diabetes October 9, 2018

Understanding Frozen Shoulder, Diabetes and Your Treatment Options

The Link Between Diabetes and Adhesive Capsulitis

Medical professionals have long suspected a link between diabetes and frozen shoulder. Why? Studies show that the incidence rate of frozen shoulder is as high as 36% in the diabetic population. 

With more than one third of diabetics suffering from the painful symptoms of frozen shoulder adhesive capsulitis at some point in their lives, the link is clear. In the general population, meanwhile, it is estimated that frozen shoulder syndrome will only affect 3% to 5% of people at some point in their lifetimes. 

Why Are Diabetics More Likely to Develop Frozen Shoulder?

The global prevalence of diabetes has risen dramatically since 1980 to currently affect hundreds of millions of people around the world. The United States and Canada have been no exception, as the rates of both type-1 and type-2 diabetes have been steadily increasing over this time frame.

Did You Know?

In 2017, an estimated 7.3% of Canadians aged 12 and older (roughly 2.3 million people) had some form of diabetes. In the United States, a recent report shows that 13% of the American adult population, roughly 34.1 million people, are diabetic.

Researchers cannot be certain why diabetics are more likely to be affected by frozen shoulder syndrome. However, they have found a greater prevalence in people who have type-2 (formerly called non-insulin-dependent, or adult-onset) diabetes than type-1 (previously known as insulin-dependent, juvenile or childhood-onset). 

In fact, people with type-2 diabetes are more than twice as likely to develop frozen shoulder than type-1 diabetics.

Frozen Shoulder and Diabetes

Diabetics who suffer from frozen shoulder syndrome face a particularly difficult situation, since both traditional surgery as well as other methods have limitations (or can be less effective) than in patients without diabetes.

Conditions like diabetes complicate frozen shoulder treatments because they change how the body produces scar tissue. High blood glucose levels lead to the glycosylation of the collagen in the shoulder joint, which leads to the development of stronger and more stubborn scar tissue in and around the shoulder.

Although all the connections between diabetes and frozen shoulder are not fully understood, researchers suspect that high blood glucose levels lead to the formation of what are known as advanced glycosylation end products. 

These end products latch on to ligaments and tendons and make them stiffer and weaker, eventually induce painful inflammation. When combined with the impaired circulation that often results from high blood glucose levels, painful stiffness quickly results and gives way to impaired mobility and sustained pain.

The end result is that the risk of complications from surgical procedures in the diabetic population are significant, even if the procedure is arthroscopic surgery, which is considered less invasive than some other forms of surgery. 

Also, other conventional treatment plans for frozen shoulder, like physical therapy, cortisone or steroid injections and hydrodilatation (also known as hydraulic arthrographic capsular distension), are less effective for diabetics because diabetes often causes connective tissue aberrations.

Luckily, the MCD Procedure from the World Frozen Shoulder Clinic is unique, and helps sufferers overcome any challenges associated with diabetes.

Frozen Shoulder Risk Factors

Both insulin-dependent and non-insulin dependent diabetics, as well as people with prediabetes (meaning that they have elevated blood sugar levels) are much more likely to get frozen shoulder symptoms than the rest of the population. 

People between the ages of 40 and 65 are at the greatest risk, and women remain more likely than men to suffer from frozen shoulder. Additionally, those that have experienced frozen shoulder in the past face an increased risk of it recurring on the other side of the body. Recurrence on the affected side is also possible, although rare, and more likely to happen to patients with diabetes.

Although a conclusive link has yet to be established, it is believed that the long-term complications of diabetes can affect connective tissues due to consistently high blood sugars, which is thought to be the explanation for the correlation between diabetes and frozen shoulder. 

Other risk factors include:

Frozen Shoulder Progression

For most people, the first signs of frozen shoulder syndrome are so subtle that they are easily dismissed as the predictable kinds of aches and pains that come with aging. But mysterious shoulder pain or stiffness that doesn’t clear up on its own after a few days could be a sign of the initial stage of adhesive capsulitis. 

