ਸ਼ੂਗਰ (ਡਾਇਬਟੀਜ਼) ਅਤੇ ਉੱਪਰਲੇ ਅੰਗ ਦੀਆਂ ਸਮੱਸਿਆਵਾਂ

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 [4].
• The prevalence of musculoskeletal disorders in people with type 2 Diabetes mellitus remains high despite advances in medical management over the last two decades [5].
• Upper extremity impairments are prevalent and significant in patients with diabetes mellitus [7].
• The systemic nature of musculoskeletal impairments in people with diabetes mellitus has traditionally been underappreciated but is recently gaining attention [12].
• Diabetes mellitus is associated with a variety of hand manifestations including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility [18].
• Musculoskeletal hand disorders were prevalent in type 2 diabetes mellitus patients in Jordan [74].
• Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) compared to non-insulin-dependent diabetic patients (28% of patients) regarding trigger finger [2].
• Insulin-dependent diabetic patients have a higher rate of requiring surgical release for relief of symptoms (56% of digits) compared to non-insulin-dependent diabetic patients (28% of digits) regarding trigger finger [2].
• The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit after carpal tunnel release [14].
• In 36 patients (4.5 per cent.), both shoulders were involved in periarthritis of the shoulder and there was a high incidence in insulin-dependent diabetics [3].
• Shoulder pain and disability are common, and persistent in adults with diabetes [6].
• The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients [23].
• There is continuing gradual deterioration of limited joint mobility with increasing duration of disease, though finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [8].
• 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 [9].
• Insulin-dependent diabetic patients have a greater risk of complications following hand and upper extremity surgery, specifically surgical site infections [11].
• More than one third of patients in a clinical series of diabetic hand infections are diabetic [17].
• Hand infection requiring hospitalization is an infrequent complication in diabetics [32].

Background & Causes¶

General Musculoskeletal Impact¶

• The systemic nature of musculoskeletal impairments in people with diabetes has traditionally been underappreciated but is recently gaining attention [12].
• The frequencies of hand region abnormalities are significantly higher in diabetic subjects as compared to the controls [34].

Pathophysiology and Risk Factors¶

• Diabetes is a significant risk factor for Dupuytren's Disease [38].
• Strong evidence indicates that diabetes is associated with a higher risk of tendinopathy [39].
• In diabetic patients, the presence of limited joint mobility is positively associated with the prevalence of multiple digit involvement by stenosing flexor tenosynovitis [33].
• Finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [8].
• There is continuing gradual deterioration of limited joint mobility with increasing duration of diabetes [8].
• In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome [15].
• Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles [24].

Frozen Shoulder (Adhesive Capsulitis)¶

• People with diabetes are more likely to develop frozen shoulder [54].
• A genome-wide association study identifies diabetes as a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels [55].
• Type 2 diabetes may be a cause of frozen shoulder, but the effect is not supported to be mediated by metabolic health [43].
• Although frozen shoulder might be associated with the duration of diabetes, the association between metabolic control and frozen shoulder has yet to be clearly shown [27].
• Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic adhesive capsulitis with idiopathic adhesive capsulitis, suggesting these are distinct clinical entities [72].

Carpal Tunnel Syndrome¶

• Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome [69].
• Diabetic patients without peripheral neuropathy have an association with higher incidence of carpal tunnel syndrome, suggesting disparate mechanisms causing diabetic peripheral neuropathy and carpal tunnel syndrome [66].
• Molecular and pathological studies provide a potential basis for the predisposition of diabetic patients to the development of carpal tunnel syndrome [71].
• Among patients with diabetes who had carpal tunnel syndrome, higher RAGE expression was observed in those with more severe disease, suggesting that RAGE-mediated pathways may play a role in the pathophysiology [70].

Trigger Finger and Infections¶

• Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) and of requiring surgical release for relief of symptoms (56% of digits) when compared to non-insulin-dependent diabetic patients (28% of patients with multiple digit involvement; 28% of digits requiring surgery) [2].
• Three patients were found to have overt diabetes and four had latent diabetes in a study of pyogenic human hand infections, representing a disproportionately high incidence of metabolic disorders [13].

Symptoms & Presentation¶

General Musculoskeletal Manifestations¶

• Upper limb musculoskeletal abnormalities are associated with poor metabolic control in diabetes [1].
• The frequencies of hand region abnormalities are significantly higher in diabetic subjects compared to controls [34].
• Hand manifestations of diabetes often present with multiple visits for hand conditions over time [18].
• Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed [10].

