without DM, but still this was not statistically significant. In chapter 4, it was reported that subacromial pain disorders are the most frequently observed disorders in patients with T2DM suffering from shoulder pain, and only 3% of all patients had neuropathic shoulder pain [3]. These results were based on findings from a physical exam only.…”