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Diabetes y afecciones de la extremidad superior
Why diabetes makes frozen shoulder, trigger finger, carpal tunnel syndrome and Dupuytren's more common, and how it affects healing and surgery.
Qué está sintiendo¶
Si padece diabetes y ha comenzado a sentir dolor en el hombro o en la mano, no está solo. El dolor y la rigidez en el hombro son frecuentes en adultos con diabetes; suelen aparecer de forma gradual, no tras una lesión. El dolor suele localizarse en lo profundo del hombro y aumenta progresivamente durante semanas. Resulta más difícil levantar el brazo por encima de la cabeza, colgar la ropa para secar o levantar una tetera. Por la noche el dolor suele ser peor, y acostarse sobre ese lado puede despertarlo.
También es posible que su hombro se sienta rígido. Girar el brazo para rascarse la espalda o alcanzar el bolsillo trasero se vuelve difícil. Ambos hombros pueden verse afectados, aunque esto es menos común. El hombro congelado, en el que la membrana articular se tensa y limita el movimiento, ocurre con mayor frecuencia en personas con diabetes que en quienes no la padecen.
Las manos también pueden verse afectadas. La diabetes está relacionada con varios problemas en las manos: el dedo en gatillo, en el que el dedo se atrapa o se bloquea al doblarlo; la contractura de Dupuytren, en la que bandas fibrosas en la palma tiran de los dedos hacia ella; el síndrome del túnel carpiano, que provoca hormigueo y entumecimiento en los dedos; y la limitación de la movilidad articular, en la que la rigidez de las articulaciones dificulta apoyar la palma sobre una mesa. Estos problemas suelen aparecer uno tras otro con el tiempo, por lo que es probable que deba acudir varias veces por problemas en las manos.
Las infecciones en las manos también son más frecuentes en personas con diabetes, y suelen ser más graves. Más de un tercio de los pacientes de una serie clínica de infecciones de mano padecían diabetes. Si sus niveles de azúcar en sangre han estado elevados, las infecciones pueden ser más intensas y tardar más en mejorar.
La rigidez de las articulaciones de los dedos tiende a empeorar gradualmente cuanto más tiempo padezca diabetes; las contracturas de los dedos, por lo general, solo aparecen después de nueve años o más. Si su hombro comenzó a doler y a volverse rígido de forma lenta, sin una lesión evidente, vale la pena comentarle a su médico que padece diabetes, ya que ambos problemas pueden estar relacionados.
¿Qué está ocurriendo realmente?¶
El nivel elevado de azúcar en sangre afecta mucho más que a los vasos sanguíneos y los nervios. Con el tiempo, modifica los tejidos que mantienen unidas las articulaciones y permiten su movimiento fluido. En el hombro, la articulación está recubierta por una membrana elástica, similar a una “manga” suelta alrededor de la misma. Cuando hay diabetes, dicha membrana puede inflamarse, endurecerse y acortarse. Una vez que se contrae, queda menos espacio para el movimiento del brazo; por eso resulta difícil y doloroso levantar el brazo o llevarlo detrás de la espalda.
En las manos, el mismo proceso afecta a los pequeños túneles y ligamentos que guían los tendones de los dedos. Un tendón es una estructura fibrosa resistente que conecta el músculo con el hueso; cada vez que doblamos un dedo, el tendón se desliza a través de un túnel ajustado. Si el revestimiento de ese túnel se engrosa, el tendón se “atrapara” al deslizarse, provocando que el dedo haga “clic” o se bloquee. Los ligamentos engrosados también pueden formarse en la palma y mantener un dedo doblado; además, el nervio de la muñeca puede quedar comprimido al pasar por un canal estrecho.
Existe un patrón claro: la diabetes está relacionada con el hombro congelado, el dedo en gatillo, la contractura de Dupuytren, el síndrome del túnel carpiano y la limitación de la movilidad articular. No se trata de cinco problemas independientes; todos comparten una misma causa: los niveles elevados de azúcar que dañan el tejido conectivo en todo el cuerpo. Por eso estos trastornos suelen aparecer uno tras otro, y por qué con el tiempo pueden verse afectados ambos hombros o varios dedos.
