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Diabetes at mga Kondisyon sa Itaas na Limbo

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Why diabetes makes frozen shoulder, trigger finger, carpal tunnel syndrome and Dupuytren's more common, and how it affects healing and surgery.

Updated Aug 2026
Isang patak ng dugo sa dulo ng daliri para sa pagsusuri ng asukal sa dugo, kasama ang maliit na glucometer.
Ang diabetes ay nagpapakita ng mas madalas at mas mabagal na pagbawi sa ilang kondisyon sa kamay — trigger finger, carpal tunnel, at stiffness. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Maaaring mapansin mo ang sakit sa balikat na parang galing sa malalim sa loob ng kasu-kasuan. Sa mga taong may diyabetes, maaaring senyales ito ng frozen shoulder. Ang kondisyong ito ay nagpapatigas sa kapsula ng balikat, na nagpapahirap sa paggalaw. Maaari mo ring mapansin na napakahirap na umabot sa likod ng iyong likod upang isara ang bra o itabi ang damit. Karaniwang lumalala ang sakit sa gabi, na nagpapahirap sa pagtulog sa gilid.

Maaari ring lumabas ang mga sintomas sa kamay nang walang anumang pinsala. Maaari kang maranasan ang biglaang sakit at pamamaga sa iyong kamay. Ito ay kilala bilang spontaneous diabetic myonecrosis. Maaari itong magmukhang impeksyon o pamamaga, ngunit nagsisimula ito nang sarili. Mag-ingat dahil maaaring magkaroon ng mas malalang impeksyon sa kamay kung hindi maayos ang iyong asukal sa dugo. Ang riskong ito ay tinalakay noong pandemya ng COVID-19 at nananatiling mahalaga hanggang ngayon. Kung mayroon kang sakit sa bato kasama ang diyabetes, maaaring irekomenda ng iyong doktor ang pag-aalaga sa ospital para sa mga impeksyon sa kamay imbes na gamutin ito sa bahay.

Ang pagkakaroon ng kawalan ng pakiramdam o pangangati sa iyong kamay at mga daliri ay isa pang karaniwang isyu. Madalas itong carpal tunnel syndrome. Ipakita ng mga pananaliksik na ang mga sangkap na tinatawag na advanced glycation end products ay nagtitipon sa mga tisyu sa paligid ng iyong flexor tendons. Ang pagtitipon na ito ay may kaugnayan sa pag-unlad ng carpal tunnel syndrome sa mga pasyenteng may diyabetes. Kung ikaw ay nag-aalala ng operasyon, gustong susubaybayan ng iyong doktor ang iyong HbA1c levels muna. Tinitiyak nito ang mas magandang resulta ng operasyon.

Ang obesity ay maaari ring magkaroon ng malaking papel. Maaari itong magkaroon ng katulad o kahit mas malakas na ugnayan sa carpal tunnel syndrome kaysa sa diyabetes lamang. Ang pagkakaroon ng parehong obesity at diyabetes ay nagdaragdag sa risk, na nagpapataas ng tsansang makaranas ng mga sintomas na ito. Bukod dito, kung mayroon kang primary frozen shoulder, may 37.5% na prevalence ng prediabetes sa mga pasyente. Ang pagpapanatili ng iyong diyabetes sa ilalim ng aktibong kontrol at paggawa ng regular na ehersisyo sa itaas na bahagi ng katawan ay maaaring makatulong upang maantala ang pagkasira ng supraspinatus tendon, kahit wala pa man ang sakit.

Ano ang nangyayari talaga

Ang diabetes ay nagbabago sa paraan ng iyong katawan na humahawak ng asukal, na maaaring makasama sa mga tisyo sa loob ng panahon. Ang mataas na antas ng asukal sa dugo ay nagdudulot ng pag-ipon ng mga waste product na tinatawag na advanced glycation end products. Ang mga matitigas na substansyang ito ay dumikit sa lining ng iyong flexor tendons sa pulso. Ang pagkapal nito ay pumipiga sa median nerve, na nagdudulot ng carpal tunnel syndrome. Ito ay parang isang lubid na nagkakaroon ng fraying at pamamaga sa loob ng isang mahigpit na tubo.

Sa balikat, ang diabetes ay nagpapataas ng risk ng frozen shoulder. Ang joint capsule ay ang sleeve ng tisyo na nakakubli sa iyong shoulder joint. Sa ilang mga taong may diabetes, ang sleeve na ito ay nagiging inflamed at matigas. Ang stiffness na ito ay nagbabawas ng iyong galaw at nagdudulot ng sakit. Mahalagang tandaan na 37.5% ng mga pasyenteng may primary frozen shoulder ay may prediabetes. Ibig sabihin, ang iyong antas ng asukal sa dugo ay maaaring mas mataas kaysa sa normal, kahit hindi pa ito na-diagnose bilang full diabetes.

