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Diabetes and Upper-Limb Conditions

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

63 citationsUpdated Sep 2026

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Overview

Diabetes mellitus is a systemic condition that significantly impacts the upper limb, with musculoskeletal impairments that have traditionally been underappreciated but are now gaining clinical attention [11]. The prevalence of these disorders remains high in type 2 diabetes despite advances in medical management [4], and shoulder pain and disability are common and persistent in affected adults [5]. Assessment of upper limb locomotor disease must include an estimate of glycaemic control and a search for other complications [1], with examination of the hands and shoulders included in the standard evaluation of diabetic patients [3]. Upper extremity impairments are both prevalent and significant in this population [6], and musculoskeletal hand disorders were prevalent in type 2 diabetes mellitus patients in Jordan [60].

The clinical presentation often involves multiple conditions and bilateral involvement. In a cohort of 36 patients, both shoulders were involved in 4.5 per cent of cases, with a high incidence of bilateral shoulder involvement noted in insulin-dependent diabetics [2]. Limited joint mobility shows continuing gradual deterioration with increasing disease duration, while finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [8]. Diabetes mellitus is associated with stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility [21]. Hand manifestations often present with multiple visits for hand conditions over time [21], and diabetic patients showed a significantly higher prevalence of multiple digit involvement by stenosing flexor tenosynovitis than nondiabetic patients [19]. The prevalence of frozen shoulder is greater in diabetic patients, although recent data suggest it is less than previously reported [15].

Surgical management carries specific risks, particularly for patients with insulin-dependent diabetes mellitus (IDDM), who have a greater risk of complications following hand and upper extremity surgery [7]. This increased risk is specifically characterized by surgical site infections [7]. Diabetes exacerbates the burden of surgical upper-extremity infections, which are characterized by more proximal locations, deeper involved anatomy, and broader pathogenic microbiology [9]. These infections have an increased need for repeat drainage and carry a higher risk for amputation [9]. More than one third of patients in a clinical series of hand infections were diabetic [12]. Additionally, the presence of diabetes mellitus was the most important factor for developing trigger digit after carpal tunnel release, with severity being less important than its presence [13]. Current evidence supports the efficacy of surgical interventions for the management of upper limb conditions in diabetic individuals [14], though additional research is required to determine whether treatment outcomes are equivalent to those of nondiabetic patients and whether diabetes is associated with an increased risk of complications [14].

Background & Causes

Epidemiology and Prevalence

Upper extremity impairments are prevalent and clinically significant in patients with diabetes mellitus [6]. Shoulder pain and disability are common and persistent in this population [5]. In a study of 36 patients, bilateral shoulder involvement occurred in 4.5 per cent of cases, with a high incidence observed specifically in insulin-dependent diabetics [2]. The frequencies of hand region abnormalities were significantly higher in diabetic subjects compared to controls [33]. The systemic nature of musculoskeletal impairments in people with diabetes has traditionally been underappreciated but is recently gaining attention [11].

Causal Associations and Risk Factors

Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels [27]. A Mendelian randomization analysis supports a genetic causal relationship between type 2 diabetes and fasting glucose and frozen shoulder [61]. A cohort 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 [38]. People with diabetes are more likely to develop frozen shoulder [47]. Strong evidence indicates that diabetes is associated with a higher risk of tendinopathy [35]. The presence of diabetes mellitus, rather than its severity, was the most important factor for developing trigger digit after carpal tunnel release [13]. Conversely, type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome [56]. A patient presenting with a painful shoulder of insidious onset with restricted motion and no intrinsic radiographic cause has a 38.6% chance of being diabetic and a 32.95% chance of being prediabetic [20].

Pathophysiology and Disease Progression

Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic adhesive capsulitis with idiopathic adhesive capsulitis, suggesting they are distinct clinical entities [31]. Matrix metalloproteinase-1 and matrix metalloproteinase-9 are highly expressed in the joint capsule of diabetic frozen shoulder, demonstrating their potential involvement in the pathophysiology [62]. Higher RAGE expression was observed in the flexor tendon synovium of patients with diabetes who had more severe carpal tunnel syndrome, suggesting RAGE-mediated pathways may play a role in the pathophysiology [57]. Molecular and pathological studies provide a potential basis for the predisposition of diabetic patients to the development of carpal tunnel syndrome [58]. Limited joint mobility in diabetes shows continuing gradual deterioration with increasing duration of disease [8]. 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 [18].

