Diabetes at mga Kondisyon sa Upper-Limb Impormasyon

Ang iyong nararamdaman

Kung ikaw ay may diabetes at nagsimulang sumakit ang iyong balikat o kamay, hindi ka nag-iisa. Ang pananakit at paninigas ng balikat ay karaniwan sa mga adult na may diabetes, at madalas itong dahan-dahang lumalabas sa halip na pagkatapos ng isang pinsala. Ang sakit ay madalas na nararamdaman nang malalim sa balikat at lumalala sa loob ng ilang linggo. Ang pag-abot sa itaas, pagsasampay ng labada, o pagbuhat ng kettle ay maaaring maging mas mahirap. Madalas na pinakamalala ito sa gabi, at ang paghiga sa panig na iyon ay maaaring magpagising sa iyo.

Maaari ring makaramdam ng paninigas sa iyong balikat. Ang pagpihit ng iyong braso upang kamutin ang iyong likod o abutin ang bulsa sa likuran ay nagiging mahirap. Maaaring maapektuhan ang parehong balikat, bagaman ito ay hindi gaanong karaniwan. Ang frozen shoulder, kung saan humihigpit ang lining ng joint at nililimitahan ang paggalaw, ay mas madalas mangyari sa mga taong may diabetes kaysa sa mga taong wala nito.

Maaari ring maapektuhan ang iyong mga kamay. Ang diabetes ay nauugnay sa ilang mga problema sa kamay: trigger finger, kung saan ang daliri ay sumasabit o nagla-lock habang ibinabaluktot ito; Dupuytren's contracture, kung saan ang mga cords sa palad ay humihila sa mga daliri patungo rito; carpal tunnel syndrome, na nagdudulot ng pangingilig at pamamanhid sa mga daliri; at limited joint mobility, kung saan ang paninigas ng mga joint ng daliri ay nagpapahirap sa paglalapat ng iyong palad nang patag sa mesa. Ang mga problemang ito ay madalas na lumalabas nang sunod-sunod sa paglipas ng panahon, kaya maaaring bumalik ka para sa mga isyu sa kamay nang higit sa isang beses.

Mas malamang din ang mga impeksyon sa kamay kapag ikaw ay may diabetes, at maaari itong maging mas seryoso. Higit sa isang ikatlo ng mga pasyente sa isang clinical series ng mga impeksyon sa kamay ay may diabetes. Kung ang iyong blood sugar levels ay nananatiling mataas, ang mga impeksyon ay maaaring maging mas malala at mas mabagal gumaling.

Ang paninigas sa mga joint ng iyong daliri ay may tendensiyang lumala nang unti-unti habang tumatagal ang pagkakaroon mo ng diabetes, at ang mga finger contracture ay karaniwang lumalabas lamang pagkatapos ng siyam na taon o higit pa. Kung ang iyong balikat ay naging masakit at matigas nang dahan-dahan, nang walang malinaw na pinsala, mahalagang banggitin ang iyong diabetes sa iyong doktor, dahil ang dalawang ito ay maaaring magkakaugnay.

Ano ang aktwal na nangyayari

Ang mataas na blood sugar ay hindi lamang nakakaapekto sa iyong mga blood vessel at nerve. Sa paglipas ng panahon, binabago nito ang mga tissue na humahawak sa iyong mga joint at nagpapahintulot sa mga ito na dumulas nang maayos. Sa iyong balikat, ang joint ay nababalot ng isang stretchy lining, na parang isang maluwag na sleeve sa paligid ng joint. Kapag may diabetes, ang sleeve na iyon ay maaaring mamaga at pagkatapos ay humigpit at umikli. Kapag ito ay lumiit, nababawasan ang espasyo para gumalaw ang iyong braso, kaya nagiging mahirap at masakit ang pag-abot pataas o sa likod ng iyong likod.

Sa iyong mga kamay, ang parehong proseso ay nakakaapekto sa maliliit na tunnel at cord na gumagabay sa mga tendon ng iyong daliri. Ang tendon ay isang matibay na lubid ng mga fibre na nag-uugnay ng muscle sa buto, at dumudulas ito sa isang masikip na tunnel sa tuwing ibabaluktot mo ang isang daliri. Kung kumapal ang lining ng tunnel, sumasabit ang lubid habang dumudulas, at ang daliri ay nag-ki-click o nagla-lock. Maaari ring mabuo ang mga makakapal na cord sa palad at hilahin ang daliri upang mabukok, at ang nerve sa iyong wrist ay maaaring maipit kung saan ito dumadaan sa isang makitid na channel.

