Musculoskeletal complications in diabetes mellitus
- Lesley D Hordon, MD
Lesley D Hordon, MD
- Consultant in Rheumatology
- University of Leeds, United Kingdom
- Section Editors
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
A variety of musculoskeletal conditions have been associated with diabetes mellitus (table 1). These problems are important to recognize because they often respond to treatment, preventing pain and disability and improving quality of life. Specific arthropathies of the hand and shoulder are discussed in this review. The relationships of diabetes with osteoarthritis and gout have become more clear, and the data that bear on the associations are also briefly mentioned. Osteoarthritis and neck and shoulder disorders have a significant impact on the quality of life in people with type 2 diabetes .
Estimates of the prevalence of musculoskeletal problems in patients with diabetes mellitus vary depending upon the definitions used for the problems and the study population with diabetes, which can range from diabetics on an insurance database to primary care cohorts and patients with severe diabetes in a specialized referral setting.
There are several other musculoskeletal complications of diabetes mellitus which are discussed separately. These include limited joint mobility, neuropathic arthropathy (eg, Charcot joint), bone disease, and diabetic muscle infarction. (See "Limited joint mobility in diabetes mellitus" and "Diabetic neuropathic arthropathy" and "Bone disease in diabetes mellitus" and "Diabetic muscle infarction".)
Hand abnormalities are common in diabetic patients, reflecting pathologic changes in the microvasculature, connective tissue, and peripheral nerves. One study, for example, evaluated 100 diabetic patients selected randomly in an outpatient clinic. Hand abnormalities were observed in 50 patients, and more than one abnormality was found in 26 . Furthermore, 25 of the 50 patients with hand syndromes were disabled to such an extent that surgery was recommended. Carpal tunnel syndrome, Dupuytren's contracture, flexor tenosynovitis, and limited joint mobility were each present in approximately 20 percent .
In a study of 200 patients with type 1 or type 2 diabetes and 100 controls, the prevalence of hand or shoulder disorders was higher in the diabetic patients than in controls and correlated with the duration, but not the type, of diabetes .
- Adriaanse MC, Drewes HW, van der Heide I, et al. The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Qual Life Res 2016; 25:175.
- Gamstedt A, Holm-Glad J, Ohlson CG, Sundström M. Hand abnormalities are strongly associated with the duration of diabetes mellitus. J Intern Med 1993; 234:189.
- Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM. Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. Am J Med 2002; 112:487.
- Chaudhuri KR, Davidson AR, Morris IM. Limited joint mobility and carpal tunnel syndrome in insulin-dependent diabetes. Br J Rheumatol 1989; 28:191.
- Phalen GS. Reflections on 21 years' experience with the carpal-tunnel syndrome. JAMA 1970; 212:1365.
- BLODGETT RC Jr, LIPSCOMB PR, HILL RW. Incidence of hematologic disease in patients with carpal tunnel syndrome. JAMA 1962; 182:814.
- Gulliford MC, Latinovic R, Charlton J, Hughes RA. Increased incidence of carpal tunnel syndrome up to 10 years before diagnosis of diabetes. Diabetes Care 2006; 29:1929.
- Pourmemari MH, Shiri R. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med 2016; 33:10.
- Thomsen NO, Cederlund R, Rosén I, et al. Clinical outcomes of surgical release among diabetic patients with carpal tunnel syndrome: prospective follow-up with matched controls. J Hand Surg Am 2009; 34:1177.
- Thomsen NO, Rosén I, Dahlin LB. Neurophysiologic recovery after carpal tunnel release in diabetic patients. Clin Neurophysiol 2010; 121:1569.
- Thomsen NO, Cederlund RI, Andersson GS, et al. Carpal tunnel release in patients with diabetes: a 5-year follow-up with matched controls. J Hand Surg Am 2014; 39:713.
- Sibbitt WL. Fibrosing syndromes: diabetic stiff hand syndrome, Dupuytren's contracture and plantar fasciitis. In: Arthritis and Allied Conditions, 11th Edition, McCarty DJ (Ed), Lea & Febiger, Philadelphia 1989.
- Noble J, Heathcote JG, Cohen H. Diabetes mellitus in the aetiology of Dupuytren's disease. J Bone Joint Surg Br 1984; 66:322.
- Yosipovitch G, Yosipovitch Z, Karp M, Mukamel M. Trigger finger in young patients with insulin dependent diabetes. J Rheumatol 1990; 17:951.
- Vance MC, Tucker JJ, Harness NG. The association of hemoglobin A1c with the prevalence of stenosing flexor tenosynovitis. J Hand Surg Am 2012; 37:1765.
- Kameyama M, Meguro S, Funae O, et al. The presence of limited joint mobility is significantly associated with multiple digit involvement by stenosing flexor tenosynovitis in diabetics. J Rheumatol 2009; 36:1686.
