Diabetes Forecast

I have frozen shoulder. Is this related to my diabetes?

David Rubenstein, MD, responds:

Adhesive capsulitis—commonly known as frozen shoulder—is a painful condition characterized by a decreased range of motion in the shoulder without signs of arthritis. We aren’t sure what causes frozen shoulder, but we do know that it’s more prevalent in people with diabetes.

What to Know

Your shoulder is made up of bones, ligaments, and tendons encased in a capsule of connective tissue. When this capsule thickens and tightens around the shoulder joint, it gradually restricts movement.

The condition typically develops over many months. Initially, you may notice that any movement of your shoulder is painful. That so-called “freezing” stage progresses to a “frozen” stage, during which there’s less pain but more stiffness in the shoulder. During the final “thawing” stage, the range of motion in your shoulder returns. 

The average age of people with frozen shoulder is 52. Among people 40 and over, it affects 2 to 4 percent of the general population and up to 25 percent of people with diabetes. Doctors aren’t entirely certain why people with diabetes get frozen shoulder more often than people who don’t have diabetes. It could be a result of high glucose. One theory: Glucose molecules may attach to the collagen of the lining of the shoulder, making an already stiff area even stiffer.

Find Out More

If it’s painful to reach for a book on a high shelf or to scratch the middle of your back, and the pain has gotten progressively worse, you may have frozen shoulder.

The condition is often misdiagnosed. An MRI may show “age-appropriate” partial rotator cuff tears. If you are diagnosed with a rotator cuff condition and you have a markedly stiff shoulder, ask your doctor whether it could be frozen shoulder because the treatment is different.

Treatment for frozen shoulder may include some combination of nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, acupuncture, and steroid injections. Surgery is reserved for people whose range of motion doesn’t improve. There have been no definitive studies to prove that better blood glucose management would make a difference in outcome. (Of course, it benefits your health in plenty of other ways.)

People with diabetes tend to have the most severe cases of frozen shoulder and often need the most aggressive treatment.

Takeaway

You can recover from frozen shoulder and regain range of motion, but it takes time. We measure improvement not over days or weeks but rather over months to years. The earlier you start treatment for frozen shoulder, the quicker your recovery will be.


David Rubenstein, MD, is a sports medicine surgeon in Wynnewood, Pennsylvania, who specializes in shoulder disorders (including among people with diabetes), rotator cuff repair, shoulder instability, and arthroscopic knee surgery.

 

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