Greetings from Spinalogy Clinic!!
We all know that 14th November is celebrated as children’s day across our country. But this day co-insides with another important day worldwide, its World Diabetes Day. Globally statistical analysis shows that as of 2012, an estimated 346 million people have diabetes.
We all are familiar with the term ‘Diabetes’ or ‘the sweet disease ’. But still just a short review regarding diabetes is that, it is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Hyperglycemia (raised blood sugar level in body) is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
This article mainly focuses on diabetes and its associated musculoskeletal problems. Now the question is how diabetes affects musculoskeletal system? It’s because the cells in the body can’t absorb the glucose (sugar) either because the pancreas don’t make any insulin or body doesn’t use the insulin efficiently. Insulin is the catalyst (inter-mediator) that allows cells to absorb the sugar. What makes person with diabetes tired is that the cells that aren’t absorbing the sugar are starving from the lack of sugar and they release toxins called Ketones, which ultimately affects the muscle work.
One such common musculoskeletal problem in diabetes is ‘FROZEN SHOULDER’. Now how many of you exactly know what is frozen shoulder??? Lets us be aware of this condition. Frozen shoulder, also known as “Adhesive Capsulitis”, is the inflammation of structures in and around shoulder joint causing pain and stiffness in the shoulder. Over a period of time, the shoulder becomes very hard to move.
There are three stages of frozen shoulder.
First one is the stage of Freezing. In the “freezing” stage, you slowly and gradually develop pain. As the pain increases, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
Second stage is Frozen. Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities (grooming, dressing and personal care) may be very difficult.
Third is stage Thawing, in which shoulder movements slowly improves. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.
Once diagnosed with diabetes, the incidence for occurrence of frozen shoulder increases, affecting 10% to 20% of these individuals. Women are more prone to develop frozen shoulder than men, and frozen shoulder occurs most frequently in people between the ages of 40 and 60. It usually affects only one shoulder at a time, and due to unknown reason, the non-dominant shoulder is affected most often.
Now one might be wondering what is the reason for this increased incidence of frozen shoulder in diabetes…one theory explains the involvement of collagen, one of the building blocks of ligaments and tendons in the human body. Collagen is a major part of the ligaments that hold the bones together in a joint. Glucose (sugar) molecules get attached to collagen. This can contribute to abnormal deposits of collagen in the cartilage and tendons of the shoulder. This deposition then causes the affected shoulder with pain and loss of movements.
Regular exercises are very essential for the proper functioning of the systems in body of a diabetic person. The main part is to prevent such consequences of diabetes to the shoulder joint. Regular exercises to the shoulder like normal shoulder movements, such as forward movement of arm, backward movement, and sideways movement should be performed. General shoulder stretching exercises and pendular exercises are very beneficial to improve movements of affected shoulder. Some of the important shoulder exercises are listed below:
- Pendular exercises-
- Forwards and backwards movement.
- Side-to-side movements.
- Circular movements- clockwise and anti-clockwise
2. Shoulder blade squeeze exercise.
3. Shoulder flexion and extension exercises(forward and backward movement)
4. Shoulder flexion exercise in lying down
These are few of the important exercises which one can do when diagnosed with frozen shoulder. But it is necessary to initiate these exercises after pain /inflammation reduction, and under proper guidance.
Slight experience of pain in shoulder joint in diabetes which persists for more then two or three days, immediately consult Orthopedician and Physiotherapist at the earliest to prevent the consequences. Hope the information is sufficient to explain the need of protecting shoulder in diabetes.
Vipin banugade (MPT)
Dr. Kiran Shete
MS (Ortho), DNB, F.ASIF (Swiss), MNAMS, PGP (ISB)
Founder and Chief Medical Director