Long-term complications of diabetes may include changes in connective tissue that occur as a result of high glucose levels. One such condition is adhesive capsulitis, commonly referred to as frozen shoulder. This pathological condition of the shoulder joint causes a gradual loss of motion, typically affecting just one shoulder.
Prevalence and Causes
Adhesive capsulitis (AC) has a prevalence of approximately 2% in the general population, but it is reported to occur in 10% to 29% of individuals with diabetes. Research indicates that the condition is associated with the glycosylation of collagen within the shoulder joint, which is triggered by elevated blood sugar levels. This process leads to inflammation and joint stiffness. Another related condition is Dupuytren’s Contracture, which affects the palms and fingers, illustrating the broader impact of diabetes on connective tissues.
Stages of Adhesive Capsulitis
| Stage | Duration | Description | Treatment Goals |
|---|---|---|---|
| Stage 1: Initialization | 0 to 3 months | Characterized by pain and a reduced range of motion (ROM). Individuals may notice difficulty performing tasks such as combing their hair or reaching for items on high shelves. Pain is often achy, particularly at rest or during the night. Arthroscopy may reveal joint changes and inflammation. | Treatment focuses on reducing pain and inflammation using nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and implementing range-of-motion exercises. |
| Stage 2: Freezing | 3 to 9 months | Presents with chronic pain and further reduced ROM. This stage transitions from inflammation to a fibrotic process. X-rays may show decreased joint space. | Treatments may include NSAIDs and corticosteroid injections to manage pain and inflammation. |
| Stage 3: Frozen | 9 to 14 months | Characterized by minimal pain but significant limitations in shoulder motion. The shoulder becomes markedly stiff, and the loss of ROM is substantial. While the painful phase may resolve on its own, stiffness often persists. | Treatment options may involve surgical intervention, manipulation, aggressive stretching, and a structured home exercise program to restore ROM. |
| Stage 4: Thawing | 15 to 24 months | Marked by minimal pain and progressive improvement in ROM. Active fibroplasia in the shoulder subsides, and individuals can begin to recover ROM through strength and conditioning exercises. | Focus on rehabilitation through strength and conditioning exercises to regain full shoulder function. |
Importance of Early Detection
Early detection, proper staging, and appropriate treatment are crucial for individuals with diabetes to avoid the painful and disabling consequences of adhesive capsulitis. Individuals experiencing shoulder pain or stiffness should consult a healthcare professional for evaluation and tailored treatment options.
For additional information, refer to “Clinical Appearance and Treatment of Adhesive Capsulitis in Diabetes” by J. MacGillvray, MD, and M. Drakos, BA, in Practical Diabetology, June 2001.
Contact Information
By Paul Schickling, RPh, CDE, and John Walsh, PA, CDE
Paul Schickling, RPh, CDE, can be reached at:
Diabetes Wisdom, Inc.1107 E. Chapman, Ste. 206,
Orange, CA 92866