Mayroong malinaw na pattern dito. Ang diabetes ay nauugnay sa frozen shoulder, trigger finger, Dupuytren's contracture, carpal tunnel syndrome at limitadong joint mobility. Ang mga ito ay hindi limang magkakahiwalay na malas na pangyayari. Mayroon silang iisang sanhi: ang parehong mataas na sugar levels na sumisira sa connective tissue sa buong iyong katawan. Iyon ang dahilan kung bakit ang mga problemang ito ay madalas na lumalabas nang sunod-sunod, at kung bakit ang parehong balikat o ilang daliri ay maaaring maapektuhan sa paglipas ng panahon.

Ipinapaliwanag din nito kung bakit magtatanong ang iyong doktor tungkol sa iyong diabetes kapag may lumitaw na problema sa balikat o kamay. Ang koneksyon ay gumagana sa dalawang direksyon: ang isang masakit at matigas na balikat na walang pinsala sa likod nito ay maaari kung minsan na maging unang senyales na ang blood sugar ay naging mataas. Ang pag-alam dito ay humuhubog sa plano, mula sa mga test na gagawin hanggang sa kung paano pinamamahalaan ang iyong blood sugar sa paligid ng anumang treatment.

Ano ang maaari nating gawin tungkol dito

Ang unang hakbang ay karaniwang ang pinakasimple. Ang banayad na paggalaw at physiotherapy ay naglalayong panatilihing kasing-mobile hangga't maaari ang joint at mga tendon, at upang palakasin ang mga kalamnan sa paligid nito. Ang approach na ito ay pinaka-epektibo kapag nagsimula nang maaga, bago pa man maging stiff ang joint. Bigyan ito ng sapat na pagkakataon sa loob ng ilang linggo bago magpasya kung ito ay nakakatulong. Mahalaga rin dito ang pagpapanatili ng iyong blood sugar sa tamang range, dahil ang mataas na levels ang nagtutulak sa mga pagbabago sa tissue na sanhi ng mga problemang ito.

Kung hindi sapat ang self-management, may mga medical options. Ang anti-inflammatory medicine ay maaaring magpakalma ng sakit at pamamaga. Ang mga corticosteroid injection, na mga anti-inflammatory medicine na direktang inilalagay sa masakit na bahagi, ay makakatulong din, ngunit may kaakibat itong trade-off kung ikaw ay may diabetes. Maaari nitong itaas ang iyong blood sugar sa loob ng maikling panahon pagkatapos, at ang pagtaas ay mas malaki at mas matagal kung ang iyong HbA1c (isang sukat ng iyong average blood sugar sa mga nakaraang buwan) ay 7% o mas mataas pa. Kung gumagamit ka ng insulin o sinusuri ang iyong sugar sa bahay, magplano para sa mas masusing monitoring pagkatapos ng anumang injection. May mga iba pang opsyon sa injection na walang ganitong epekto, at maaaring talakayin ng iyong doktor kung alin ang angkop para sa iyo.

Kung malala ang mga sintomas at nakakaabala pa rin sa iyo sa kabila ng mga nabanggit sa itaas, maaaring i-refer ka ng iyong doktor para sa isang specialist assessment. Para sa ilang partikular na kondisyon, maaaring isaalang-alang ang isang procedure paminsan-minsan. Ang mabuting balita ay para sa ilan sa mga problemang ito, ang mga taong may diabetes ay kasing-husay ng mga taong walang diabetes pagdating sa resulta. Ang carpal tunnel release, ang operasyon na nagpapalaya sa naipit na nerve sa iyong wrist, ay nagbibigay ng parehong pangmatagalang ginhawa may diabetes ka man o wala. Para sa frozen shoulder, ang treatment ay naglalayong ibalik ang paggalaw, at ang mga opsyon ay mula sa banayad na paggalaw ng shoulder habang ikaw ay tulog hanggang sa pagpapalaya ng tight lining sa pamamagitan ng keyhole surgery. Maaari itong maging epektibo, bagaman ang recovery ay maaaring mas matagal kapag may diabetes at maaaring manatili ang ilang stiffness. Para sa trigger finger, isang maliit na release procedure ang maaaring gawin sa pamamagitan ng balat gamit ang karayom, at ito ay ligtas na gumagana nang pantay sa mga taong may at walang diabetes. Susuriin din ng iyong doktor ang blood supply sa iyong kamay bago ang anumang surgery, dahil ang mga makikitid na vessel ay maaaring makaapekto sa paggaling. Anuman ang imungkahi, tapat kang sasabihan kung paano binabago ng diabetes ang plano, ang recovery, at kung ano ang dapat asahan pagkatapos.