Limited Joint Mobility and Contractures¶

• There is continuing gradual deterioration of limited joint mobility with increasing duration of disease [8].
• The presence of limited joint mobility is positively associated with the prevalence of multiple digit involvement by stenosing flexor tenosynovitis in diabetic patients [33].

Trigger Finger (Stenosing Tenosynovitis)¶

• Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) compared to non-insulin-dependent diabetic patients (28% of patients) [2].
• Insulin-dependent diabetic patients have a higher rate of requiring surgical release for relief of symptoms (56% of digits) compared to non-insulin-dependent diabetic patients (28% of digits) [2].
• In diabetic patients, flexor tenosynovitis typically affected more than one digit in the same hand [59].

Shoulder Disorders¶

• In a study of 36 patients, both shoulders were involved and there was a high incidence in insulin-dependent diabetics [3].
• Although frozen shoulder might be associated with the duration of diabetes, the association between metabolic control and shoulder disorders has yet to be clearly shown [27].
• A patient who presents with a painful shoulder of insidious onset with restricted motion for which an intrinsic cause can be ruled out radiographically has a 38.6% chance of being diabetic [35].
• A patient who presents with a painful shoulder of insidious onset with restricted motion for which an intrinsic cause can be ruled out radiographically has a 32.95% chance of being prediabetic [35].
• Patients with and without diabetes experienced similar pain except during exertion [29].
• Diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases after arthroscopic capsular release for adhesive capsulitis [64].

Infections¶

• Three patients were found to have overt diabetes and four had latent diabetes in a series of pyogenic human hand infections, representing a disproportionately high incidence of metabolic disorders [13].
• More than one third of the patients in a clinical series of hand infections were diabetic [17].
• There was an increased severity of hand infections in diabetic patients treated during the pandemic, linked to poor glycaemic control [28].
• Outcome in insulin dependent patients with poor glycemic control, deep hand infection and presence of associated ESRD, is the worst [36].

Disability and Functional Impairment¶

Management¶

Assessment and Monitoring¶

• Patients with and without diabetes experienced similar pain except during exertion in the context of diabetic frozen shoulder [29].

Non-Operative Management¶

• Exercise and diet are the first means of management for persons diagnosed with adult-onset type 2 diabetes (or noninsulin-dependent diabetes mellitus, NIDDM) [41].
• Patients with coronary artery disease, peripheral vascular disease, and diabetes mellitus must be considered individually when prescribing exercise, because their clinical status can vary greatly [61].
• Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients [19].
• A digital injection of the corticosteroid methylprednisolone acetate in diabetic patients with trigger finger causes a hyperglycemic effect that lasts for at least 5 days [22].
• A digital injection of the corticosteroid methylprednisolone acetate in diabetic patients with trigger finger can help prevent the need for surgery more than half the time [22].
• Local corticosteroid injection to the shoulder can create a significant, short-term increase in systemic glucose levels in patients with type 2 diabetes not treated with insulin [26].
• Patients with HbA1c levels of 7% or greater experience higher and longer-lasting blood glucose elevations after corticosteroid injections compared to those with lower levels [67].
• HbA1c can predict the degree of glucose elevation following local corticosteroid injection in the hand [67].
• Platelet-rich plasma injection is a safe and well-tolerated method for adhesive capsulitis management for diabetic patients [48].
• Loxoprofen seems to be a first line treatment of acute pain in diabetics [51].
• GLP 1RA users experienced a similar risk of upper extremity fragility fractures compared to matched controls without GLP1-RA use in a retrospective analysis of 194,205 older patients with T2DM and a history of metformin use [62].

Operative Management¶

• Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) for trigger finger compared to non-insulin-dependent diabetic patients (28% of patients) [2].
• Insulin-dependent diabetic patients have a higher incidence of requiring surgical release for relief of symptoms (56% of digits) for trigger finger compared to non-insulin-dependent diabetic patients (28% of digits) [2].
• In 36 patients (4.5 per cent.), both shoulders were involved in periarthritis and there was a high incidence in insulin-dependent diabetics [3].
• Percutaneous release with or without simultaneous corticosteroid injection has shown promising results and is equally effective and safe in diabetics and nondiabetics for trigger finger [46].
• 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 [49].
• Patients with diabetes have the same beneficial outcome after carpal tunnel release as nondiabetic patients [31].
• Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes [37].
• The duration of diabetes and its treatment can be related to the severity of the disease symptoms after carpal tunnel releasing surgeries [57].
• Preoperative semaglutide use was not associated with a reduction in 90-day complications or 2-year reoperation-free survival in patients with type II diabetes mellitus undergoing carpal tunnel release [68].
• The results in diabetics were significantly worse than those in non-diabetics six months post-operatively for arthroscopic release of frozen shoulder [30].
• There is a tendency towards persistent limitation of movement two years after arthroscopic release of frozen shoulder in diabetics [30].
• When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM [58].
• The best current evidence supports the efficacy of surgical interventions for the management of upper limb conditions in diabetic individuals [20].
• Additional research is required to determine whether treatment outcomes for upper limb conditions are equivalent to those of nondiabetic patients [20].
• Additional research is required to determine whether diabetes is associated with an increased risk of complications in upper limb surgery [20].

