Diabetes and Frozen Shoulder – The Connection, Symptoms, and Treatment

Patients who have diabetes can have long-term complications. Frozen shoulder is one of those complications that can be associated with diabetes.

So, in this article, we will discuss diabetes and frozen shoulder, and what you can do about it. Here is a brief explanation before we cover the details.

Diabetes and Frozen Shoulder: Chronic high blood sugar levels caused by diabetes can lead to changes in one’s connective tissue. These changes can result in frozen shoulder, which occurs in up to 29% of diabetes patients but only in 2% of the rest of the population. Frozen shoulder can be very painful and creates severe stiffness, limiting one’s range of motion.

Now that you have the basic explanation let’s cover diabetes and frozen shoulder more in-depth.

What is Frozen Shoulder

Frozen shoulder is also be called adhesive capsulitis and can be extremely painful for months if not years. This condition makes it difficult and troublesome to perform simple daily functions, such as brushing your teeth or buttoning a shirt.

The debilitating condition is often caused by inflammation of the tissue in and around the shoulder joint. The inflammation makes it difficult for proper healing to occur, contributing to the stiffness of the shoulder.

Connection Between Diabetes and Frozen Shoulder

Research has shown that those with diabetes are over twice as likely to suffer from frozen shoulder. So, what exactly is the link between diabetes and frozen shoulder?

It is believed that the high blood sugar levels associated with diabetes are the main problem. These high blood sugar levels start to form advanced glycosylation end products (AGEs). AGEs are proteins that become bonded with sugar because of the excess sugar in the blood. The AGEs will then attach to tendons and ligaments, causing stiffness and inflammation.

Having high blood sugar levels can also lead to reduced blood circulation. So, the AGEs combined with poor blood circulation leads to a high chance of immobility in the shoulder. This is why the people that are most at risk for frozen shoulder are those that have had diabetes the longest.

Symptoms and Stages of Frozen Shoulder

The main symptoms of frozen shoulder are pain and stiffness that make it difficult to move your shoulder. The pain is often dull, achy, and can be severe enough to the point where it is impossible to move your arm. Pain may also be felt in the muscles around the shoulder joint.

There are three stages to frozen shoulder, which are described below.

Stage 1: Freezing

During the freezing stage, you start to develop some pain around the joint. The pain will gradually become worse over time, and range of motion starts to become limited. It may be more painful at night, making it difficult to sleep. This stage can last anywhere between 6-9 months.

Stage 2: Frozen

During the frozen stage, the pain may subside, but the stiffness will become worse. Movement of your shoulder becomes more difficult, and performing simple daily functions can be challenging. The frozen stage can last between 4-12 months.

Stage 3: Thawing

The thawing stage is when your shoulder starts to slowly regain mobility again. Range of motion and strength typically return back to normal or close to normal. The thawing stage can take between 6 months to 2 years.

Diagnosis

Diagnosing frozen shoulder is typically done through a physical exam. Your doctor will ask you to move your arms in certain ways and evaluate your pain and range of motion. Your doctor may then ask you to relax while they control the movement of your arm (passive range of motion).

Frozen shoulder affects both active and passive range of motion. An anesthetic is sometimes injected during these examinations to better determine one’s range of motion.

If the signs and symptoms evaluated during your physical exam are not enough to diagnose frozen shoulder, then an MRI or X-ray may be needed. Going through image testing will help rule out other potential causes of shoulder pain.

Treatment and Prevention

If you have diabetes and frozen shoulder, one of the first steps in treatment should be getting your blood sugar levels under control. Since chronic high blood sugar levels are a contributing factor to this condition, you must do whatever is necessary to keep your blood sugar in range.

Beyond this, most treatments involve preserving as much range of motion as possible while also minimizing pain.

Medications, such as ibuprofen or aspirin, can be given to help relieve some pain and reduce inflammation. Your doctor may be able to prescribe stronger medication if over-the-counter medicines do not work.

When it comes to recovering your mobility, physical therapy is crucial. A physical therapist can teach you various exercises that you can do at home to improve your range of motion. Most of these exercises can be done without needing equipment. Consistently performing these exercises is crucial if you want to regain mobility in your shoulder.

Frozen shoulder will most often resolve on its own after about 12-18 months. However, if farther treatment is still needed, then there are other procedures.

One such procedure is the injection of steroids. Corticosteroid injections into the shoulder joint help with the pain and also improve mobility. It is important to mention that steroid injections can have negative effects on your blood sugar levels if you have diabetes and frozen shoulder. Therefore, this treatment option is not highly recommended, especially if you have struggled to get your glucose levels under control.

Joint distension and shoulder manipulation are other treatment methods that help stretch and loosen the tissue around the shoulder joint. Beyond this is surgery. Surgery is typically not needed but might be suggested if no other treatments have worked.

Conclusion

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