Ano ang dapat asahan

Ang tapat na sagot ay binabago ng diabetes ang bilis ng paggaling nang higit pa kaysa sa hantungan nito. Para sa carpal tunnel syndrome, ang mga taong may diabetes ay nakakakuha ng parehong pangmatagalang ginhawa mula sa operasyon gaya ng mga taong wala nito, at ang pagbuting iyon ay nananatili sa paglipas ng mga taon. Para sa trigger finger, ang needle release ay gumagana nang kasing-ligtas at kasing-epektibo mayroon ka man o walang diabetes.

Ang frozen shoulder ang isa kung saan ang diabetes ay nagdudulot ng tunay na pagkakaiba. Pagkatapos ng keyhole surgery upang paluwagin ang masikip na lining, ang mga resulta sa mga taong may diabetes ay mas malala sa loob ng anim na buwan kaysa sa mga taong wala nito, at may tendensiyang may pananatili pa ring ilang paninigas pagkalipas ng dalawang taon. Ang isang opsyon, ang dahan-dahang paggalaw ng balikat habang ikaw ay natutulog, ay hindi gumagana para sa humigit-kumulang isang katlo ng mga taong may diabetes sa unang pagkakataon, at maaaring kailangang ulitin kung bumalik ang paninigas. Sa tamang counselling at pahintulot, maaari pa rin itong maging isang workable na plano. Kapag ang balikat ay maaaring mapagalaw sa pamamagitan ng gentle manipulation, ang mga outcome ay naging kasiya-siya para sa mga taong mayroon at walang insulin dependence. Ang keyhole release mismo ay naghatid ng mabubuting outcome sa paggalaw, paginhawa sa sakit, at function ng balikat para sa mga taong mayroon at walang diabetes.

May ilang mga bagay na mahalagang malaman bago ang lahat ng ito. Ang mga taong may diabetes ay may tendensiyang magkaroon ng mas maraming sintomas bago at pagkatapos ng carpal tunnel surgery, ngunit ang relative improvement mula sa operasyon ay pareho lang. Kung gaano ka na katagal may diabetes at kung paano ito ginamot ay maaaring may kaugnayan sa kung gaano kalala ang iyong mga sintomas pagkatapos ng carpal tunnel release. Walang mahigpit na cutoff para sa blood sugar control bago ang elective hand surgery, bagaman gugustuhin ng iyong team na maayos na mapamahalaan ang iyong diabetes sa paligid ng anumang procedure. Kung ang problema sa iyong balikat o kamay ay malala, o kung may katanungan sa blood supply sa iyong kamay, maaaring mag-ayos ang iyong doktor ng detalyadong imaging ng mga vessel bago magdesisyon sa operasyon.

Ano ang tendensiyang mangyari kung hahayaan lang ang mga problemang ito? Ang paninigas, lalo na sa mga daliri, ay unti-unting lumalala habang tumatagal ang pagkakaroon mo ng diabetes. Ang paninigas ng balikat ay maaaring magpatuloy nang walang gamutan. Ang maagang paggalaw at pagpapanatili ng iyong blood sugar sa range ang nagbibigay sa iyo ng pinakamahusay na pagkakataon na maiwasan ang landas na iyon.