Clinical Implications 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 [7]. 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]. Diabetes mellitus is associated with a significantly increased risk of wound healing problems after soft tissue surgery of the hand, including carpal tunnel release and trigger finger release [59]. In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome [16]. Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles [24].

Symptoms & Presentation

Upper limb musculoskeletal abnormalities in diabetes are associated with poor metabolic control [1]. The systemic nature of these impairments has traditionally been underappreciated but is recently gaining attention [11]. In a cohort of 36 patients, both shoulders were involved in periarthritis of the shoulder associated with diabetes mellitus [2]. This condition has a high incidence in insulin-dependent diabetics [2]. While the association between metabolic control and shoulder disorders has yet to be clearly shown, frozen shoulder might be associated with the duration of diabetes [18]. The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients [15]. Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic adhesive capsulitis with idiopathic adhesive capsulitis [31].

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 [20]. The same presentation carries a 32.95% chance of being prediabetic [20]. 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 [34]. In the context of diabetic frozen shoulder, patients with and without diabetes experienced similar pain except during exertion [28]. 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 [52].

Diabetes mellitus is associated with a variety of hand manifestations including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility [21]. These hand manifestations often present with multiple visits for hand conditions over time [21]. The frequencies of hand region abnormalities were significantly higher in diabetic subjects as compared to the controls [33]. More than one third of patients in a clinical series of hand infections are diabetic [12]. There was an increased severity of hand infections in diabetic patients treated during the COVID-19 pandemic, linked to poor glycaemic control [26].

Management

Assessment and Preoperative Considerations

Patients presenting with ischemia of the hand in the context of vascular disease require a thorough workup, including evaluation of wrist pulses and use of a pencil Doppler if pulses are absent [39]. In the absence of a palpable pulse, the presence of a pulse detected by Doppler is not a sign of adequate nutritive flow to the hand [39]. 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 [39]. 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 [39]. 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 [54].

Non-Operative Management

Corticosteroid Injections: 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 [17]. Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients [22].

Alternative Therapies: Radial extracorporeal shock-wave therapy (rESWT) might be considered a safe alternative to steroid injections in diabetic patients with shoulder adhesive capsulitis [51]. Platelet-rich plasma injection is a safe and well-tolerated method for adhesive capsulitis management for diabetic patients [43].

Exercise: Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed [10].

Operative Management: Carpal Tunnel Syndrome

Patients with diabetes have the same beneficial outcome after carpal tunnel release as nondiabetic patients [30]. Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes [32]. The duration of diabetes and its treatment can be related to the severity of the disease symptoms after carpal tunnel releasing surgeries [48]. 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 [55].

Operative Management: Frozen Shoulder

The results in diabetics were significantly worse than those in non-diabetics six months post-operatively after arthroscopic release for frozen shoulder, with a tendency towards persistent limitation of movement two years after operation [29]. An initial failure rate of approximately one-third for manipulation under general anesthesia (MUA) 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 [36]. When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with insulin-dependent diabetes mellitus (IDDM) and those with non-insulin-dependent diabetes mellitus (NIDDM) [49]. Arthroscopic capsular release (ACR) offered good outcomes in both diabetic and non-diabetic patients in terms of range of motion, pain relief and shoulder function [50]. Patients with and without diabetes experienced similar pain except during exertion regarding range of motion recovery in diabetic frozen shoulder [28].

Operative Management: Trigger Finger

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 [41]. 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 [44].

Surgical Complications and Infection

More than one third of patients in a clinical series of diabetic hand infections are diabetic [12].

Amputation and Replantation

In patients with factors or injury characteristics that contraindicate single-digit replantation, such as advanced age, diabetes mellitus, or smoking, revision amputation is indicated [37]. Arterial occlusive disease in the distal upper extremity is primarily related to the combination of diabetes, renal disease, and often organ transplantation [40].

