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Diabetes and Upper-Limb Conditions

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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 Sep 2026
A fingertip blood-glucose drop beside a small glucometer.
Diabetes makes several hand conditions — trigger finger, carpal tunnel, stiffness — more common and slower to settle. Kieran Hirpara 4.0

What you're feeling

If you have diabetes and your shoulder or hand has started to hurt, you are not alone. Shoulder pain and stiffness are common in adults with diabetes, and they often come on slowly rather than after an injury. The pain tends to sit deep in the shoulder and builds over weeks. Reaching overhead, hanging out washing, or lifting a kettle can get harder. Night-time is often the worst, and lying on that side can wake you.

Your shoulder may also feel stiff. Turning your arm to scratch your back or reach into a back pocket becomes difficult. Both shoulders can be affected, though this is less common. Frozen shoulder, where the lining of the joint tightens and limits movement, happens more often in people with diabetes than in people without it.

Your hands can be affected too. Diabetes is linked with several hand problems: trigger finger, where a finger catches or locks as you bend it; Dupuytren's contracture, where cords in the palm pull fingers toward it; carpal tunnel syndrome, which causes tingling and numbness in the fingers; and limited joint mobility, where stiff finger joints make it hard to lay your palm flat on a table. These problems often appear one after another over time, so you may find yourself back for hand issues more than once.

Hand infections are also more likely when you have diabetes, and they can be more serious. More than one third of patients in a clinical series of hand infections were diabetic. If your blood sugar levels have been running high, infections can be worse and slower to settle.

The stiffness in your finger joints tends to worsen gradually the longer you have had diabetes, and finger contractures usually only appear after nine years or more. If your shoulder became painful and stiff slowly, with no clear injury, it is worth mentioning your diabetes to your doctor, as the two can be connected.

What's actually happening

High blood sugar affects more than just your blood vessels and nerves. Over time, it changes the tissues that hold your joints together and let them glide smoothly. In your shoulder, the joint is wrapped in a stretchy lining, a bit like a loose sleeve around the joint. When diabetes is involved, that sleeve can become inflamed and then tighten and shorten. Once it shrinks, there is less room for your arm to move, which is why reaching up or behind your back becomes hard and painful.

In your hands, the same process affects the small tunnels and cords that guide your finger tendons. A tendon is a strong rope of fibres that connects muscle to bone, and it slides through a snug tunnel each time you bend a finger. If the tunnel lining thickens, the rope catches as it slides, and the finger clicks or locks. Thickened cords can also form in the palm and pull a finger bent, and the nerve in your wrist can be squeezed where it passes through a narrow channel.

There is a clear pattern here. Diabetes is linked with frozen shoulder, trigger finger, Dupuytren's contracture, carpal tunnel syndrome and limited joint mobility. These are not five separate bad luck events. They share a common cause: the same high sugar levels damaging connective tissue throughout your body. That is why these problems often turn up one after another, and why both shoulders or several fingers can be affected over time.

It also explains why your doctor will ask about your diabetes when a shoulder or hand problem appears. The connection works in both directions: a painful, stiff shoulder with no injury behind it can sometimes be the first sign that blood sugar has been running high. Knowing this shapes the plan, from the tests that are done to how your blood sugar is managed around any treatment.

What we can do about it

The first step is usually the simplest. Gentle movement and physiotherapy aim to keep the joint and tendons as mobile as possible, and to build the strength around them. This approach works best when it starts early, before stiffness settles in. Give it a fair go over several weeks before deciding whether it is helping. Keeping your blood sugar in range matters here too, because high levels are what drive the tissue changes behind these problems.

If self-management is not enough, there are medical options. Anti-inflammatory medicine can settle pain and swelling. Corticosteroid injections, which are anti-inflammatory medicine placed directly into the painful area, can help too, but they come with a trade-off if you have diabetes. They can raise your blood sugar for a short time afterwards, and the rise is bigger and lasts longer if your HbA1c (a measure of your average blood sugar over recent months) is 7% or higher. If you use insulin or check your sugars at home, plan for closer monitoring after any injection. Other injection options exist that do not carry this effect, and your doctor can talk through which might suit you.