Infection and Vascular Considerations¶

• Three patients were found to have overt diabetes and four had latent diabetes, representing a disproportionately high incidence of metabolic disorders in pyogenic human hand infections [13].
• There was an increased severity of hand infections in those treated during the pandemic, linked to poor glycaemic control [28].
• Diabetes is associated with higher risk of tendinopathy [39].
• In patients with factors or injury characteristics that contraindicate single-digit replantation (eg, advanced age, diabetes mellitus, smoking), revision amputation is indicated [42].
• 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 [44].
• These types of lesion do not lend themselves to a local approach [44].
• Arterial occlusive disease in the distal upper extremity is primarily related to the combination of diabetes, renal disease, and often organ transplantation [45].

Key Considerations¶

Assessment and Prevalence¶

Specific Conditions and Risk Factors¶

• Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement in trigger finger (59% of patients) compared to non-insulin-dependent diabetic patients (28% of patients) [2].
• Insulin-dependent diabetic patients have a higher rate of requiring surgical release for trigger finger symptoms (56% of digits) compared to non-insulin-dependent diabetic patients (28% of digits) [2].
• In a study of 36 patients with periarthritis of the shoulder, both shoulders were involved and there was a high incidence in insulin-dependent diabetics [3].
• A patient who presents with a painful shoulder of insidious onset with restricted motion for which an intrinsic cause can be ruled out radiographically has a 38.6% chance of being diabetic and a 32.95% chance of being prediabetic [35].
• Patients diagnosed with idiopathic frozen shoulder who are 60 years or younger and are not known diabetics have a similar probability of having diabetes or prediabetes to an age-matched population [80].

Surgical Outcomes and Complications¶

• Patients with insulin-dependent diabetes mellitus (IDDM) have a greater risk of complications following hand and upper extremity surgery, specifically surgical site infections [11].
• The results of arthroscopic release for frozen shoulder 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 [30].
• 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 [76].
• Outcome was considered excellent if there was complete resolution of symptoms, which occurred in 35% of the treated hands in a study of carpal tunnel release in diabetic patients [77].
• An initial failure rate of approximately one-third for manipulation under general anesthesia for frozen shoulder may be considered unacceptably high in other general orthopedic procedures, but with appropriate counseling and consent and combined with a repeat MUA for recurrence, this protocol may represent a satisfactory treatment strategy in the diabetic population [78].
• There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus [79].
• The preoperative status of the ulnar nerve, based on electrophysiology, among individuals with diabetes may be clinically relevant for surgery for cubital tunnel syndrome [53].

Infection and Metabolic Control¶

• Analysis of a clinical series of hand infections demonstrates that more than one third of the patients are diabetic [17].
• Three patients were found to have overt diabetes and four had latent diabetes, representing a disproportionately high incidence of metabolic disorders in a series of pyogenic human hand infections [13].
• The data did not support the guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery overall [50].
• A collaborative and comprehensive approach to the pre-operative medical evaluation of patients with diabetes is critical for shoulder arthroplasty outcomes [52].