This slow-developing condition has three distinct phases: freezing, frozen and thawing.

Freezing Stage

The first phase can last anywhere from six weeks to nine months, and it is characterized by a gradual loss of shoulder mobility and increasing shoulder pain. People generally experience more pain during particular shoulder movements, however, a dull ache often persists throughout the day and night, which can make finding a comfortable sleeping position especially difficult. 

Anti-inflammatory medication often helps mitigate joint pain during this phase, but it will not help people regain use of their arm or range of motion in their shoulder.

Frozen Stage

As the condition progresses, the symptoms – pain and reduced mobility – continue to worsen until the shoulder becomes frozen. At this point, people generally report less pain, however, their range of motion is very restricted, which can make daily tasks, like washing your hair or putting something on a high shelf, extremely difficult or impossible. This phase usually lasts anywhere from four to six months.  

Thawing Stage

After months of declining mobility and persistent pain, the freezing and frozen stages finally give way to the gradual thawing of the shoulder. Range of motion begins to improve, and the pain starts to fade, over a period that can last from six months to two years.

From Diagnosis to Treatment

Especially in the early stages, frozen shoulder can be difficult to distinguish from other common shoulder problems, like a minor rotator cuff tear, because the symptoms are so similar. 

In these cases, a doctor will often prescribe anti-inflammatory medication and send the patient off for physical therapy without getting to the bottom of the issue.

In order to diagnose frozen shoulder syndrome, doctors need to test both the active and passive range of motion in the shoulder by seeing how well a patient can move on their own, and by moving the patient’s arm for them to see the limits of their range of motion.

Even if someone is properly diagnosed in the early stages of the condition, conventional treatment plans, even those that use arthroscopic surgery in addition to rigorous physical therapy, have low success rates. When you add in the complicating factors introduced by diabetes (either type-1 or type-2), patients sometimes search for months for an effective course of therapy.

How Diabetes Complicates Conventional Treatment Plans

The creator of the World Frozen Shoulder Clinic’s MCD procedure, Dr. Oolo-Austin, believes that the changes in connective tissues combined with the exaggerated healing response to shoulder injuries seen in diabetics results in an uncontrolled inflammation response as well as an uncontrolled healing response in cases of frozen shoulder. 

These dynamics lead to the formation of large amounts of strong, stretchy scar tissue over the capsule of the shoulder joint, which are highly resistant to conventional therapies.

Although this theory has yet to be confirmed through empirical studies, mounting anecdotal evidence suggests that diabetics experience particularly difficult shoulder adhesions. On a related note, it has been found that hydrodilatation to treat frozen shoulder has a higher failure rate with diabetics, likely because their shoulder adhesions are significantly stronger than those found in other patients.

The MCD Procedure for Diabetics

People with diabetes face challenges that make overcoming physical conditions like frozen shoulder especially difficult, like the increased chances of complications from surgery and decreased chances of success with physical therapy. But a frozen shoulder diagnosis does not have to be a long-term issue, even for type-1 or type-2 diabetics.

The World Frozen Shoulder Clinic’s MCD procedure effectively restores range of motion in the shoulder joint and relieves pain, for diabetics and non-diabetics alike. Although people with diabetes may experience more pronounced symptoms than some other frozen shoulder patients, the MCD procedure has an outstanding success rate for all patients. 

The MCD procedure and ensuing physical therapy regimen provided by the World Frozen Shoulder Clinic avoids the potential complications of surgery to help patients regain complete range of motion in the affected arm through methods that are completely non-invasive. 

Diabetic patients diagnosed with frozen shoulder who undergo the MCD procedure and take the time to perform all of their exercises and stretches as prescribed report overwhelming success.

Testimonial

Joanna Grant, from Toronto, Ontario, Canada, suffers from type-1 diabetes and was diagnosed with frozen shoulder adhesive capsulitis. Following her diagnosis and assessment, she had her doubts about the MCD procedure. 

She experienced very painful symptoms as her condition worsened and has tried conventional therapies without success. But after her visit to the World Frozen Shoulder Clinic, that all changed…

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