Ang iyong mga kamay ay vulnerable din. Ang diabetes ay maaaring magdulot ng biglaang sakit at pamamaga sa kamay nang walang anumang sugat. Ito ay tinatawag na diabetic myonecrosis. Ito ay nangyayari kapag ang muscle tissue ay nabubulok dahil sa mahinang daloy ng dugo at mataas na antas ng asukal. Maaaring mukhang ito ay isang infection o inflammation, ngunit ito ay direktang resulta ng sakit.

Ang mahinang kontrol sa diabetes ay nagpapatibay din sa mga infection na mahirap gamutin. Kung ikaw ay magkakaroon ng infection sa kamay, ito ay maaaring mas malala. Ito ay lalo na totoo kung ang iyong antas ng asukal sa dugo ay hindi maayos na pinamamahalaan. Ang diabetes at kidney disease kasama ay nagpapataas ng risk na ang outpatient treatment ay mabigo. Maaaring kailanganin mo ang hospital care upang linisin ang infection nang ligtas.

Sa huli, ang diabetes ay maaaring mahinain ang supraspinatus tendon sa iyong balikat. Ang tendon na ito ay tumutulong sa pagtaas ng iyong braso. Kahit hindi mo pa nararamdaman ang sakit, ang tendon ay maaaring nagde-degenerate na. Ang aktibong kontrol sa iyong diabetes at regular na ehersisyo sa upper limb ay maaaring tumulong na ma-delay ang pinsalang ito. Ang pagpapanatili ng stable na antas ng asukal sa dugo ay nagpoprotekta sa structural integrity ng iyong mga tendon at joints.

Ano ang inaasahan

Ang iyong prognosis ay nakadepende nang malaki sa kung gaano ka magaling na pamahalaan ang iyong asukal sa dugo. Ang pagpapanatili ng aktibong kontrol sa iyong diyabetes at ang paggawa ng regular na ehersisyo sa itaas na bahagi ng katawan ay maaaring makatulong na mapabagal ang pagkasira ng supraspinatus tendon. Ito ay lalo na totoo kung mayroon kang type II diabetes ngunit wala pa sa iyo ang sakit. Kung hindi mo pansinin ang mga hakbang na ito, maaaring mabilis na umunlad ang degenerasyon.

Ang sakit sa balikat sa mga taong may diyabetes ay maaaring senyales ng frozen shoulder. Ito ay isang kondisyon kung saan ang joint ng balikat ay nagiging matigas at masakit. Mahalagang malaman na 37.5% ng mga pasyenteng may primary frozen shoulder ay may prediabetes din. Ibig sabihin, mas mataas ang iyong antas ng asukal sa dugo kaysa sa normal ngunit hindi pa sapat na mataas upang itawag na diyabetes. Hinahanap ng iyong surgeon ang ugnayang ito kapag sinusuri ang iyong sakit.

Ang mga sintomas sa kamay ay nangangailangan ng maingat na pag-aalala. Kung mayroon kang biglaan, walang paliwanag na sakit at pamamaga sa iyong kamay nang walang anumang pinsala, agad mong ipaalam sa iyong doktor. Maaaring ito ay spontaneous diabetic myonecrosis, isang bihirang kondisyon kung saan ang tissue ng kalamnan ay bumubuo. Madalas itong maling akala na impeksyon o pamamaga. Ang maagang diagnosis ay susi upang maiwasan ang pagkalito sa ibang seryosong kondisyon tulad ng impeksyon o mga problema sa daloy ng dugo.

Ang mga impeksyon sa kamay ay maaaring maging mas seryoso sa mga taong may diyabetes, lalo na kung mahina ang kontrol sa asukal sa dugo. Ipinakita ang risk na ito noong pandemya ng COVID-19. Kung mayroon kang diyabetes at sakit sa bato, mas mataas ang iyong risk ng pagkabigo sa paggamot para sa mga impeksyon sa kamay. Maaaring rekomendahan ng iyong surgeon ang pag-aalaga sa ospital imbes na outpatient treatment upang matiyak na malinis nang buo ang impeksyon.