Kailan dapat magpatingin

Magpatingin sa iyong GP kung ang problema sa balikat o kamay ay pabalik-balik, lalo na kung mayroon kang diabetes o kung mataas ang iyong blood sugar. Ang mga impeksyon sa kamay ay nangangailangan ng mabilis na atensyon. Kung ang kamay ay naging masakit, mapula, namamagâ o mainit, ipasuri ito agad, dahil ang mga impeksyon sa mga taong may diabetes ay maaaring mas malubha at mas mabagal gumaling. Pumunta sa emergency department kung ang impeksyon ay kumakalat, kung nakararamdam ka ng lagnat o hindi mabuti ang pakiramdam, o kung ang kamay o daliri ay mabilis na lumalala. Humingi ng pagsusuri ng isang espesyalista kung ang balikat ay naging masakit at naninigas nang dahan-dahan nang walang anumang pinsala, o kung ang paninigas ay pumipigil sa iyo sa pag-abot sa itaas ng iyong ulo o sa likod ng iyong likuran. Ganoon din kung ang isang daliri ay sumasabit o nagla-lock, kung ang pangingilig o pamamanhid sa iyong mga daliri ay nakakaabala sa iyong pagtulog, o kung ang mga naninigas na kasukasuan ng daliri ay nagpapahirap sa mga pang-araw-araw na gawain. Dahil ang mga problemang ito ay madalas na lumilitaw nang sunod-sunod, banggitin din ang anumang mga nakaraang problema sa balikat o kamay.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications [1].
In a study of 36 patients, both shoulders were involved in 4.5 per cent of cases [2].
There was a high incidence of bilateral shoulder involvement in insulin-dependent diabetics [2].
Examination of the hands and shoulders should be included in the evaluation of patients with diabetes [3].
The prevalence of musculoskeletal disorders in people with type 2 diabetes mellitus remains high despite advances in medical management over the last two decades [4].
Diabetes exacerbates the burden of surgical upper-extremity infections [5].
Surgical upper-extremity infections in diabetic patients are characterized by more proximal locations [5].
Surgical upper-extremity infections in diabetic patients are characterized by deeper involved anatomy [5].
Surgical upper-extremity infections in diabetic patients are characterized by broader pathogenic microbiology [5].
Surgical upper-extremity infections in diabetic patients are characterized by an increased need for repeat drainage [5].
Surgical upper-extremity infections in diabetic patients are characterized by a higher risk for amputation [5].
The presence of diabetes mellitus was the most important factor for developing trigger digit after carpal tunnel release [7].
The severity of diabetes mellitus was less important than its presence for developing trigger digit after carpal tunnel release [7].
The prevalence of frozen shoulder is still greater in diabetic patients [14].
The prevalence of frozen shoulder in diabetic patients is less than previously reported [14].
Musculoskeletal hand disorders were prevalent in type 2 diabetes mellitus patients in Jordan [40].

Background & Causes

In 36 patients (4.5 per cent.), both shoulders were involved and there was a high incidence in insulin-dependent diabetics [2].
Diabetes exacerbates the burden of surgical upper-extremity infections, characterized by more proximal locations, deeper involved anatomy, broader pathogenic microbiology, increased need for repeat drainage, and higher risk for amputation [5].
There is continuing gradual deterioration with increasing duration of disease, though finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [6].
The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit [7].
The NIDDM patients did not have an increased rate of complications relative to nondiabetic patients [8].
Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients [9].
Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles [15].
In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome [16].
Type 2 diabetes may be a cause of frozen shoulder but the effect is not supported to be mediated by metabolic health [21].
Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels [33].
Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome [35].
Among patients with diabetes who had CTS, higher RAGE expression was observed in those with more severe disease, suggesting that RAGE-mediated pathways may play a role in the pathophysiology of CTS in patients with diabetes [36].
Molecular and pathological studies provide a potential basis for the predisposition of diabetic patients to the development of CTS [37].
Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic adhesive capsulitis with idiopathic adhesive capsulitis, suggesting that these conditions are distinct clinical entities [38].

Symptoms & Presentation

General Assessment

Moderate correlations between upper and lower extremity range of motion, strength, and function suggest a concurrent development of musculoskeletal complications in people with DM [34].

Shoulder

Shoulder pain and disability are common, and persistent in adults with diabetes [11].
Patients with diabetes mellitus reported shoulder pain and/or disability, with 63% (149/236) indicating such issues and a median SPADI score of 10.0 [13].
The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients [14].
Patients with and without diabetes experienced similar pain except during exertion [17].
Diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases [31].

