How is Frozen Shoulder Associated with Diabetes?

I have had type 1 for 22 years. I am a 41-year-old female. Is there a link between frozen shoulder and diabetes? What can be done to ease it?

Annie Kilsby
Penola, South Australia

Yes, there is a connection between frozen shoulder and diabetes. Frozen shoulder leads to pain at the tip of the shoulder that restricts movement and then limits the movement because of fibrosis. It appears that in diabetes, certain compounds accumulate in the linings of joints in the collagen. The collagen fibers then stick together and limit the capacity for the joint and ligaments to stretch with movement. Ultimately this ends up as a frozen shoulder.

Several drugs are being developed for the treatment of frozen shoulder. One such compound is able to prevent the tendon shortening that occurs in rats with diabetes. This compound has not yet reached the market. In the meantime, you should use stretching, anti-inflammatory drugs, injections of local steroids and anesthetic agents judiciously.

Aaron Vinik, MD, PhD
Director, Diabetes Research Institute
Eastern Virginia Medical School
Norfolk, Virginia

Dr. Richard Bernstein of the Diabetes Center offer this perspective on frozen shoulder.

Muscular and skeletal problems such as yours are virtually universal among people with long-standing, poorly controlled diabetes. Sometimes the problems are very painful and even disabling. They probably stem from glycosylation of collagen (a protein in tendons).

Collagen fibers normally slide along one another during muscular movement. In glycosylation, they become glued together by glucose. This process can also occur in the skin, which becomes hard and tough (diabetic scleredema).

Frozen shoulder, or diabetic shoulder capsulitis, is usually more severe in the dominant shoulder. Impairment is most apparent on internal rotation, like back scratching from below, where the dominant hand does not reach as high as the other hand. Other features include pain while putting on a sweater or T-shirt and tender trigger points in the trapezius muscle (between shoulder and neck), deltoid muscle (outer, upper arm) and capsule of the shoulder joint. Treatment is deep massage of the affected trigger points and tendons. This should be performed once every other week for perhaps 15 sessions.

All of the above treatments absolutely work if properly performed with the right equipment. If blood sugars remain elevated, such problems will in all likelihood recur.

Richard K. Bernstein, MD, FACE, FACN
Mamaroneck, New York

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