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Dear Diabetes: Frozen Shoulder

Understanding “frozen shoulder”

Dear Diabetes: I’ve heard about something called diabetic frozen shoulder. What is it?

Ask the average person what parts of the body diabetes might affect, and chances are that shoulders will not be at the top of the list. But it actually turns out that diabetes and shoulders may be more closely linked than you might think.

Both type 1 and type 2 diabetes have been associated with a puzzling condition called “frozen shoulder,” in which the shoulder becomes so stiff and immobilized that it can be difficult to even button a shirt. Also known as adhesive capsulitis, frozen shoulder affects a disproportionate number of people living with diabetes: An estimated twenty percent of people with type 1 or type 2 diabetes will develop it, compared to an estimated five percent of the population at large.

So far, no connection has been proven between hemoglobin A1C levels and more frequent occurrence of frozen shoulder among people living with diabetes. Nor does anyone know exactly why diabetes increases the risk for frozen shoulder – though according to the American Diabetes Association, it may have to do with the fact that glucose (sugar) molecules can adhere to collagen, which is one of the building blocks of your ligaments and tendons, and helps to hold your bones together in a joint. In people who are living with diabetes, the theory is that this adhesion “can contribute to abnormal deposits of collagen in the cartilage and tendons of the shoulder. The buildup then causes the affected shoulder to stiffen up.”

Regardless of its cause, frozen shoulder has three distinct phases. During the initial inflammatory stage (the “freeze”), you might experience increasing pain in your shoulder as your range of motion decreases – a process that could last anywhere from a few weeks to ten months. It’s a dull and aching pain that could feel worse when you move your arm. Also, unlike other injuries like rotator cuff tears, frozen shoulder may impede both your active and passive range of motion – meaning that it would be as difficult for someone else to move your arm as it is for you to do it yourself.

Next would come the “frozen” phase: Once inflammation has subsided and scar tissue has formed, you could experience less pain, but your shoulder might be extremely stiff, and daily activities may become difficult. It is during this period that the ligaments shorten and do not stretch, thereby decreasing mobility in your shoulder. This can last from two to six months.

And then finally, like spring after a long winter, your shoulder will usually “thaw” – the ligaments will start to stretch and, while the process may be painful and slow, you may eventually regain some of your range of motion. This recovery process can take between one and nine months.

Add it all up, and frozen shoulder can take up to two years to resolve. “That’s why it’s important for those living with diabetes to be educated about their increased risk,” says Steve Petersen, MD, co-director of the Division of Shoulder Surgery, Department of Orthopaedic Surgery at Johns Hopkins Medicine.

According to Dr. Petersen, “if you notice inflammation, pain and/or decreased range of motion in your shoulder without any specific cause, visit your doctor. He or she may order x-rays to rule out other conditions, but don’t be afraid to bring up the correlation between diabetes and frozen shoulder to your primary care physician.”

“Once diabetic frozen shoulder has been diagnosed,” adds Dr. Petersen, “The goal of treatment is to shorten the natural length of the condition.”

It may be frustrating not to be able to prevent frozen shoulder, but knowing your risk may improve the likelihood of a speedy recovery. “This is just another one of those things that can occur with diabetes,” says Dr. Petersen. “The better educated you are about it, the better treatment you may get.”

© 2013 The DX: The Diabetes Experience

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