Esto también explica por qué el médico pregunta sobre la diabetes cuando se presentan problemas en el hombro o en la mano. La relación es bidireccional: un hombro doloroso y rígido, sin causa traumática aparente, a veces es el primer indicio de niveles altos de azúcar en sangre. Conocer esta conexión orienta el plan de tratamiento, desde los exámenes que se realizan hasta el control del azúcar durante cualquier intervención médica.
Qué podemos hacer al respecto¶
El primer paso suele ser el más sencillo. Los movimientos suaves y la fisioterapia tienen como objetivo mantener la articulación y los tendones lo más móviles posible, así como fortalecer los músculos circundantes. Este enfoque funciona mejor si se inicia temprano, antes de que aparezca la rigidez. Pruebe este tratamiento durante varias semanas antes de decidir si le resulta útil. También es importante mantener el nivel de azúcar en sangre dentro de los límites normales, ya que los niveles elevados favorecen los cambios tisulares que provocan estos problemas.
Si el autocuidado no es suficiente, existen opciones médicas. Los antiinflamatorios pueden aliviar el dolor y la inflamación. Las inyecciones de corticoides, que son medicamentos antiinflamatorios administrados directamente en la zona afectada, también pueden ayudar; sin embargo, conllevan ciertos riesgos si padece diabetes. Pueden elevar temporalmente el nivel de azúcar en sangre, y este aumento es mayor y más prolongado si su HbA1c (una medida del promedio de azúcar en sangre durante los últimos meses) es del 7 % o superior. Si utiliza insulina o mide su azúcar en sangre en casa, deberá vigilarlo más de cerca tras recibir cualquier inyección. También existen otras opciones de inyección que no tienen este efecto; su médico podrá explicarle cuál se adapta mejor a su caso.
Si los síntomas son graves y persisten a pesar de lo anterior, su médico podría derivarlo a un especialista para una evaluación. En algunos casos específicos, podría considerarse algún procedimiento quirúrgico. La buena noticia es que, en muchos de estos problemas, las personas con diabetes obtienen resultados igual de buenos que quienes no la padecen. La liberación del túnel carpiano, operación que descomprime el nervio comprimido en la muñeca, brinda el mismo alivio duradero tanto en diabéticos como en no diabéticos. En el caso del hombro congelado, el tratamiento busca restaurar el movimiento; las opciones van desde movilizar suavemente el hombro mientras el paciente está sedado hasta liberar la cápsula tensa mediante cirugía laparoscópica. Estos tratamientos suelen ser eficaces, aunque la recuperación puede ser más lenta en personas con diabetes y es posible que persista cierta rigidez. Para el dedo en gatillo, se puede realizar un pequeño procedimiento de liberación mediante una aguja a través de la piel; este método es igualmente seguro tanto en diabéticos como en no diabéticos. Antes de cualquier cirugía, su médico también evaluará el flujo sanguíneo de su mano, ya que los vasos sanguíneos estrechados pueden afectar la cicatrización. Sea cual sea el tratamiento propuesto, se le informará con total transparencia sobre cómo la diabetes influye en el plan terapéutico, la recuperación y lo que puede esperar después.
Qué esperar¶
La respuesta honesta es que la diabetes altera el ritmo de la recuperación, pero no el resultado final. En el caso del síndrome del túnel carpiano, las personas con diabetes obtienen el mismo alivio duradero tras la cirugía que quienes no la padecen; este mejoramiento se mantiene a lo largo de los años. En cuanto al dedo en gatillo, la liberación mediante aguja resulta igualmente segura y eficaz, independientemente de si la persona tiene o no diabetes.
