Diabetes And Shoulder Pain: What Can You Do?

Diabetes is a chronic condition that can affect many aspects of your life. Unmanaged blood sugar levels can lead to a variety of complications. One of them is a condition called Frozen Shoulder.

Frozen shoulder causes pain and stiffness that reduce your quality of life. Taking control of your blood sugar can help avoid this unpleasant condition and get your range of movement back to normal.

Let's look at the relationship between diabetes and shoulder pain.

What is frozen shoulder?

Frozen shoulder (also called FS or Adhesive Capsulitis) is a condition that affects your shoulder joint. It causes pain and stiffness while limiting your range of motion. Symptoms tend to go away with time. However, it can take several years to achieve full recovery.

The three stages of frozen shoulder are:

1. Freezing – your shoulder starts hurting. As the pain worsens, you start experiencing stiffness and lose some range of motion. This stage can last between six weeks and nine months.

2. Frozen – the pain starts going away, but the stiffness remains. The range of motion worsens, making it harder to participate in daily activities. This stage can last between four and six months.

3. Thawing – the pain goes away, and the range of motion starts improving slowly. The complete recovery can take anywhere from six months to two years.

Your shoulder consists of three bones (upper arm, shoulder blade, and collarbone). A joint connects the upper arm bone to the shallow socket in your shoulder blade. This joint is surrounded by connective tissue, called the shoulder capsule.

When you have a frozen shoulder, this capsule thickens, inflames, and turns into scar tissue (adhesions). This causes pain and prevents your shoulder from moving properly. Since pain keeps you from moving your shoulder, the shoulder capsule thickens even further.

Statistics say that around 5% to 20% of people¹ will experience an episode of Frozen Shoulder at some point in their lives.

Symptoms of frozen shoulder 

The symptoms of this condition depend on its stage. They are:

• Dull and aching pain in your shoulder and upper arm.

• Limited range of motion

• Stiffness

Symptoms change over time and typically go away once the inflammation and thickness of the joint pass.

Risk factors for frozen shoulder 

While many people develop frozen shoulder, some are at a higher risk of suffering from this condition. The risk factors are:

• Age – Frozen Shoulder usually affects adults between 40 and 60 years of age (most often in the 50s and 60s). The peak age is 56.²

• Gender – women are four times more likely to develop frozen shoulder than men are.

• Recent injury – any injury that reduces the movement in your shoulder can contribute to the development of this condition, such as a rotator cuff tear.

• Recent surgery – similar to a recent injury, any surgery that keeps your shoulder joint immobile can contribute to the development of FS.

• Diabetes – people who have diabetes are more likely to develop Frozen shoulder than those who don't. Studies show that between 10 and 20 percent of diabetics³ experience this condition. The number is higher for people with insulin dependence.

• Existing health conditions – underactive or overactive thyroid, Parkinson's disease, heart disease.

• Stroke – if you've experienced a stroke that kept your shoulder immobilized for a long time, you may develop FS.

• HIV treatment - highly active antiretroviral therapy (HAART) that doctors prescribe as HIV treatment could lead to the development of frozen shoulder.

According to studies,² 6%-17% of people who experienced frozen shoulder in the past may develop it again within five years after the first episode. The problem is likely to reoccur in the shoulder that wasn't affected previously. The non-dominant shoulder is slightly more likely to be affected first.

Causes of frozen shoulder 

Scientists are yet to discover the exact underlying cause of FS. In most cases, it's caused by inflammation of the capsule. Once the inflammation occurs, the scarring begins. It causes pain and restricts the range of motion.

Diabetes and shoulder pain 

Musculoskeletal (muscles and skeleton) disorders are common complications of diabetes. While their consequences may not appear as serious as the consequences of cardiovascular (heart and blood vessels) diseases, these conditions warrant extra attention since they affect the quality of life considerably.

Reports show that the prevalence of shoulder disorders in diabetics is 27.5%⁵ as compared to 5% in people without diabetes.

Frozen shoulder 

Diabetes is one of the most common conditions that lead to frozen shoulder.  Diabetics are two to four times³ more likely to develop FS than the rest of the population. In fact, Frozen Shoulder is one of the most disabling musculoskeletal complications of diabetes.

The reason why diabetics are at a higher risk of developing FS is still unclear.

One theory has to do with collagen. Collagen is a major protein that helps build ligaments, tendons, and cartilage. Unmanaged blood sugar can cause glucose molecules to stick to collagen and change its internal structure. When normal collagen can't help replace damaged collagen in your tissues, they get stiffer.

Overall, FS affects 11% - 30% of people with diabetes³ and only around 2%-10% of people without it. Managing blood sugar levels can help prevent the development of this condition in people with diabetes.

Rotator cuff disorders

Frozen Shoulder isn't the only musculoskeletal disorder that causes shoulder pain in people with diabetes. The second common condition is rotator cuff disease.

The symptoms of rotator cuff problems are similar to FS:

• Pain in the shoulder

• Limited range of movement

• Shoulder weakness

• Clicking and catching when moving the shoulder

Studies show⁶ that patients with diabetes are 48% more likely to develop rotator cuff disorders. Diabetics who use insulin are 8.8 times more likely to suffer from this condition than those who use other blood sugar management methods.