Ang carpal tunnel syndrome ay mas karaniwan din sa diyabetes. Nangyayari ito kapag nagkakaroon ng pagtaas ng presyon sa median nerve sa iyong pulso. Ang pag-ipon ng ilang mga protina sa iyong mga tendon, na kilala bilang advanced glycation end products, ay may papel sa pag-unlad nito. Kung kailangan mong magkaroon ng operasyon para sa carpal tunnel syndrome, susuriin ng iyong surgeon ang iyong long-term na antas ng asukal sa dugo (HbA1c) bago ito. Ang mahusay na kontrol bago ang operasyon ay nagdudulot ng mas magandang resulta.

Ang obesity ay nakakaapekto rin sa iyong risk. Maaari itong may mas malakas na ugnayan sa carpal tunnel syndrome kaysa sa diyabetes lamang. Ang pagkakaroon ng parehong obesity at diyabetes ay nagpapataas pa ng iyong risk. Ang pamamahala ng iyong timbang at asukal sa dugo nang sabay-sabay ay nag-aalok ng pinakamahusay na proteksyon laban sa mga kondisyon sa itaas na bahagi ng katawan.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

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].
  • 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, characterized by more proximal locations, deeper involved anatomy, broader pathogenic microbiology, increased need for repeat drainage, and higher risk for amputation [5].
  • The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit [7].
  • The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients [13].
  • Musculoskeletal hand disorders were prevalent in type 2 diabetes mellitus patients in Jordan [37].
  • Both shoulders were involved in 36 patients (4.5 per cent) with periarthritis of the shoulder and there was a high incidence in insulin-dependent diabetics [2].

Background & Causes

  • Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes are associated [1].
  • There is continuing gradual deterioration of limited joint mobility with increasing duration of disease in diabetes mellitus [6].
  • 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 after carpal tunnel release [7].
  • Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients [9].
  • Insulin dependence is associated with increased risk of complications after upper extremity surgery in diabetic patients [14].
  • NIDDM patients did not have an increased rate of complications relative to nondiabetic patients [14].
  • 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 mediated by metabolic health [20].
  • Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels [30].
  • Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome [32].
  • 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 [33].
  • Molecular and pathological studies in the posterior interosseous nerve provide a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS [34].
  • 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 [35].

Symptoms & Presentation

  • There is continuing gradual deterioration with increasing duration of disease in limited joint mobility in diabetes mellitus [6].
  • Shoulder pain and disability are common, and persistent in adults with diabetes [8].
  • 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 [12].
  • Patients with and without diabetes experienced similar pain except during exertion regarding range of motion recovery in diabetic frozen shoulder [17].
  • 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 [19].
  • Clinicians should consider spontaneous diabetic myonecrosis in diabetic patients with atraumatic acute-onset pain and swelling in the hand to avoid confusion with other inflammatory, infectious, or vascular conditions [21].
  • Diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases following arthroscopic capsular release for shoulder adhesive capsulitis [28].
  • 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 [31].

Management

  • Percutaneous release with or without simultaneous corticosteroid injection has shown promising results and is equally effective and safe in diabetics and nondiabetics for the management of trigger finger [23].
  • 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 [25].
  • 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 surgical treatment outcomes 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 following surgical intervention [10].
  • Steroid injection into the shoulder causes glycemic changes that are short-lived, mostly limited to the 2-3 days after the injection [26].
  • None of the patients in the study on shoulder steroid injections required any change in antidiabetic treatment [26].
  • Platelet-rich plasma injection is a safe and well-tolerated method for adhesive capsulitis management in diabetic patients [24].
  • When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM [27].
  • The 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 operation for frozen shoulder in diabetic patients [18].
  • Patients with and without diabetes experienced similar pain from frozen shoulder except during exertion [17].
  • Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed [11].

Key Considerations

  • There is continuing gradual deterioration of limited joint mobility with increasing duration of disease [6].
  • Additional research is required to determine whether treatment outcomes for diabetic patients are equivalent to those of nondiabetic patients [10].
  • Additional research is required to determine whether diabetes is associated with an increased risk of complications [10].
  • There is a tendency towards persistent limitation of movement two years after arthroscopic release for frozen shoulder in diabetic patients [18].
  • Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes [36].
  • Patients with diabetes experience more symptoms both before and after open carpal tunnel release [38].
  • Patients with diabetes can expect the same relative improvement from open carpal tunnel release as patients without diabetes [38].
  • More than one third of patients with diabetic hand infections are diabetic [39].
  • Insulin-dependent diabetic patients (NIDDM) did not have an increased rate of complications relative to nondiabetic patients after upper extremity surgery [14].