Key Considerations

Prevalence and Assessment

Diabetes is a significant comorbidity in hand and upper-limb pathology. In a clinical series of hand infections, more than one third of the patients were diabetic [12]. For frozen shoulder, there is continuing gradual deterioration of limited joint mobility with increasing duration of disease [8]. When a patient presents with a painful shoulder of insidious onset and restricted motion, and an intrinsic cause can be ruled out radiographically, the probability of underlying metabolic dysfunction is substantial: the patient has a 38.6% chance of being diabetic and a 32.95% chance of being prediabetic [20].

Risk Factors and Causality

Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels [27]. Bilateral involvement is common; in 36 patients (4.5 per cent.), both shoulders were involved in periarthritis, and there was a high incidence in insulin-dependent diabetics [2].

Surgical Outcomes and Complications

The best current evidence supports the efficacy of surgical interventions for the management of upper limb conditions in diabetic individuals [14]. However, additional research is required to determine whether treatment outcomes in diabetic patients are equivalent to those of nondiabetic patients [14], and whether diabetes is associated with an increased risk of complications in upper limb surgery [14].

Frozen Shoulder Interventions: * Arthroscopic Release: Results for arthroscopic release of frozen shoulder in diabetics were significantly worse than those in non-diabetics six months post-operatively [29]. There is a tendency towards persistent limitation of movement two years after arthroscopic release for frozen shoulder in diabetic patients [29]. However, there were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus [64]. * Manipulation Under Anesthesia (MUA): An initial failure rate of approximately one-third for manipulation under general anesthesia (MUA) for frozen shoulder in diabetic patients may be considered unacceptably high in other general orthopedic procedures [36]. With appropriate counseling and consent and combined with a repeat MUA for recurrence, the MUA protocol may represent a satisfactory treatment strategy in the diabetic population [36].

Carpal Tunnel Release: 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 [63].

Shoulder Arthroplasty: Future prospective research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes [42].

Perioperative Management and Medical Considerations

A collaborative and comprehensive approach to the pre-operative medical evaluation of patients with diabetes is critical for shoulder arthroplasty [46]. Future investigation into alternative methods associated with outcomes after shoulder arthroplasty in patients with diabetes is required [46]. Regarding glycemic control, data did not support the guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery overall [45]. In a hand and upper extremity surgery clinic, the incidence of poorly controlled blood glucose in the community was high, but the rate of diabetes follow-up was surprisingly high and timely [65].

Research Gaps

The findings of a study on low-level laser therapy versus muscle energy technique may provide evidence on the efficacy of these interventions and the optimal treatment approach for frozen shoulder related to diabetes [25].