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] Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) and of requiring surgical release for relief of symptoms (56% of digits) when compared to non-insulin-dependent diabetic patients (28% of patients with multiple digit involvement; 28% of digits requiring surgery). [2] (10.1016/s0363-5023(05)80432-0)
• [L4] In 36 patients (4.5 per cent.), both shoulders were involved and there was a high incidence in insulin-dependent diabetics. [3] (10.1136/ard.31.1.69)
• [L3] Examination of the hands and shoulders should be included in the evaluation of patients with diabetes. [4] (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. [5] (10.1016/j.jht.2021.04.013)
• [L4] Shoulder pain and disability are common, and persistent in adults with diabetes. [6] (10.1093/rheumatology/ken333)
• [L3] These findings suggest that upper extremity impairments are prevalent and significant in this population. [7] (10.1016/j.physio.2014.07.003)
• [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. [8] (10.1136/ard.44.2.93)
• [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. [9] (10.1016/j.jhsa.2017.11.003)
• [L3] Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed. [10] (10.1007/s10067-003-0704-7)
• [L2] Our data demonstrate a greater risk of complications following hand and upper extremity surgery for patients with IDDM, specifically surgical site infections. [11] (10.1016/j.jhsa.2018.06.006)
• [L4] The systemic nature of musculoskeletal impairments in people with DM traditionally has been underappreciated but recently is gaining attention. [12] (10.1016/j.foot.2020.101680)
• [L4] Three patients were found to have overt diabetes and four had latent diabetes, representing a disproportionately high incidence of metabolic disorders. [13] (10.1016/s0363-5023(78)80140-3)
• [L4] The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit. [14] (10.1016/j.jhsa.2013.10.023)
• [L4] In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome. [15] (10.3899/jrheum.090239)
• [L4] Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic. [17] (10.1016/s0749-0712(21)00424-8)
• [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. [18] (10.1016/j.jhsa.2008.01.038)
• [L3] Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. [19] (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. [20] (10.1016/j.jhsa.2011.10.002)
• [L4] A digital injection of the corticosteroid methylprednisolone acetate in diabetic patients with trigger finger causes a hyperglycemic effect that lasts for at least 5 days but can help prevent the need for surgery more than half the time. [22] (10.1016/j.jhsa.2006.03.022)
• [L3] The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients. [23] (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. [24] (10.1186/s12891-022-05627-9)
• [L2] Local corticosteroid injection to the shoulder can create a significant, short-term increase in systemic glucose levels in patients with type 2 diabetes not treated with insulin. [26] (10.1016/j.jseint.2022.05.016)
• [L2] Although frozen shoulder might be associated with the duration of diabetes, the association between metabolic control and the two aforementioned shoulder disorders has yet to be clearly shown. [27] (10.1111/jdi.12491)
• [L4] While fewer patients attended the service during the pandemic, there was an increased severity of hand infections in those treated, linked to poor glycaemic control. [28] (10.1177/17531934231196026)
• [L3] Patients with and without diabetes experienced similar pain except during exertion. [29] (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. [30] (10.1302/0301-620x.96b10.34476)
• [L2] Patients with diabetes have the same beneficial outcome after carpal tunnel release as nondiabetic patients. [31] (10.1016/j.jhsa.2009.04.006)
• [L4] Hand infection requiring hospitalization is an infrequent complication in diabetics. [32] (10.1016/s0266-7681(97)80041-1)
• [L2] Multiple regression analysis in diabetic patients revealed that the presence of limited joint mobility was positively associated with the prevalence of multiple digit involvement. [33] (10.3899/jrheum.081024)
• [L3] The study found that the frequencies of hand region abnormalities were significantly higher in diabetic subjects as compared to the controls (p-value <0.001). [34] (10.1186/1756-0500-6-16)
• [L4] The study shows with statistical significance that a patient who presents with a painful shoulder of insidious onset with restricted motion for which an intrinsic cause can be ruled out radiographically has a 38.6% chance of being diabetic and a 32.95% chance of being prediabetic. [35] (10.1097/smj.0b013e3181705d39)
• [L4] Outcome in insulin dependent patients with poor glycemic control, deep hand infection and presence of associated ESRD, is the worst. [36] (10.1142/s2424835519500401)
• [L2] Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. [37] (10.1016/j.jhsa.2014.01.012)
• [L3] Diabetes is a significant risk factor for Dupuytren's Disease. [38] (10.1016/s0363-5023(03)80324-6)
• [L1] These findings provide strong evidence that diabetes is associated with higher risk of tendinopathy. [39] (10.1136/bjsports-2015-094735)
• [L5] Exercise and diet are the first means of management for persons diagnosed with adult-onset type 2 diabetes (or noninsulin-dependent diabetes mellitus, NIDDM). [41] (10.1016/s0278-5919(05)70170-8)
• [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. [43] (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. [46] (10.1016/j.jhsa.2018.03.045)