A rotator cuff is a group of tendons that provides motion control and stability to the shoulder joint. Rotator cuff disease involves damage to the rotator cuff that occurs due to injury, inflammation, arthritis, bursitis, or tendonitis.

Just as with Frozen Shoulder, high blood sugar levels can affect collagen structure and lead to rotator cuff inflammation.

Diagnosing frozen shoulder

If you are suffering from continuous pain in your shoulder, you need to consult a doctor. If the physician suspects FS, they will:

• Go over your symptoms (if you keep a journal of your shoulder pain, it can be helpful).

• Review your medical history, including diabetes or risk factors for it.

• Conduct a physical exam that involves checking your range of motion.

• Order an X-ray of your shoulder to rule out other conditions, arthritis, calcium deposits, etc. 

• If a doctor suspects a rotator cuff problem, they may order an MRI or an ultrasound.

You can also run a preliminary test for FS⁷ at home:

• Stretch both arms in front of you and lift them overhead. If you have FS, the motion is likely to cause pain, which will prevent you from lifting the arm entirely.

• Lift the arm out to one side. If the shoulder moves up to your ear, and you feel pain, you may have FS.

Any shoulder pain and motion restriction are a sign of a problem. You need to speak to a doctor to confirm the diagnosis and start treatment.

Treatment for frozen shoulder 

While frozen shoulder may go away on its own, the discomfort substantially hinders your quality of life. That's why your doctor can recommend a course of treatment.

Pain relievers 

Pain is the most debilitating symptom of FS. Your doctor is likely to recommend several pain relief options regardless of the stage of your condition.

• NSAIDs – nonsteroidal inflammatory drugs that can both reduce pain and fight inflammation. You can try over-the-counter NSAIDs. If they don't work, your doctor may prescribe a more potent NSAID. The most common NSAIDs for FS are ibuprofen and naproxen.

• Acetaminophen – a doctor may recommend this medication for extended pain relief.

• Prescription painkillers – if NSAIDs and acetaminophen don't work, your doctor may prescribe opiate-based painkillers to relieve pain until the acute phase of the condition passes.

Another way to relieve FS-related pain is to use heat or ice. Cold packs can reduce inflammation, while hot packs can help muscles relax. You can alternate between these two options or choose the one that works best.

It's imperative to speak to your doctor before using heat and ice for pain relief. 

Corticosteroid injections 

Corticosteroids can help fight inflammation. When injected directly into your shoulder, steroids can provide excellent short-term relief. However, long-term corticosteroid use can lead to osteonecrosis, gastrointestinal problems, immune system issues, and other adverse side effects.

Patients may benefit from these injections during the first stage of FS when pain is the worst. As acute symptoms subside, other pain management options are preferable.

Transcutaneous electrical nerve stimulation (TENS)

This procedure numbs nerve endings that control pain in the spinal cord. Small electric pads applied to the skin send a tiny electric current.

TENS can be a helpful pain relief procedure. You need to speak to your doctor about the possible side effects of this option since they vary for each patient. TENS can be an excellent non-invasive option for FS patients who want to reduce or avoid pain medication.

Physical therapy (PT)

Since pain prevents FS patients from moving their shoulders, it can worsen. Special exercises that are aimed at improving mobility and flexibility can be helpful.

This type of PT should initially be done under a physical therapist's supervision. Once you learn the exercises, you can continue doing them at home. PT usually includes stretching and range of motion exercises.

Joint distension 

Joint distension involves injecting saline into your shoulder capsule to help it stretch. This can provide short-term improvement in your range of motion. Joint distension can be more effective when complemented by corticosteroid injections.

Surgery

If the symptoms of Frozen Shoulder can't be controlled by medication and non-invasive procedures, your doctor may suggest surgery. The two common surgical treatment options are:

• Tearing and stretching the capsule – while you are under general anesthesia, the surgeon forcefully pulls your shoulder to stretch or rip the capsule. This can improve your range of motion and help you proceed with physical therapy.

• Shoulder arthroscopy – this endoscopic procedure involves inserting a tube through a small incision in your shoulder and removing scar tissue from the capsule.

Sometimes, the surgeon may use these procedures to achieve better results. The recovery time after FS surgery is between six weeks and three months.

Frozen shoulder in diabetics is usually more severe and harder to treat. If you have diabetes, medications and non-invasive procedures may not be sufficient.

How to prevent Frozen shoulder

If you have diabetes, preventing Frozen Shoulder isn't easy. However, by keeping your blood sugar levels normal, you can reduce your chances of developing this condition.

You can also prevent frozen shoulder by regularly stretching your back and shoulder muscles. If you injure your shoulder, consult a medical professional immediately. Most likely, you can reduce your chances of developing FS by doing physical therapy and avoiding joint immobilization.

The lowdown 

Diabetes and shoulder pain often go hand in hand. The most common shoulder pain issue that diabetics face is Frozen shoulder. With early diagnosis and proper treatment, you can take care of FS and prevent complications.

While FS often goes away on its own, it could take years to feel relief. That's why it's important to speak to your primary care physician as soon as you experience the first symptoms.