El hombro congelado es el caso en el que la diabetes realmente marca una diferencia. Tras una cirugía artroscópica para liberar la cápsula rígida, los resultados a los seis meses en personas con diabetes son peores que en quienes no la padecen; además, persiste cierta rigidez al cabo de dos años. Una opción terapéutica consiste en mover suavemente el hombro mientras el paciente está bajo anestesia; sin embargo, este método no funciona en aproximadamente un tercio de los diabéticos la primera vez, y podría requerir repetición si la rigidez reaparece. Con el asesoramiento adecuado y el consentimiento informado, este plan sigue siendo viable. Cuando el hombro puede ser movilizado mediante manipulación suave, los resultados han sido satisfactorios tanto en personas con diabetes como en quienes no la padecen. La liberación artroscópica, por su parte, ha arrojado buenos resultados en cuanto a movilidad, alivio del dolor y función del hombro, independientemente de la presencia de diabetes.
Hay algunos aspectos que conviene conocer antes de someterse a cualquier intervención. Las personas con diabetes suelen presentar más síntomas tanto antes como después de la cirugía del túnel carpiano; no obstante, el grado de mejoría tras la operación es similar en ambos grupos. El tiempo de evolución de la diabetes y el tipo de tratamiento recibido pueden influir en la gravedad de los síntomas posteriores a la liberación del túnel carpiano. No existe un límite estricto para el control de la glucosa antes de una cirugía electiva de mano; no obstante, su equipo médico procurará que su diabetes esté bien controlada antes y después del procedimiento. Si su problema de hombro o mano es grave, o si existe duda sobre la perfusión sanguínea de la mano, su médico podría solicitar estudios de imagen detallados de los vasos sanguíneos antes de decidir sobre la cirugía.
¿Qué sucede si estos problemas no se tratan? La rigidez, especialmente en los dedos, empeora progresivamente conforme aumenta el tiempo de evolución de la diabetes. La rigidez del hombro también puede persistir sin tratamiento. El movimiento temprano y el mantenimiento de los niveles de glucosa dentro de los límites normales son la mejor forma de evitar este desenlace.
Cuándo consultar a un profesional¶
Acuda a su médico de cabecera si un problema en el hombro o en la mano se repite con frecuencia, especialmente si padece diabetes o si sus niveles de azúcar en sangre han estado elevados. Las infecciones de la mano requieren atención inmediata. Si la mano presenta dolor, enrojecimiento, hinchazón o calor, debe ser examinada sin demora, pues las infecciones en personas diabéticas pueden ser más graves y tardar más en mejorar. Diríjase a urgencias si la infección se extiende, si tiene fiebre o se siente mal, o si la mano o un dedo empeoran rápidamente. Solicite una evaluación especializada si el hombro empieza a doler y a ponerse rígido de forma gradual sin causa aparente, o si esa rigidez le impide levantar el brazo por encima de la cabeza o llevarlo detrás de la espalda. Lo mismo aplica si un dedo se traba o se “bloquea”, si el hormigueo o entumecimiento en los dedos le impide dormir, o si la rigidez de las articulaciones dificulta las actividades cotidianas. Dado que estos problemas suelen aparecer uno tras otro, no olvide mencionar cualquier problema previo en el hombro o en la mano.
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview¶
- Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications [1].
- In a study of 36 patients, both shoulders were involved in 4.5 per cent of cases [2].
- There was a high incidence of bilateral shoulder involvement in insulin-dependent diabetics [2].
- Examination of the hands and shoulders should be included in the evaluation of patients with diabetes [3].
- The prevalence of musculoskeletal disorders in people with type 2 diabetes mellitus remains high despite advances in medical management over the last two decades [4].
- Diabetes exacerbates the burden of surgical upper-extremity infections [5].
- Surgical upper-extremity infections in diabetic patients are characterized by more proximal locations [5].
- Surgical upper-extremity infections in diabetic patients are characterized by deeper involved anatomy [5].
- Surgical upper-extremity infections in diabetic patients are characterized by broader pathogenic microbiology [5].
- Surgical upper-extremity infections in diabetic patients are characterized by an increased need for repeat drainage [5].
- Surgical upper-extremity infections in diabetic patients are characterized by a higher risk for amputation [5].
- The presence of diabetes mellitus was the most important factor for developing trigger digit after carpal tunnel release [7].
