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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Musculoskeletal complications of diabetes include carpal tunnel syndrome, Dupuytren contracture, adhesive capsulitis, and sclerodactyly. Carpal tunnel syndrome is compression of the median nerve along its course through the carpal tunnel in the wrist. Dupuytren contracture is progressive contracture of the palmar fascial bands, resulting in finger flexion deformities. Adhesive capsulitis is commonly known as frozen shoulder, associated with shoulder pain and stiffness. Sclerodactyly is a localized thickening and tightness of the skin on the fingers or toes.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Painful shoulder – can be due to several causes. Frozen shoulder is a clinical diagnosis and imaging is not normally required. Impingement (pressure on the supraspinatus tendon in the tunnel above the humeral head and below the acromion process of the scapula/acromioclavicular joint [ACJ]) is also a clinical diagnosis, but imaging is used to assess the extent of swelling and inflammation of the tendon and any tendon tears. Ultrasound is the first-line investigation for this, with MRI used for cases of uncertainty or where the clinical and ultrasound findings are discordant. Plain radiographs are useful to show the bony anatomy if only ultrasound has been performed, and to assess tendon calcification in calcific tendonitis.
Upper limb
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Frozen shoulder is characterised by the onset of severe pain and may follow minor trauma. The differential diagnosis includes infection, fractures and rotator cuff tears. Initially there is severe pain but this improves with time. However, there is global loss of active and passive movement, limited by pain. The pathognomonic sign is loss of external rotation active. Radiographs are normal and distinguish it from the other condition that can globally and painfully affect shoulder movement: osteoarthritis.
Physiotherapy treatment of the diabetic shoulder: health-related quality of life and measures of shoulder function regarding patients with type 1 diabetes
Published in Disability and Rehabilitation, 2019
Maria Kyhlbäck, Anne Söderlund, Tomas Thierfelder, Gunilla Elmgren Frykberg
The aetiology of diabetes-associated peri-articular disorders is not yet fully understood, but connective tissue disturbance, neuropathy, vasculopathy, or combinations of these, may be possible explanatory mechanisms. The alterations in connective tissue may influence conditions, such as shoulder capsulitis, limited joint motion, and Dupuytren’s disease [5]. Long-standing hyperglycaemia leads to non-enzymatic glycosylation. This implies that glucose binds to proteins and forms advanced glycosylation end-products, which can damage the cells and disturb their function by changing the properties of intra-cellular proteins and extra-cellular matrix substances [14]. This leads to an increased number of cross-bindings in soft tissue collagen, and also to an excessive accumulation of collagen [5]. Hand et al. [15] have performed histological analysis regarding frozen shoulder tissue and observed the presence of proliferating fibroblasts and chronic inflammatory cells.
Upper extremity impairments in type 1 diabetes with long duration; common problems with great impact on daily life
Published in Disability and Rehabilitation, 2019
Kerstin Gutefeldt, Christina A. Hedman, Ingrid S. M. Thyberg, Margareta Bachrach-Lindström, Hans J. Arnqvist, Anna Spångeus
The first part of the questionnaire, which was constructed from our group, focused on background data including medical history (including co-morbidities such as coeliac disease and previous cardiovascular events), demographic data, smoking habits, occupation, current sick leave, physical activity and questions on diabetic complications. This part also included questions regarding upper extremity impairments and previous surgery for carpal tunnel syndrome or trigger finger. By combining the symptoms of shoulder pain and stiffness, we made a proxy variable called “shoulder impairment” which is suggestive of frozen shoulder (adhesive capsulitis). In the analysis, a variable for cardiovascular disease (CVD) was created and was defined as individuals with previous myocardial infarction, stroke or angina pectoris. Smoking was defined as individuals with ongoing smoking.
Defining subgroups of patients with a stiff and painful shoulder: an analytical model using cluster analysis
Published in Disability and Rehabilitation, 2021
“Frozen shoulder” and “adhesive capsulitis” are commonly used as diagnostic labels to refer to patients with essentially the same clinical presentation: a stiff and painful shoulder. The lack of specificity of these diagnostic labels has resulted in confusion in adequately defining and effectively treating this group of patients. Regardless of the diagnosis label used, these patients are commonly referred to physical therapy for treatment [1–5]. While clinicians and authors often use the terms interchangeably, some have suggested that there is a need to differentiate the general condition (frozen shoulder) from the more specific condition (adhesive capsulitis) [6].