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)
  • [L4] Shoulder pain and disability are common, and persistent in adults with diabetes. [8] (10.1093/rheumatology/ken333)
  • [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)
  • [L3] Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed. [11] (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. [12] (10.1016/j.physio.2014.07.003)
  • [L3] The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients. [13] (10.1016/j.jse.2007.02.133)
  • [L2] The NIDDM patients did not have an increased rate of complications relative to nondiabetic patients. [14] (10.1016/j.jhsa.2018.06.006)
  • [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. [19] (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. [20] (10.1186/s12891-025-08672-2)
  • [L4] Clinicians should consider this diagnosis in diabetic patients with atraumatic acute-onset pain and swelling in the hand to avoid confusion with other inflammatory, infectious, or vascular conditions. [21] (10.1016/j.jhsg.2021.10.006)
  • [L4] Percutaneous release with or without simultaneous corticosteroid injection has shown promising results and is equally effective and safe in diabetics and nondiabetics. [23] (10.1016/j.jhsa.2018.03.045)
  • [L3] Additionally, it is a safe and well-tolerated method for AC management for diabetic patients. [24] (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. [25] (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. [26] (10.1016/j.jseint.2022.05.016)
  • [L3] When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM. [27] (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. [28] (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. [30] (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. [31] (10.1016/j.foot.2020.101680)
  • [L3] Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome. [32] (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. [33] (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. [34] (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. [35] (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. [36] (10.1016/j.jhsa.2014.01.012)
  • [L4] In the present study, musculoskeletal hand disorders were prevalent in T2DM patients in Jordan. [37] (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. [38] (10.1136/bmjopen-2019-030179)
  • [L4] Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic. [39] (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] Predictors of shoulder pain and shoulder disability after one year in diabetic outpatients. Rheumatology. 2008. DOI: 10.1093/rheumatology/ken333

[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] The musculoskeletal complications seen in type II diabetics: predominance of hand involvement. Clinical Rheumatology. 2003. DOI: 10.1007/s10067-003-0704-7

[12] Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy. 2015. DOI: 10.1016/j.physio.2014.07.003

[13] 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

[14] 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

[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

[19] Hand Manifestations of Diabetes Mellitus. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.038

[20] Type 2 diabetes, metabolic health, and the development of frozen shoulder: a cohort study in UK electronic health records. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08672-2

[21] Spontaneous Diabetic Myonecrosis Presenting as Acute Carpal Tunnel Syndrome. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2021.10.006

[23] Management of Diabetic Trigger Finger. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.03.045

[24] The benefit of platelet-rich plasma injection over institution-based physical therapy program in adhesive capsulitis patients with diabetes mellitus: prospective observational cohort study. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00381

[25] Treating Trigger Finger in Diabetics Using Excision of the Ulnar Slip of the Flexor Digitorum Superficialis with or without A1 Pulley Release. HAND. 2007. DOI: 10.1007/s11552-007-9065-z

[26] The effect of steroid injection into the shoulder on glycemia in patients with type 2 diabetes. JSES International. 2022. DOI: 10.1016/j.jseint.2022.05.016

[27] Operative management of the frozen shoulder in patients with diabetes. Journal of Shoulder and Elbow Surgery. 2002. DOI: 10.1067/mse.2002.127301

[28] Comparison of outcomes following arthroscopic capsular release for idiopathic, diabetic and secondary shoulder adhesive capsulitis: A Systematic Review. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.02.014

[30] A genome-wide association study identifies 5 loci associated with frozen shoulder and implicates diabetes as a causal risk factor. PLOS Genetics. 2021. DOI: 10.1371/journal.pgen.1009577

[31] Relationships within and between lower and upper extremity dysfunction in people with diabetes. The Foot. 2020. DOI: 10.1016/j.foot.2020.101680

[32] Type 2 diabetes seems not to be a risk factor for the carpal tunnel syndrome: a case control study. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-346

[33] Is RAGE Expression in Flexor Tendon Synovium Associated With Carpal Tunnel Syndrome in Patients With Diabetes?. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003800

[34] Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome. Diabetologia. 2014. DOI: 10.1007/s00125-014-3271-3

[35] Evaluating whole-genome expression differences in idiopathic and diabetic adhesive capsulitis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.06.016

[36] Carpal Tunnel Release in Patients With Diabetes: A 5-Year Follow-Up With Matched Controls. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.01.012

[37] Musculoskeletal disorders of the hand in type 2 diabetes mellitus: prevalence and its associated factors. International Journal of Rheumatic Diseases. 2015. DOI: 10.1111/1756-185x.12617

[38] Open carpal tunnel release and diabetes: a retrospective study using PROMs and national quality registries. BMJ Open. 2019. DOI: 10.1136/bmjopen-2019-030179

[39] DIABETIC HAND INFECTIONS. Hand Clinics. 1998. DOI: 10.1016/s0749-0712(21)00424-8

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