Previous reports showed that there is a higher prevalence rate (27.5%) of shoulder disorders in patients with diabetes as compared with the rate of 5.0% found in general medical patients(1) Frozen shoulder is characterized by progressive pain, stiffness, limited active and passive range of motion of the shoulder joints, especially external rotation, and night pain. Current available managements include use of analgesia, such as non- steroidal anti-inflammatory drugs (NSAIDs) or paracetamol and/or intra- articular steroid injection, and can be combined with local anesthetic applications. Encouragement of activity is also crucial. Once the symptoms of pain and inflammation have reduced, gentle stretching and exercises that enhance the range of motion should be encouraged. In rare cases, surgical procedures can be considered, such as manipulation under anesthesia or capsular release under arthroscopic guidance.(2)
The muscles or their tendons may tear or become inflamed or calcium deposits may form inside tendons. Symptoms can vary according to exactly what has happened, but most people with rotator cuff problems have pain and stiffness in their shoulder, sometimes with a feeling that something is ‘catching’ when the arm is lifted above shoulder level.
Rotator cuff tears are the most common cause of shoulder disability in people older than 50 years, and surgical intervention is usually required for restoring functioning. However, in patients undergoing rotator cuff repair surgery, patients with DM had poorer functional outcomes than those without DM, and hence, DM is one of the possible risks factor for rotator cut off tear (3)
Since diabetes has a negative influence on the evolution after the repair of the cuff, this repair must be carried out quickly after the diagnosis of rupture in order to avoid a shortening of the tendon and a fatty degeneration which can diminish the good results of arthroscopic repair.
1. Thomas SJ, McDougall C, Brown ID, et al Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg 2007; 16: 748–751.
2. Cherng Lan Hsu and Wayne H-H Sheu, Diabetes and shoulder disease,J Diabetes Investig. 2016 Sep; 7(5): 649–651.
3. Shih-Wei Huang et al, Diabetes mellitus increases the risk of rotator cuff tear repair surgery: A population-based cohort study, Journal of diabetes and its complications vol 30/8, dec 2016