- The severity of diabetes mellitus was less important than its presence for developing trigger digit after carpal tunnel release [7].
- The prevalence of frozen shoulder is still greater in diabetic patients [14].
- The prevalence of frozen shoulder in diabetic patients is less than previously reported [14].
- Musculoskeletal hand disorders were prevalent in type 2 diabetes mellitus patients in Jordan [40].
Background & Causes¶
- In 36 patients (4.5 per cent.), both shoulders were involved and there was a high incidence in insulin-dependent diabetics [2].
- Diabetes exacerbates the burden of surgical upper-extremity infections, characterized by more proximal locations, deeper involved anatomy, broader pathogenic microbiology, increased need for repeat drainage, and higher risk for amputation [5].
- There is continuing gradual deterioration with increasing duration of disease, though finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [6].
- The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit [7].
- The NIDDM patients did not have an increased rate of complications relative to nondiabetic patients [8].
- Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients [9].
- Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles [15].
- In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome [16].
- Type 2 diabetes may be a cause of frozen shoulder but the effect is not supported to be mediated by metabolic health [21].
- Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels [33].
- Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome [35].
- Among patients with diabetes who had CTS, higher RAGE expression was observed in those with more severe disease, suggesting that RAGE-mediated pathways may play a role in the pathophysiology of CTS in patients with diabetes [36].
- Molecular and pathological studies provide a potential basis for the predisposition of diabetic patients to the development of CTS [37].
- Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic adhesive capsulitis with idiopathic adhesive capsulitis, suggesting that these conditions are distinct clinical entities [38].
Symptoms & Presentation¶
General Assessment¶
- Moderate correlations between upper and lower extremity range of motion, strength, and function suggest a concurrent development of musculoskeletal complications in people with DM [34].
Shoulder¶
- Shoulder pain and disability are common, and persistent in adults with diabetes [11].
- Patients with diabetes mellitus reported shoulder pain and/or disability, with 63% (149/236) indicating such issues and a median SPADI score of 10.0 [13].
- The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients [14].
- Patients with and without diabetes experienced similar pain except during exertion [17].
- Diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases [31].
Hand¶
- Diabetes mellitus is associated with a variety of hand manifestations including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility, which often present with multiple visits for hand conditions over time [20].
Infection¶
Management¶
Assessment and Monitoring¶
- Finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [6].
- There is continuing gradual deterioration of limited joint mobility with increasing duration of disease [6].
Non-Operative Interventions¶
- Glycemic changes following steroid injection into the shoulder are short-lived, mostly limited to the 2-3 days after the injection, and none of the patients required any change in antidiabetic treatment [29].
- Platelet-rich plasma injection is a safe and well-tolerated method for adhesive capsulitis management for diabetic patients [27].
- Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed [12].
Operative Interventions¶
- Percutaneous release with or without simultaneous corticosteroid injection for trigger finger is equally effective and safe in diabetics and nondiabetics [26].
- Excision of the ulnar slip of the flexor digitorum superficialis with or without A1 pulley release is a safe and effective treatment for stenosing flexor tenosynovitis in the diabetic patient [28].
- The best current evidence supports the efficacy of surgical interventions for the management of upper limb conditions in diabetic individuals [10].
- Additional research is required to determine whether treatment outcomes for upper limb conditions in diabetics are equivalent to those of nondiabetic patients [10].
- Additional research is required to determine whether diabetes is associated with an increased risk of complications in upper limb surgery [10].
- Results of arthroscopic release for frozen shoulder in diabetics were significantly worse than those in non-diabetics six months post-operatively [18].
- There is a tendency towards persistent limitation of movement two years after arthroscopic release for frozen shoulder in diabetics [18].
- When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM [30].
- Patients with and without diabetes experienced similar pain except during exertion following frozen shoulder treatment [17].
Vascular Disease and Amputation¶
- Arterial occlusive disease in the distal upper extremity is primarily related to the combination of diabetes, renal disease, and often organ transplantation [25].
