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Terrie 09-26-2007 06:14

"Frozen Shoulder"
This is a painful condition that many Diabetics seem to suffer from:

By Paul Schickling, RPh, CDE, and John Walsh, PA, CDE

Long term complications of diabetes may include changes in connective tissue that occur as a result of high glucose levels. Adhesive capsulitis, often referred to as frozen shoulder refers to a pathological condition of the shoulder joint which causes a gradual loss of motion usually in just one shoulder.

Adhesive capsulitis (AC) has a prevalence of 2% in the general population, but is reported to occur in 10 to 29% of those with diabetes. Studies have shown it is caused by glycosylation of the collagen within the shoulder joint triggered by the presence of high blood sugars. Dupuytren's Contracture of the palms and fingers of the hand is another example of contracture syndrome related to diabetes. It is sometimes referred to as stiff-man syndrome although it occurs in both sexes.

Stages of Adhesive Capsulitis
Stage 1: The Initialization Stage has a duration of 0 to 3 months is associated with pain and reduced range of motion (ROM). It may be noticed when the person can no longer do things like comb their hair or reach a shelf above their shoulder.

Pain is described as achy at rest and at night. Arthroscopy and biopsy reveal joint changes and an influx of inflammatory cells. Evaluation is important to establish reference points for later assessment of the progression of the disease. Treatment goals are to lessen pain and inflammation by use of nonsteroidal anti-imflammatory drugs (NSAID) like aspirin and ROM exercises.

Stage 2: The Freezing Stage, which lasts from 3 to 9 months, presents itself with chronic pain and further reduced ROM. This stage moves from the inflammatory stage to the fibrotic process. X-rays reveal decreased joint space. Treatments may consist of NSAIDs and corticosteroid injections.

Stage 3: The Frozen Stage has a duration from 9 to 14 months with minimal pain, but a significantly limited range of motion in the shoulder. In stage 3, a person shows marked stiffening of the shoulder and substantial loss of ROM. In general, an extremely painful phase may resolve itself spontaneously, but with continued stiffness and loss of ROM. Treatment may be possible with surgical intervention, manipulation, aggressive stretching and a home exercise program.

Stage 4: The Thawing Stage is from 15 to 24 months and shows minimal pain and progressive improvement in ROM. At this stage the pain and active fibroplasia in the shoulder have completely subsided. An individual has to recover ROM by strength and conditioning exercises.

Early detection, proper staging, and appropriate treatment can allow the patient with diabetes to avoid the painful and disabling consequences of Adhesive Capsulitis.

Reference: For additional information, read "Clinical Appearance and Treatment of Adhesive Capsulitis in Diabetes" by J. MacGillvray, MD. and M. Drakos, BA in Practical Diabetology, June, 2001.

Paul Schickling, RPh, CDE, can be reached at Diabetes Wisdom, Inc. 1107 E. Chapman, Ste. 206, Orange, CA 9286




anuradha.m 03-03-2011 19:01

I had frozen shoulder(s) successively 4 years ago. I had a bad fall from bike and hurt my hip and right shoulder. Hip was alright but shoulder gave meproblem for quite sometime, could not lift it at certan angles, pain wa mostly at night times. Had gone for physiotherapy for almost 1whole year and continued exercises even at home. Same thing happend to my left shoulder,again fell down(this time while climbing down), landed on my left this time and same procedure followed. Now I have enough experience and I help people with physiotheraphy. But one this sure, diabetics have more chances of getting frozenshoulders and to prevent that one has to be n the right side of their BGs...

Rad Warrier 03-05-2011 16:03

I don't know if it is the beginning stage of "frozen shoulder" but once in a while I feel light pain in the right shoulder. But my blood glucose levels are reasonably under control. BG hardly goes up above 7.8 mmol/L (140 mg/dL) anytime after food. But is 7.8 (140) a harmless level? I have checked the BG of my son, daughter-in-law and nephew a few times. The BG levels of these young people have never shown a value above 5.5 (99) any time after a sumptuous, high carb breakfast or lunch followed by sweet desserts. Two hours after food, their BG levels go down to the low fours, typically around 4 (72). So, perhaps the BG levels of 7.8 (140) one hour after food and 6.8 (122) two hours after food of us "well controlled" diabetics may not be as harmless as believed. Who really knows!