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)
  • [L4] Shoulder pain and disability are common, and persistent in adults with diabetes. [5] (10.1093/rheumatology/ken333)
  • [L3] These findings suggest that upper extremity impairments are prevalent and significant in this population. [6] (10.1016/j.physio.2014.07.003)
  • [L2] Our data demonstrate a greater risk of complications following hand and upper extremity surgery for patients with IDDM, specifically surgical site infections. [7] (10.1016/j.jhsa.2018.06.006)
  • [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)
  • [L4] The systemic nature of musculoskeletal impairments in people with DM traditionally has been underappreciated but recently is gaining attention. [11] (10.1016/j.foot.2020.101680)
  • [L4] Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic. [12] (10.1016/s0749-0712(21)00424-8)
  • [L4] The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit. [13] (10.1016/j.jhsa.2013.10.023)
  • [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. [14] (10.1016/j.jhsa.2011.10.002)
  • [L3] The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients. [15] (10.1016/j.jse.2007.02.133)
  • [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)
  • [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. [17] (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. [18] (10.1111/jdi.12491)
  • [L2] Diabetic patients showed a significantly higher prevalence of multiple digit involvement by stenosing flexor tenosynovitis than nondiabetic patients. [19] (10.3899/jrheum.081024)
  • [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. [20] (10.1097/smj.0b013e3181705d39)
  • [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. [21] (10.1016/j.jhsa.2008.01.038)
  • [L3] Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. [22] (10.1016/j.jhsa.2014.01.014)
  • [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] The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice. [25] (10.1186/s13018-024-04735-7)
  • [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. [26] (10.1177/17531934231196026)
  • [L1] Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels. [27] (10.1371/journal.pgen.1009577)
  • [L3] Patients with and without diabetes experienced similar pain except during exertion. [28] (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. [29] (10.1302/0301-620x.96b10.34476)
  • [L2] Patients with diabetes have the same beneficial outcome after carpal tunnel release as nondiabetic patients. [30] (10.1016/j.jhsa.2009.04.006)
  • [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. [31] (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. [32] (10.1016/j.jhsa.2014.01.012)
  • [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). [33] (10.1186/1756-0500-6-16)
  • [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. [34] (10.1177/2325967117716450)
  • [L1] These findings provide strong evidence that diabetes is associated with higher risk of tendinopathy. [35] (10.1136/bjsports-2015-094735)
  • [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. [36] (10.1016/j.jse.2011.11.006)
  • [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. [38] (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. [41] (10.1016/j.jhsa.2018.03.045)
  • [L2] Future prospective research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes. [42] (10.1016/j.jse.2014.01.046)
  • [L3] Additionally, it is a safe and well-tolerated method for AC management for diabetic patients. [43] (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. [44] (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. [45] (10.1177/1558944720937363)
  • [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. [46] (10.1007/s00264-018-3874-2)
  • [L1] People with diabetes are more likely to develop frozen shoulder. [47] (10.1136/bmjopen-2022-062377)
  • [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. [48] (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. [49] (10.1067/mse.2002.127301)
  • [L3] ACR offered good outcomes in both diabetic and non-diabetic patients in terms of range of motion, pain relief and shoulder function. [50] (10.1016/j.jor.2019.02.003)
  • [L2] Therefore, rESWT might be considered a safe alternative to steroid injections in diabetic patients with shoulder AC. [51] (10.1016/j.jse.2020.03.005)
  • [L4] However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. [52] (10.1016/j.otsr.2019.02.014)
  • [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. [54] (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. [55] (10.1016/j.jhsa.2025.09.003)
  • [L3] Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome. [56] (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. [57] (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. [58] (10.1007/s00125-014-3271-3)
  • [L3] Diabetes mellitus is associated with a significantly increased risk of wound healing problems after soft tissue surgery of the hand (CTR and TFR). [59] (10.1016/j.jhsa.2021.05.009)
  • [L4] In the present study, musculoskeletal hand disorders were prevalent in T2DM patients in Jordan. [60] (10.1111/1756-185x.12617)
  • [L1] This study supports a genetic causal relationship between type 2 diabetes and fasting glucose and frozen shoulder. [61] (10.1016/j.jse.2023.08.006)
  • [L4] The findings of this study demonstrate the potential involvement of MMP-1 and 9 in the pathophysiology of diabetic FS. [62] (10.1016/j.jse.2024.03.062)
  • [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. [63] (10.1136/bmjopen-2019-030179)
  • [L3] There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus. [64] (10.1016/j.jseint.2023.06.007)
  • [L4] The incidence of poorly controlled blood glucose in the community was high, but the rate of diabetes follow-up was surprisingly high and timely. [65] (10.5435/jaaos-d-23-00593)

References

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[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

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

[7] 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

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

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

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

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[14] Impact of Diabetes on Outcomes in Hand Surgery. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.10.002

[15] 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

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

[17] 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

[18] Diabetes and shoulder disorders. Journal of Diabetes Investigation. 2016. DOI: 10.1111/jdi.12491

[19] The Presence of Limited Joint Mobility Is Significantly Associated with Multiple Digit Involvement by Stenosing Flexor Tenosynovitis in Diabetics. The Journal of Rheumatology. 2009. DOI: 10.3899/jrheum.081024

[20] The Prevalence of a Diabetic Condition and Adhesive Capsulitis of the Shoulder. Southern Medical Journal. 2008. DOI: 10.1097/smj.0b013e3181705d39

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

[22] 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

[24] 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

[25] Comparative effectiveness of low-level laser therapy versus muscle energy technique among diabetic patients with frozen shoulder: a study protocol for a parallel group randomised controlled trial. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04735-7

[26] The incidence and severity of diabetic hand infection presentations during the COVID-19 pandemic. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231196026

[27] 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

[28] Range of motion of diabetic frozen shoulder recovers to the contralateral level. Journal of International Medical Research. 2016. DOI: 10.1177/0300060516675112

[29] 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

[30] Clinical Outcomes of Surgical Release Among Diabetic Patients With Carpal Tunnel Syndrome: Prospective Follow-Up With Matched Controls. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.04.006

[31] 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

[32] 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

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