• [L3] Additionally, it is a safe and well-tolerated method for AC management for diabetic patients. [48] (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. [49] (10.1007/s11552-007-9065-z)
• [L3] The data did not support the guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery overall. [50] (10.1177/1558944720937363)
• [L4] Loxoprofen seems to be a first line treatment of acute pain in diabetics. [51] (10.1016/j.injury.2026.113298)
• [L4] A collaborative and comprehensive approach to the pre-operative medical evaluation of patients with DM is critical, as is future investigation into alternative methods associated with outcomes after shoulder arthroplasty in patients with DM. [52] (10.1007/s00264-018-3874-2)
• [L5] They note that the preoperative status of the ulnar nerve, based on electrophysiology, among individuals with diabetes may also be clinically relevant. [53] (10.1177/17531934231172595)
• [L1] People with diabetes are more likely to develop frozen shoulder. [54] (10.1136/bmjopen-2022-062377)
• [L1] Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels. [55] (10.1371/journal.pgen.1009577)
• [Paper] However, the duration of diabetes and its treatment can be related to the severity of the disease symptoms after the carpal tunnel releasing surgeries. [57] (10.1055/s-0039-1697059)
• [L4] When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM. [58] (10.1067/mse.2002.127301)
• [L3] In the diabetic patients studied here, flexor tenosynovitis typically affected more than one digit in the same hand. [59] (10.1016/s0363-5023(05)80068-1)
• [L5] Patients with coronary artery disease, peripheral vascular disease, and diabetes mellitus must be considered individually when prescribing exercise, because their clinical status can vary greatly. [61] (10.1016/s0278-5919(02)00035-2)
• [L3] In this retrospective analysis of 194,205 older patients with T2DM and a history of metformin use, GLP 1RA users experienced a similar risk of upper extremity fragility fractures compared to matched controls without GLP1-RA use. [62] (10.1016/j.injury.2026.113456)
• [L4] However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. [64] (10.1016/j.otsr.2019.02.014)
• [L4] Diabetic patients without peripheral neuropathy have an association with higher incidence of CTS in this study, suggesting that there are disparate mechanisms causing DPN and CTS. [66] (10.1177/15589447211014607)
• [L2] Patients with HbA1c levels of 7% or greater experience higher and longer-lasting blood glucose elevations after corticosteroid injections compared to those with lower levels, suggesting HbA1c can predict the degree of glucose elevation. [67] (10.1016/j.jhsa.2014.06.035)
• [L3] Preoperative semaglutide use was not associated with a reduction in 90-day complications or 2-year reoperation-free survival in patients with type II diabetes mellitus undergoing carpal tunnel release. [68] (10.1016/j.jhsa.2025.09.003)
• [L3] Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome. [69] (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. [70] (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. [71] (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. [72] (10.1016/j.jse.2021.06.016)
• [L4] In the present study, musculoskeletal hand disorders were prevalent in T2DM patients in Jordan. [74] (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. [76] (10.1136/bmjopen-2019-030179)
• [L4] Outcome was considered excellent if there was complete resolution of symptoms and this occurred in 35% of the treated hands. [77] (10.1016/0266-7681(94)90131-7)
• [L3] An initial failure rate of approximately one-third may be considered unacceptably high in other general orthopedic procedures; however, with appropriate counseling and consent and combined with a repeat MUA for recurrence, this protocol may represent a satisfactory treatment strategy in the diabetic population. [78] (10.1016/j.jse.2011.11.006)
• [L3] There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus. [79] (10.1016/j.jseint.2023.06.007)
• [L4] Patients diagnosed with idiopathic frozen shoulder who are 60 years or younger and are not known diabetics have a similar probability of having diabetes or prediabetes to an age-matched population. [80] (10.1177/2325967117716450)

References¶

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[2] Treatment of trigger finger in patients with diabetes mellitus. The Journal of Hand Surgery. 1995. DOI: 10.1016/s0363-5023(05)80432-0

[3] Periarthritis of the shoulder and diabetes mellitus.. Annals of the Rheumatic Diseases. 1972. DOI: 10.1136/ard.31.1.69

[4] 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

[5] 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

[6] Predictors of shoulder pain and shoulder disability after one year in diabetic outpatients. Rheumatology. 2008. DOI: 10.1093/rheumatology/ken333

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

[8] Limited joint mobility in diabetes mellitus.. Annals of the Rheumatic Diseases. 1985. DOI: 10.1136/ard.44.2.93

[9] 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

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

[11] 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

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

[13] Immune competence and diabetes mellitus: Pyogenic human hand infections. The Journal of Hand Surgery. 1978. DOI: 10.1016/s0363-5023(78)80140-3

[14] 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

[15] Hand Syndromes Associated with Diabetes: Impairments and Obesity Predict Disability. The Journal of Rheumatology. 2009. DOI: 10.3899/jrheum.090239

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

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