ذیابیطس اور اوپری ٹانگوں کی بیماریاں

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