ABSTRACT
Background:
Frozen shoulder, also known as adhesive capsulitis, is marked by pain and restricted shoulder movement, with diabetes mellitus being a known risk factor. However, its occurrence in diabetic individuals in health care settings is underreported.
Objective:
To estimate the occurrence of frozen shoulder among diabetic patients in a tertiary hospital.
Methods:
This observational study evaluated patients with diabetes for frozen shoulder through clinical diagnosis and imaging. Prevalence was calculated.
Results:
Frozen shoulder was observed in 11% of diabetic cases, highlighting the need for routine screening in this population.
Conclusion:
The study emphasizes the importance of screening for frozen shoulder in diabetic patients to ensure early diagnosis and management.
KEYWORDS: Adhesive capsulitis, diabetes mellitus, frozen shoulder, musculoskeletal complications, prevalence, tertiary care
INTRODUCTION
Frozen shoulder, also termed as adhesive capsulitis, is characterized by progressive stiffness and restricted shoulder movement, significantly impacting daily activities and quality of life.[1] Diabetes mellitus, a metabolic disorder, is a well-known risk factor for frozen shoulder.[2] Diabetic patients have a greater prevalence of adhesive capsulitis compared to the general population, likely due to glycosylation of collagen in the shoulder capsule, leading to inflammation and fibrosis.[3]
Prevalence rates of this condition amongst diabetic cohorts vary widely, with studies in primary care and community settings reporting rates from 10% to 36%.[4] However, data from tertiary care centers, where patients often present with more advanced disease, are limited. This research aims to evaluate the occurrence of frozen shoulder among diabetic patients seeking tertiary health care services. By highlighting the burden of frozen shoulder in this population, the study underscores the need for routine musculoskeletal screening in diabetic patients to inform clinical practice and improve management strategies for this disabling condition.
METHODOLOGY
This descriptive study was done at a tertiary health care’s outpatient department, focusing on diabetic patients. The research was ethically approved, ensuring informed consent and patient confidentiality throughout the study. Eligible participants were those aged above 18 years, those confirmed with type 1 or type 2 diabetes, and those who provided informed consent. Exclusion criteria included a previous history of trauma or surgery in the shoulder, other known causes of shoulder pain, and severe systemic illnesses. The sample size was calculated using a prevalence rate of 20% for frozen shoulder, resulting in a final sample size of 300. Participants underwent thorough clinical assessments, including demographic data, medical history, HbA1c levels, and shoulder pain/mobility evaluation. The condition was diagnosed based on the insidious onset of pain, progressive restriction of shoulder movements, and exclusion of other causes. Data analysis was done using SPSS 25.0 version and below 5% level of significance.
RESULTS
The occurrence of frozen shoulder among diabetic patients was 11%, with a higher prevalence in females (13.13%) compared to males (9.95%). It increased with the diabetic duration, being the highest in patients with diabetes for greater than 10 years (15.24%). Individuals with poor glycemic control (HbA1c > 8%) had a significantly higher prevalence of frozen shoulder (21.11%) compared to those with better glycemic control [Tables 1 and 2].
Table 1.
Demographic and clinical characteristics and occurrence of frozen shoulder
| Characteristic | Value |
|---|---|
| Total Patients | 300 |
| Age (Mean±SD) | 55±12 years |
| Gender (Male: Female) | 201:99 (67%:33%) |
| Type of Diabetes | |
| Type 1 | 45 (15%) |
| Type 2 | 255 (85%) |
| Diabetic Duration | |
| <5 years | 75 (25%) |
| 5–10 years | 120 (40%) |
| >10 years | 105 (35%) |
| HbA1c Level (Mean±SD) | 8.1±1.5 |
| Prevalence of Frozen Shoulder | 33 (11%) |
Table 2.
Frozen shoulder distribution by gender, duration of diabetes, and glycemic control
| Variable | Total Patients | Patients with Frozen Shoulder | Percentage (%) |
|---|---|---|---|
| Gender | |||
| Male | 201 | 20 | 9.95 |
| Female | 99 | 13 | 13.13 |
| Duration of Diabetes | |||
| <5 years | 75 | 5 | 6.67 |
| 5-10 years | 120 | 12 | 10.00 |
| >10 years | 105 | 16 | 15.24 |
| HbA1c Levels | |||
| <7% | 90 | 4 | 4.44 |
| 7-8% | 120 | 10 | 8.33 |
| >8% | 90 | 19 | 21.11 |
DISCUSSION
Frozen shoulder can lead to significant impairment in shoulder mobility and function.[5] The pathology involves a progressive thickening and contractures of the shoulder capsule, which restrict movements, especially rotation away from the midline along a vertical axis.[6] Patients commonly report persistent pain, especially at night, and difficulty performing daily activities, making it a chronic condition with a potentially long recovery period of up to 3 years.[7] Contrary to the belief that it is self-limiting, many patients continue to experience symptoms without timely and appropriate intervention.[8]
Literature evidence shows correlation between diabetes mellitus and frozen shoulder, with diabetic patients having a greater odds of developing the condition compared to the general population.[9] This study identified a prevalence of 11% of frozen shoulder among diabetic cases, aligning with findings from other studies reporting higher rates in females (13.13%) than in males (9.95%).[10,11] The prevalence was notably higher among those with a longer duration of diabetes and poorer glycemic control, suggesting that these factors may exacerbate the risk.[12] While some research suggests a higher incidence of frozen shoulder in insulin-dependent patients, recent meta-analyses have not found significant differences between insulin-dependent and non-insulin-dependent individuals.[4,13] Additionally, while frozen shoulder is predominantly unilateral, it has been observed that 68% of bilateral cases occur in diabetic patients, indicating a strong link between diabetes and this condition.[14]
The study’s findings highlight the need for early diagnosis and intervention of frozen shoulder in diabetic cases, particularly those with poor glycemic control or a long history of diabetes. However, the causality cannot be established owing to the descriptive study nature and the focus on a single tertiary care center may affect the generalizability of the results. Further longitudinal studies across multiple centers are recommended to better comprehend the risk and to develop more effective avoidance and intervention strategies for frozen shoulder in diabetic cases.
CONCLUSION
The findings highlight the need for routine screening for frozen shoulder in diabetic patients, especially those with long-standing diabetes and poor glycemic control. Early detection and intervention are crucial for effective management. Awareness programs should target diabetic communities, particularly women, to educate them on the prevalence, symptoms, and risks of frozen shoulder. Patients suspected of having frozen shoulder should undergo early screening and radiographs as early detection improves outcomes.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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