- •Of patients with type 1 diabetes for ≥45 years, 59% had frozen shoulder, with 73% affected bilaterally.
- •Patients with painful frozen shoulder had highest disability and least shoulder mobility.
- •High glycemic index was associated with severe disability and restricted shoulder mobility.
To compare the prevalence of shoulder disorders and self-reported shoulder disability in patients with long-term type 1 diabetes mellitus and diabetes-free subjects; and to explore the association between the long-term glycemic burden and shoulder disability in the diabetes group.
Cross-sectional study of shoulder diagnoses with 30 years' historical data on glycemic burden in patients with diabetes.
Diabetics center and a university hospital.
Subjects attending the Norwegian Diabetics Center in 2015 with type 1 diabetes since 1970 or earlier were eligible (N=136). One hundred and five patients were included, and 102 (50% women; mean age, 61.9y) completed the study together with 73 diabetes-free subjects (55% women; mean age, 62.5y).
Main Outcome Measure
Shoulder diagnoses decided through clinical examination according to scientific diagnostic criteria.
Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 diabetes-free subjects, with a lifetime prevalence of 76% in the diabetes group versus 14% in the diabetes-free subjects. Patients with diabetes had higher disability and higher mean QuickDASH scores (23.0±19.9) than diabetes-free subjects (8.9±12.0), with a mean difference of −14.2 (95% confidence interval, −19.3 to −9.0) points (P<.001). We found an association between chronic hyperglycemia and QuickDASH scores, with a 6.16-point increase in QuickDASH scores per unit increase in glycated hemoglobin A1c (HbA1c) (P=.014).
The point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes was 59%, and the lifetime prevalence was 76%. The diabetes group had more shoulder disability than diabetes-free subjects. The historical HbA1c level was associated with increased shoulder disability.
List of abbreviations:AGE (advanced glycation end-product), CI (confidence interval), DASH (Disabilities of Arm, Shoulder and Hand), HbA1c (glycated hemoglobin A1c)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Prevalence of rheumatological manifestations in diabetic population from North-West India.J Assoc Physicians India. 2014; 62: 788-792
- Rheumatological manifestations occurring in patients with diabetes mellitus.Scand J Rheumatol. 2013; 42: 1-10
- The musculoskeletal manifestations of type 2 diabetes mellitus in a Kashmiri population.Int J Health Sci. 2016; 10: 57-68
- Association of diabetes mellitus with the risk of developing adhesive capsulitis of the shoulder: a longitudinal population-based followup study.Arthritis Care Res. 2013; 65: 1197-1202
- Molecular mechanisms of AGE/RAGE-mediated fibrosis in the diabetic heart.World J Diabetes. 2014; 5: 860-867
- Glycation products and the pathogenesis of diabetic complications.Diabetes Care. 1992; 15: 1835-1843
- Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases.Ann Rheum Dis. 1996; 55: 907-914
- Musculoskeletal complications in type 1 diabetes.Diabetes Care. 2014; 37: 1863-1869
- The Southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb.Ann Rheum Dis. 2000; 59: 5-11
- Soft-tissue rheumatic disorders of the neck and upper limb: prevalence and risk factors.Semin Arthritis Rheum. 2003; 33: 185-203
- Shoulder diagnoses in secondary care, a one year cohort.BMC Musculoskelet Disord. 2014; 15: 89
- Evaluating change in clinical status: reliability and measures of agreement for the assessment of glenohumeral range of motion.N Am J Sports Phys Ther. 2010; 5: 98-110
- Range of shoulder motion in patients with adhesive capsulitis; intra-tester reproducibility is acceptable for group comparisons.BMC Musculoskelet Disord. 2008; 9: 49
- Effects of age on passive range of motion of selected peripheral joints in healthy adult females.Physiother Theory Pract. 2009; 25: 145-164
- Management of frozen shoulder: a systematic review and cost-effectiveness analysis.Health Technol Assess. 2012; 16: 1-264
- Long-term outcome of frozen shoulder.J Shoulder Elbow Surg. 2008; 17: 231-236
- Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG).Am J Ind Med. 1996; 29: 602-608
- A systematic review of measures of shoulder pain and functioning using the International classification of functioning, disability and health (ICF).BMC Musculoskelet Disord. 2013; 14: 73
- [Norwegian version of the DASH questionnaire for examination of the arm shoulders and hand].Tidsskr Nor Laegeforen. 2008; 128 ([Norwegian]): 1070
- Reliability and validity of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire in patients with shoulder impingement syndrome.BMC Musculoskelet Disord. 2014; 15: 78
- The DASH and the QuickDASH instruments. Normative values in the general population in Norway.J Hand Surg Eur Vol. 2014; 39: 140-144
- Reliability of physical examination tests used in the assessment of patients with shoulder problems: a systematic review.Physiotherapy. 2010; 96: 179-190
- [Report 2015].([Norwegian])2015 (Available at)Accessed November 1, 2016)
- The advanced glycation end product Nepsilon-(carboxymethyl)lysine is increased in serum from children and adolescents with type 1 diabetes.Diabetes Care. 1998; 21: 1997-2002
- Increased serum levels of the specific AGE-compound methylglyoxal-derived hydroimidazolone in patients with type 2 diabetes.Metabolism. 2003; 52: 163-167
- Methylglyoxal evokes pain by stimulating TRPA1.PLoS One. 2013; 8: e77986
- Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial.Ann Rheum Dis. 2004; 63: 1460-1469
- Manual therapy and exercise for adhesive capsulitis (frozen shoulder).Cochrane Database Syst Rev. 2014; 8: CD011275
- Determinants of the shoulder pain and disability index in patients with subacromial shoulder pain.J Rehabil Med. 2010; 42: 499-505
- Does hand-behind-back range of motion accurately reflect shoulder internal rotation?.J Shoulder Elbow Surg. 2006; 15: 311-314
Published online: February 17, 2017
Supported by Sophies Minde Ortopedi AS, Oslo, Norway (grant no. 19/2014); Oslo Diabetes Research Center, Oslo, Norway; and The Norwegian Diabetics Center, Oslo, Norway.
© 2017 by the American Congress of Rehabilitation Medicine