- An aggressive approach is warranted for patients with critical ischemia of the hand to try and avoid loss of the hand [25].
- Arteriography remains the gold standard for most patients with critical ischemia of the hand because proper evaluation requires good visualization of the forearm vessels, palmar arch, and digital vessels [23].
- Many patients with critical ischemia due to complications of diabetes and renal disease will have multiple levels of partial occlusion that can be seen in the forearm vessels on arteriography [23].
- In patients with factors or injury characteristics that contraindicate single-digit replantation, such as diabetes mellitus, revision amputation is indicated [19].
Key Considerations¶
Assessment and Prevalence¶
Pathophysiology and Natural History¶
Surgical Outcomes and Complications¶
- The best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications [10].
- The results in diabetics were significantly worse than those in non-diabetics six months post-operatively with a tendency towards persistent limitation of movement two years after operation [18].
- Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes [39].
- Patients with diabetes experience more symptoms both before and after open carpal tunnel release, but can expect the same relative improvement from surgery as patients without diabetes [41].
Infections¶
- Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic [42].
Key Evidence¶
- [L3] Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications. [1] (10.1016/j.ejim.2009.08.001)
- [L4] In 36 patients (4.5 per cent.), both shoulders were involved and there was a high incidence in insulin-dependent diabetics. [2] (10.1136/ard.31.1.69)
- [L3] Examination of the hands and shoulders should be included in the evaluation of patients with diabetes. [3] (10.1016/s0002-9343(02)01045-8)
- [L3] The prevalence of musculoskeletal disorders in people with type 2 Diabetes mellitus remains high despite advances in medical management over the last two decades. [4] (10.1016/j.jht.2021.04.013)
- [L2] Diabetes exacerbates the burden of surgical upper-extremity infections, characterized by more proximal locations, deeper involved anatomy, broader pathogenic microbiology, increased need for repeat drainage, and higher risk for amputation. [5] (10.1016/j.jhsa.2017.11.003)
- [L3] There is continuing gradual deterioration with increasing duration of disease, though finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more. [6] (10.1136/ard.44.2.93)
- [L4] The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit. [7] (10.1016/j.jhsa.2013.10.023)
- [L2] The NIDDM patients did not have an increased rate of complications relative to nondiabetic patients. [8] (10.1016/j.jhsa.2018.06.006)
- [L3] Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. [9] (10.1016/j.jhsa.2014.01.014)
- [L4] The best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications. [10] (10.1016/j.jhsa.2011.10.002)
- [L4] Shoulder pain and disability are common, and persistent in adults with diabetes. [11] (10.1093/rheumatology/ken333)
- [L3] Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed. [12] (10.1007/s10067-003-0704-7)
- [L3] Patients with diabetes mellitus reported shoulder pain and/or disability, with 63% (149/236) indicating such issues and a median SPADI score of 10.0. [13] (10.1016/j.physio.2014.07.003)
- [L3] The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients. [14] (10.1016/j.jse.2007.02.133)
- [L3] Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles. [15] (10.1186/s12891-022-05627-9)
- [L4] In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome. [16] (10.3899/jrheum.090239)
- [L3] Patients with and without diabetes experienced similar pain except during exertion. [17] (10.1177/0300060516675112)
- [L3] The results in diabetics were significantly worse than those in non-diabetics six months post-operatively with a tendency towards persistent limitation of movement two years after operation. [18] (10.1302/0301-620x.96b10.34476)
- [L4] Diabetes mellitus is associated with a variety of hand manifestations including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility, which often present with multiple visits for hand conditions over time. [20] (10.1016/j.jhsa.2008.01.038)
- [L2] This study suggests that type 2 diabetes may be a cause of frozen shoulder but does not support the hypothesis that the effect is mediated by metabolic health. [21] (10.1186/s12891-025-08672-2)
- [L4] Percutaneous release with or without simultaneous corticosteroid injection has shown promising results and is equally effective and safe in diabetics and nondiabetics. [26] (10.1016/j.jhsa.2018.03.045)