Hand

Diabetes mellitus is associated with a variety of hand manifestations including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility, which often present with multiple visits for hand conditions over time [20].

Infection

Management

Assessment and Monitoring

Finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [6].
There is continuing gradual deterioration of limited joint mobility with increasing duration of disease [6].

Non-Operative Interventions

Glycemic changes following steroid injection into the shoulder are short-lived, mostly limited to the 2-3 days after the injection, and none of the patients required any change in antidiabetic treatment [29].
Platelet-rich plasma injection is a safe and well-tolerated method for adhesive capsulitis management for diabetic patients [27].
Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed [12].

Operative Interventions

Percutaneous release with or without simultaneous corticosteroid injection for trigger finger is equally effective and safe in diabetics and nondiabetics [26].
Excision of the ulnar slip of the flexor digitorum superficialis with or without A1 pulley release is a safe and effective treatment for stenosing flexor tenosynovitis in the diabetic patient [28].
The best current evidence supports the efficacy of surgical interventions for the management of upper limb conditions in diabetic individuals [10].
Additional research is required to determine whether treatment outcomes for upper limb conditions in diabetics are equivalent to those of nondiabetic patients [10].
Additional research is required to determine whether diabetes is associated with an increased risk of complications in upper limb surgery [10].
Results of arthroscopic release for frozen shoulder in diabetics were significantly worse than those in non-diabetics six months post-operatively [18].
There is a tendency towards persistent limitation of movement two years after arthroscopic release for frozen shoulder in diabetics [18].
When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM [30].
Patients with and without diabetes experienced similar pain except during exertion following frozen shoulder treatment [17].

Vascular Disease and Amputation

Arterial occlusive disease in the distal upper extremity is primarily related to the combination of diabetes, renal disease, and often organ transplantation [25].
An aggressive approach is warranted for patients with critical ischemia of the hand to try and avoid loss of the hand [25].
Arteriography remains the gold standard for most patients with critical ischemia of the hand because proper evaluation requires good visualization of the forearm vessels, palmar arch, and digital vessels [23].
Many patients with critical ischemia due to complications of diabetes and renal disease will have multiple levels of partial occlusion that can be seen in the forearm vessels on arteriography [23].
In patients with factors or injury characteristics that contraindicate single-digit replantation, such as diabetes mellitus, revision amputation is indicated [19].

Key Considerations

Assessment and Prevalence

Pathophysiology and Natural History

Surgical Outcomes and Complications

The best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications [10].
The results in diabetics were significantly worse than those in non-diabetics six months post-operatively with a tendency towards persistent limitation of movement two years after operation [18].
Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes [39].
Patients with diabetes experience more symptoms both before and after open carpal tunnel release, but can expect the same relative improvement from surgery as patients without diabetes [41].

Infections

Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic [42].

