Frozen Shoulder – Risk Factors, Signs, Treatment, and Prevention

Adhesive capsulitis, i.e. frozen shoulder might make usual activities such as changing our insulin pump or getting dressed impossible. This is the most prevalent injury to the upper body in those who have diabetes. Surprised? Read on to find out more about these two conditions.

Is There a Link Between Frozen Shoulder and Diabetes?

In order to understand if there is a link between both conditions, first, we need to learn more about frozen shoulder. This is a rheumatic condition that might make us unable to reach behind the back or above the head. This occurs due to the inflammatory changes in the connective tissue in the shoulder capsule. This tissue can become tight or thicken over time. Then, stiff tissue bands known by the name adhesions might develop, and this can lead to painful movement and reduced motion of the joint. Over time our shoulder will become extremely stiff and painful to move as if it's frozen, hence the name. In case we have an insulin pump this might be challenging for us since inserting infusion might be too hard for us to do. There are 2 kinds of adhesive capsulitis. The first type has no direct clarification for the condition, and so stiffness and pain occur gradually. So, we might not notice we have the first type until it starts to interfere with our activities on a daily basis. On the other hand, the second type occurs due to a certain type of trauma, like a fall, where stiffness and pain stay.

Risk Factors for Developing Frozen Shoulder

Approximately 3 % of the population gets the frozen shoulder in comparison to 20 percent of those with prediabetes and those with non-insulin-dependent and insulin-dependent diabetes. As a matter of fact, women are more likely to have this condition. This is in comparison to men. Mainly this condition impacts people from 40 to 65 years old. There is no definite connection to insulin use or high sugars, but long-term diabetes-related complications might involve changes in the connective tissue which happens due to high sugar levels. People with a history of frozen shoulder are at elevated risk to have this condition on the other side of their body. Also, there is a possibility of a recurrence on the affected side.

Other Risk Factors Are:

• Surgery
• Cardiac disease
• Thyroid issues
• Parkinson’s disease
• Hormone changes, like during menopause
• Cervical disk disease in the neck
• Shoulder injury
• Open heart surgery
• Shoulder surgery

It is said that there might be a genetic predisposition for frozen shoulder. However, there is still no evidence to back up this statement. Now that we know more about the condition and its risk factors, we need to learn how to recognize it, and we can easily do that if we know the signs.

Signs of Frozen Shoulder

We should know the signs of frozen shoulder in order to recognize it and treat it. The condition causes limited range of motion in the joint of the shoulder, progressive pain, night pain, and stiffness. Often, the pain of the frozen shoulder is explained as a dull, poorly localized ache or if it is localized it is found in the part of the shoulder capsule. Also, this pain might radiate in the biceps and be notable enough to disturb our sleep.

Diagnosis of Frozen Shoulder

Our physician will take a thorough shoulder history in order to find out if there has been any injury in the past and also do a physical exam. Furthermore, there might be a need for x-rays in order to find out if there is another issue, like osteoarthritis. An MRI exam is better when it comes to soft tissue issues like a rotator cuff problem and might reveal inflammation. However, imaging tests don’t present certain symptoms in order to diagnose a frozen shoulder.

Treatment for Frozen Shoulder

When it comes to frozen shoulder, there are a few treatments. The American Family Physicians recommends an active and early treatment. Moreover, care needs to be taken in order to prevent the shoulder from being immobile. 90 to 95 percent of people with frozen shoulder improve their condition with nonsurgical treatments. Such nonsurgical treatments are NSAIDS, i.e. anti-inflammatory medications, physical therapy, corticosteroid injections, and heat. For those who have diabetes, mainly people who have poor glycemic control or insulin-dependent people, a cortisone shot might lead to blood glucose spikes in the first couple of days after the shot. Dr. Vasudevan recommends that a shot needs to be done with image guidance – fluoroscopy or ultrasound- in order to correctly deliver the drug into the shoulder joint. This maximizes the number of steroids which is supplied to the painful region and minimizes the amount which might be taken into the bloodstream and lead to a rise in the blood sugar levels. But in case there is no improvement with different non-surgical treatments after 2 months, then surgery might be recommended. Surgery is used only for difficult and severe cases and it is not necessary for most people with frozen shoulders.

The Prognosis

Often, treatment with NSAIDs restores the function and motion of the shoulder in 1 year. If left untreated, the shoulder might heal in 2 years. But in 10 percent of people who have it, this condition never disappears. After surgery, one must continue with physical therapy for a couple of weeks in order to prevent the recurrence of the condition.

Prevention of Frozen Shoulder

Those with diabetes might have an increased risk. However there are many causes, so it is difficult to pin the issue to this disease itself. But just to be on the safe side, we need to try and prevent this.

Ways to Prevent Frozen Shoulder

• Stretch the shoulders
• Include friendly bacteria and vitamin D in the daily diet
• Stretch the spine
• Strengthen the tendons found around the shoulders
• Follow a healthy and balanced diet

By knowing the signs, and risk factors, we can prevent and treat this common condition. However, when it comes to suitable prevention and treatment, it would be best to consult a doctor.