If symptoms are severe and still troubling you despite the above, your doctor may refer you for a specialist assessment. For some specific conditions, a procedure may occasionally be considered. The good news is that for several of these problems, people with diabetes do just as well as people without it. Carpal tunnel release, the operation that frees the squeezed nerve in your wrist, brings the same lasting relief whether or not you have diabetes. For frozen shoulder, treatment aims to restore movement, and options range from gently moving the shoulder while you are asleep to releasing the tight lining through keyhole surgery. These can work well, though recovery can take longer with diabetes and some stiffness may persist. For trigger finger, a small release procedure can be done through the skin with a needle, and this works equally safely in people with and without diabetes. Your doctor will also check the blood supply to your hand before any surgery, because narrowed vessels can affect healing. Whatever is proposed, you will be told honestly how diabetes changes the plan, the recovery, and what to expect afterwards.

What to expect

The honest answer is that diabetes changes the pace of recovery more than the destination. For carpal tunnel syndrome, people with diabetes get the same lasting relief from surgery as people without it, and that improvement holds up over the years. For trigger finger, a needle release works just as safely and effectively whether or not you have diabetes.

Frozen shoulder is the one where diabetes makes a real difference. After keyhole surgery to release the tight lining, results in people with diabetes are worse at six months than in people without it, and there is a tendency for some stiffness to still be there two years later. One option, gently moving the shoulder while you are asleep, does not work for about one third of people with diabetes the first time, and may need to be repeated if the stiffness comes back. With the right counselling and consent, this can still be a workable plan. When the shoulder can be mobilised with gentle manipulation, outcomes have been satisfactory for people with and without insulin dependence. Keyhole release itself has brought good outcomes in movement, pain relief and shoulder function for people with and without diabetes.

Some things are worth knowing before any of this. People with diabetes tend to have more symptoms both before and after carpal tunnel surgery, but the relative improvement from the operation is the same. How long you have had diabetes and how it has been treated can relate to how severe your symptoms are after carpal tunnel release. There is no hard cutoff for blood sugar control before elective hand surgery, though your team will want your diabetes well managed around any procedure. If your shoulder or hand problem is severe, or the blood supply to your hand is in question, your doctor may arrange detailed imaging of the vessels before deciding on surgery.

What tends to happen if these problems are left alone? Stiffness, especially in the fingers, worsens gradually the longer you have had diabetes. Shoulder stiffness can persist without treatment. Early movement and keeping your blood sugar in range give you the best chance of avoiding that path.

When to see someone

See your GP if a shoulder or hand problem keeps coming back, especially if you have diabetes or your blood sugar has been running high. Hand infections deserve quick attention. If a hand becomes painful, red, swollen or warm, get it checked promptly, because infections in people with diabetes can be more serious and slower to settle. Go to an emergency department if an infection is spreading, if you feel feverish or unwell, or if a hand or finger is rapidly getting worse. Ask for a specialist review if a shoulder has become painful and stiff slowly without any injury, or if stiffness is stopping you reaching overhead or behind your back. The same applies if a finger is catching or locking, if tingling or numbness in your fingers is disturbing your sleep, or if stiff finger joints are making everyday tasks harder. Because these problems often appear one after another, mention any past shoulder or hand troubles as well.

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].
  • 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

[19] Aaos Comprehensive Orthopaedic Review 3. Orthoses, Amputations, and Prostheses > V. Upper Limb Amputations.

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

[21] 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

[23] Green S Operative Hand Surgery. Vascular Disease > Preoperative Evaluation.

[25] Green S Operative Hand Surgery. Vascular Disease.

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

[27] 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

[28] 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

[29] 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

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

[31] 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

[33] 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

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

[35] 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

[36] 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

[37] 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

[38] 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

[39] 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

[40] 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

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

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

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.