- [L3] Additionally, it is a safe and well-tolerated method for AC management for diabetic patients. [27] (10.5397/cise.2021.00381)
- [L4] This procedure is a safe and effective treatment for the often-difficult problem of stenosing flexor tenosynovitis in the diabetic patient. [28] (10.1007/s11552-007-9065-z)
- [L2] These glycemic changes are short-lived, mostly limited to the 2-3 days after the injection, and none of the patients required any change in antidiabetic treatment. [29] (10.1016/j.jseint.2022.05.016)
- [L4] When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM. [30] (10.1067/mse.2002.127301)
- [L4] However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. [31] (10.1016/j.otsr.2019.02.014)
- [L1] Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels. [33] (10.1371/journal.pgen.1009577)
- [L4] The moderate correlations between upper and lower extremity range of motion, strength, and function suggest a concurrent development of musculoskeletal complications in people with DM. [34] (10.1016/j.foot.2020.101680)
- [L3] Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome. [35] (10.1186/1471-2474-15-346)
- [L2] Among patients with diabetes who had CTS, higher RAGE expression was observed in those with more severe disease, suggesting that RAGE-mediated pathways may play a role in the pathophysiology of CTS in patients with diabetes. [36] (10.1097/corr.0000000000003800)
- [L4] It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS. [37] (10.1007/s00125-014-3271-3)
- [L5] Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. [38] (10.1016/j.jse.2021.06.016)
- [L2] Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. [39] (10.1016/j.jhsa.2014.01.012)
- [L4] In the present study, musculoskeletal hand disorders were prevalent in T2DM patients in Jordan. [40] (10.1111/1756-185x.12617)
- [L3] Patients with diabetes experience more symptoms both before and after open carpal tunnel release, but can expect the same relative improvement from surgery as patients without diabetes. [41] (10.1136/bmjopen-2019-030179)
- [L4] Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic. [42] (10.1016/s0749-0712(21)00424-8)
References¶
[1] Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. European Journal of Internal Medicine. 2009. DOI: 10.1016/j.ejim.2009.08.001
[2] Periarthritis of the shoulder and diabetes mellitus.. Annals of the Rheumatic Diseases. 1972. DOI: 10.1136/ard.31.1.69
[3] Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. The American Journal of Medicine. 2002. DOI: 10.1016/s0002-9343(02)01045-8
[4] Proportion and distribution of upper extremity musculoskeletal disorders and its association with disability in type 2 diabetes mellitus. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2021.04.013
[5] Quantifying the Effect of Diabetes on Surgical Hand and Forearm Infections. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.11.003
[6] Limited joint mobility in diabetes mellitus.. Annals of the Rheumatic Diseases. 1985. DOI: 10.1136/ard.44.2.93
[7] The Incidence of Trigger Digit After Carpal Tunnel Release in Diabetic and Nondiabetic Patients. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.10.023
[8] Insulin Dependence Is Associated With Increased Risk of Complications After Upper Extremity Surgery in Diabetic Patients. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.006
[9] Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections Into the Hand and Wrist. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.01.014
[10] Impact of Diabetes on Outcomes in Hand Surgery. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.10.002
[11] Predictors of shoulder pain and shoulder disability after one year in diabetic outpatients. Rheumatology. 2008. DOI: 10.1093/rheumatology/ken333
[12] The musculoskeletal complications seen in type II diabetics: predominance of hand involvement. Clinical Rheumatology. 2003. DOI: 10.1007/s10067-003-0704-7
[13] Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy. 2015. DOI: 10.1016/j.physio.2014.07.003
[14] Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.133
[15] Shoulder muscle changes in patients with type 2 diabetes mellitus who have a painful shoulder: a quantitative muscle ultrasound study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05627-9
[16] Hand Syndromes Associated with Diabetes: Impairments and Obesity Predict Disability. The Journal of Rheumatology. 2009. DOI: 10.3899/jrheum.090239
[17] Range of motion of diabetic frozen shoulder recovers to the contralateral level. Journal of International Medical Research. 2016. DOI: 10.1177/0300060516675112
[18] Comparative outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b10.34476
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