- Kapoor A, Sibbitt WL Jr. Contractures in diabetes mellitus: the syndrome of limited joint mobility. Semin Arthritis Rheum 1989; 18:168.
- Jelinek JE. The skin in diabetes. Diabet Med 1993; 10:201.
- Seibold JR. Digital sclerosis in children with insulin-dependent diabetes mellitus. Arthritis Rheum 1982; 25:1357.
- Kozin F. Painful shoulder and the reflex sympathetic dystrophy syndrome. In: Arthritis and Allied Conditions, 11th, McCarty DJ (Ed), Lea and Febiger, Philadelphia 1989.
- Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus. Br J Rheumatol 1986; 25:147.
- Balci N, Balci MK, Tüzüner S. Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications. J Diabetes Complications 1999; 13:135.
- Thomas SJ, McDougall C, Brown ID, et al. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg 2007; 16:748.
- Ramchurn N, Mashamba C, Leitch E, et al. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med 2009; 20:718.
- Lequesne M, Dang N, Bensasson M, Mery C. Increased association of diabetes mellitus with capsulitis of the shoulder and shoulder-hand syndrome. Scand J Rheumatol 1977; 6:53.
- Mavrikakis ME, Sfikakis PP, Kontoyannis SA, et al. Clinical and laboratory parameters in adult diabetics with and without calcific shoulder periarthritis. Calcif Tissue Int 1991; 49:288.
- Huang YP, Fann CY, Chiu YH, et al. Association of diabetes mellitus with the risk of developing adhesive capsulitis of the shoulder: a longitudinal population-based followup study. Arthritis Care Res (Hoboken) 2013; 65:1197.
- Morén-Hybbinette I, Moritz U, Scherstén B. The clinical picture of the painful diabetic shoulder--natural history, social consequences and analysis of concomitant hand syndrome. Acta Med Scand 1987; 221:73.
- Fisher L, Kurtz A, Shipley M. Association between cheiroarthropathy and frozen shoulder in patients with insulin-dependent diabetes mellitus. Br J Rheumatol 1986; 25:141.
- Mehta SS, Singh HP, Pandey R. Comparative outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. Bone Joint J 2014; 96-B:1355.
- Koorevaar RC, Van't Riet E, Ipskamp M, Bulstra SK. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study. Arch Orthop Trauma Surg 2017; 137:293.
- Hochberg MC. Epidemiology of osteoarthritis: current concepts and new insights. J Rheumatol Suppl 1991; 27:4.
- Forgács SS. Diabetes mellitus and rheumatic disease. Clin Rheum Dis 1986; 12:729.
- Horn CA, Bradley JD, Brandt KD, et al. Impairment of osteophyte formation in hyperglycemic patients with type II diabetes mellitus and knee osteoarthritis. Arthritis Rheum 1992; 35:336.
- Gibson N, Guermazi A, Clancy M, et al. Relation of hand enthesophytes with knee enthesopathy: is osteoarthritis related to a systemic enthesopathy? J Rheumatol 2012; 39:359.
- Nieves-Plaza M, Castro-Santana LE, Font YM, et al. Association of hand or knee osteoarthritis with diabetes mellitus in a population of Hispanics from Puerto Rico. J Clin Rheumatol 2013; 19:1.
- Schett G, Kleyer A, Perricone C, et al. Diabetes is an independent predictor for severe osteoarthritis: results from a longitudinal cohort study. Diabetes Care 2013; 36:403.
- Eymard F, Parsons C, Edwards MH, et al. Diabetes is a risk factor for knee osteoarthritis progression. Osteoarthritis Cartilage 2015; 23:851.
- Velasquez MT, Katz JD. Osteoarthritis: another component of metabolic syndrome? Metab Syndr Relat Disord 2010; 8:295.
- Courties A, Sellam J. Osteoarthritis and type 2 diabetes mellitus: What are the links? Diabetes Res Clin Pract 2016; 122:198.
- Choi HK, De Vera MA, Krishnan E. Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile. Rheumatology (Oxford) 2008; 47:1567.
- Kim SC, Liu J, Solomon DH. Risk of incident diabetes in patients with gout: a cohort study. Arthritis Rheumatol 2015; 67:273.
- Krishnan E, Pandya BJ, Chung L, et al. Hyperuricemia in young adults and risk of insulin resistance, prediabetes, and diabetes: a 15-year follow-up study. Am J Epidemiol 2012; 176:108.
- HAND ABNORMALITIES
- Carpal tunnel syndrome
- Limited joint mobility
- Flexor tenosynovitis
- Diabetic sclerodactyly
- Reflex sympathetic dystrophy
- SHOULDER PAIN
- DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS
- NEUROPATHIC ARTHROPATHY
- BONE DISEASE
- DIABETIC MUSCLE INFARCTION
- INFORMATION FOR PATIENTS