Key Evidence

[L3] Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications. [1] (10.1016/j.ejim.2009.08.001)
[L4] In 36 patients (4.5 per cent.), both shoulders were involved and there was a high incidence in insulin-dependent diabetics. [2] (10.1136/ard.31.1.69)
[L3] Examination of the hands and shoulders should be included in the evaluation of patients with diabetes. [3] (10.1016/s0002-9343(02)01045-8)
[L3] The prevalence of musculoskeletal disorders in people with type 2 Diabetes mellitus remains high despite advances in medical management over the last two decades. [4] (10.1016/j.jht.2021.04.013)
[L2] Diabetes exacerbates the burden of surgical upper-extremity infections, characterized by more proximal locations, deeper involved anatomy, broader pathogenic microbiology, increased need for repeat drainage, and higher risk for amputation. [5] (10.1016/j.jhsa.2017.11.003)
[L3] There is continuing gradual deterioration with increasing duration of disease, though finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more. [6] (10.1136/ard.44.2.93)
[L4] The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit. [7] (10.1016/j.jhsa.2013.10.023)
[L2] The NIDDM patients did not have an increased rate of complications relative to nondiabetic patients. [8] (10.1016/j.jhsa.2018.06.006)
[L3] Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. [9] (10.1016/j.jhsa.2014.01.014)
[L4] The best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications. [10] (10.1016/j.jhsa.2011.10.002)
[L4] Shoulder pain and disability are common, and persistent in adults with diabetes. [11] (10.1093/rheumatology/ken333)
[L3] Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed. [12] (10.1007/s10067-003-0704-7)
[L3] Patients with diabetes mellitus reported shoulder pain and/or disability, with 63% (149/236) indicating such issues and a median SPADI score of 10.0. [13] (10.1016/j.physio.2014.07.003)
[L3] The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients. [14] (10.1016/j.jse.2007.02.133)
[L3] Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles. [15] (10.1186/s12891-022-05627-9)
[L4] In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome. [16] (10.3899/jrheum.090239)
[L3] Patients with and without diabetes experienced similar pain except during exertion. [17] (10.1177/0300060516675112)
[L3] The results in diabetics were significantly worse than those in non-diabetics six months post-operatively with a tendency towards persistent limitation of movement two years after operation. [18] (10.1302/0301-620x.96b10.34476)
[L4] Diabetes mellitus is associated with a variety of hand manifestations including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility, which often present with multiple visits for hand conditions over time. [20] (10.1016/j.jhsa.2008.01.038)
[L2] This study suggests that type 2 diabetes may be a cause of frozen shoulder but does not support the hypothesis that the effect is mediated by metabolic health. [21] (10.1186/s12891-025-08672-2)
[L4] Percutaneous release with or without simultaneous corticosteroid injection has shown promising results and is equally effective and safe in diabetics and nondiabetics. [26] (10.1016/j.jhsa.2018.03.045)
[L3] Additionally, it is a safe and well-tolerated method for AC management for diabetic patients. [27] (10.5397/cise.2021.00381)
[L4] This procedure is a safe and effective treatment for the often-difficult problem of stenosing flexor tenosynovitis in the diabetic patient. [28] (10.1007/s11552-007-9065-z)
[L2] These glycemic changes are short-lived, mostly limited to the 2-3 days after the injection, and none of the patients required any change in antidiabetic treatment. [29] (10.1016/j.jseint.2022.05.016)
[L4] When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM. [30] (10.1067/mse.2002.127301)
[L4] However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. [31] (10.1016/j.otsr.2019.02.014)
[L1] Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels. [33] (10.1371/journal.pgen.1009577)
[L4] The moderate correlations between upper and lower extremity range of motion, strength, and function suggest a concurrent development of musculoskeletal complications in people with DM. [34] (10.1016/j.foot.2020.101680)
[L3] Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome. [35] (10.1186/1471-2474-15-346)
[L2] Among patients with diabetes who had CTS, higher RAGE expression was observed in those with more severe disease, suggesting that RAGE-mediated pathways may play a role in the pathophysiology of CTS in patients with diabetes. [36] (10.1097/corr.0000000000003800)
[L4] It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS. [37] (10.1007/s00125-014-3271-3)
[L5] Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. [38] (10.1016/j.jse.2021.06.016)
[L2] Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. [39] (10.1016/j.jhsa.2014.01.012)
[L4] In the present study, musculoskeletal hand disorders were prevalent in T2DM patients in Jordan. [40] (10.1111/1756-185x.12617)
[L3] Patients with diabetes experience more symptoms both before and after open carpal tunnel release, but can expect the same relative improvement from surgery as patients without diabetes. [41] (10.1136/bmjopen-2019-030179)
[L4] Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic. [42] (10.1016/s0749-0712(21)00424-8)

References

[1] Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. European Journal of Internal Medicine. 2009. DOI: 10.1016/j.ejim.2009.08.001

[2] Periarthritis of the shoulder and diabetes mellitus.. Annals of the Rheumatic Diseases. 1972. DOI: 10.1136/ard.31.1.69

[3] Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. The American Journal of Medicine. 2002. DOI: 10.1016/s0002-9343(02)01045-8

[4] Proportion and distribution of upper extremity musculoskeletal disorders and its association with disability in type 2 diabetes mellitus. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2021.04.013

[5] Quantifying the Effect of Diabetes on Surgical Hand and Forearm Infections. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.11.003

[6] Limited joint mobility in diabetes mellitus.. Annals of the Rheumatic Diseases. 1985. DOI: 10.1136/ard.44.2.93

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