Unfortunately, it looks like we diabetics are vulnerable to many other problems besides those brought about by high BG. Hyperinsulinemia (this long word that my browser shows with a wavy red underline as if I made a spelling mistake, means high circulating insulin levels in the blood) can also wreak havoc with our health. In retrospect, I think that I had hyperinsulinemia for a few years prior to my diabetes diagnosis, as part of the package of metabolic syndrome which also included a burgeoning central obesity. As my weight increased, my skin inexplicably (but now I think it is explicable) darkened and also developed dark patches here and there. Not that I was snow white before; for thousands of years, my ancestors had lived in a sunny, warm, tropical land, and from them I have inherited a naturally dark skin liberally supplied with melanin. But even with this dense distribution of melanin in the skin, the darkening was clearly noticeable. So were the dark patches that developed on the cheeks and the sides of the neck. I think my case is somewhat similar to the case of King Nala of Indian mythology, the husband of the pretty Damayanti. Nala was reputed to be very handsome and fair. (The undersigned was never reputed to be handsome, but a long, long time ago he used to be called so by his better half whenever some profoundly important tasks had to be performed like shopping for hours for clothes.) Back to the ancient king Nala. He was bitten by a serpent whose venom made him dark and a dwarf. Of course in the end he gets back his original appearance and lives happily ever after with his pretty queen, princes and princesses. The "venom" of hyperinsulinemia made the undersigned quite dark. Thanks to perhaps a dwindling production of insulin, the undersigned has more or less regained his original (albeit a little more aged) appearance now.


anuradha.m 03-05-2011 18:46

looks like you are managing alright going by the medications you are given. BTW, Nala, Nalla, Nalupu means dark or black color in Telugu..:)
As for your shoulder, like you said most diabetics are affected by frozen shoulder irrespective of their BG readings. With a little physiotheraphy and a little from ultra violet lamp it can be managed comfortably, exercises are on the net anyway, so get going and cure your shoulder...:D

jwags 03-06-2011 18:05


The skin condition is caused by Acanthosis Nigricans. Although it is typical in diabetics with unbalanced homones it is also found in normal people. Although frozen shoulder and carpal tunnel are found a lot in diabetics I have several non diabetic members of my family with frozen shoulder. So I'm not sure if high bgs have anything to do with it sometimes. I think as we age, just moving something the wrong way can cause damage.

anuradha.m 03-15-2011 19:17

All the spring cleaning for Holi brought back my bad shoulders..both shoulders paining like mad and cannot lift beyond certain height. I dont how I will manage with cooking, checking out with physiotheraphy this week.

Rad Warrier 03-16-2011 02:31


Originally Posted by anuradha.m (Post 33376)
All the spring cleaning for Holi brought back my bad shoulders..both shoulders paining like mad and cannot lift beyond certain height. I dont how I will manage with cooking, checking out with physiotheraphy this week.

Wish you find relief from pain soon.


jwags 03-16-2011 02:53

I had problems with all my muscles this summer from a bad reaction to statins. Most of it has disappeared but still have a lot less mobility in my shoulders. I live with the pain but feel it when I am trying to pull a sweater off and there are certain weight exercises that are difficult. I'm not sure if it is the beginnings of frozen shoulder or just my old creaky body. My bgs are usually below 120, mostly below 100. I've been doing lots of spring cleaning, too and get myself into some awkward cleaning positions.

anuradha.m 03-16-2011 08:12

It does'nt matter even your BGs are low, if you are a diabetic frozen shoulder willl happen(my observation)! Looks like its starting for you , you should start with arm circling(like wheel), and walking the wall with fingers with arms in front. They are most helpful, and dont do any wts if you are in pain, it will aggravate, should go for ultraviolet heating and ultra sound stimulation of the upperarm muscles. I feel very relaxed after my physios..goodluck..:)
@Rad, thankq, got over once, will get over again, It will take time as am aging and more diabetic than last year.

girotogo 08-17-2011 09:51

will it go away eventually.
I have been diagnosed with frozen shoulder. It's about 1.5 years- 2 yrs. Doctor says I need it manipulated. Will the frozen should get better by itself?

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