Hey, it's winter... and frozen shoulder definitely sounds like something you might get after shoveling snow for too many hours — but it's actually one of several less-common complications of diabetes. Shoulder problems certainly aren't the first thing that comes to mind when it comes to diabetes. Most of our complications deal with vital, internal organs. But let's face it, the effects of excess sugar in the bloodstream seem to know no bounds!
We've been covering the various complications of diabetes in our 411 series, and (sorry to say), we're not done yet. In fact, frozen shoulder is just one of five musculoskeletal complications that can affect people with diabetes.
Frozen shoulder, more formally called "adhesive capsulitis," actually has nothing to do with the weather and everything to do with the ligaments in your shoulder. Frozen shoulder occurs when your shoulder joint capsule sticks to the head of the humerus bone. This causes extreme pain and stiffness in the shoulder joint and eventually leads to immobility, followed by a long period of "thawing" in which the shoulder slowly returns to normal.
Where does the diabetes come in?
Well, doctors still aren't exactly sure. But they believe that excess glucose impacts the collagen in the shoulder. Collagen is a major building block in the ligaments that hold the bones together in a joint. When sugar molecules attach to the collagen, it can make the collagen sticky. The buildup then causes the affected shoulder to stiffen, and the pain prevents you from moving your arm. Ouch!
Frozen shoulder is estimated to affect about 20% of people with diabetes, compared with only 5% of people without diabetes, so clearly high blood sugar is a big risk factor.
Diagnosis + Treatment
If your initial pain doesn't go away with the usual pain relievers, it's probably time to check with a doctor. That's because frozen shoulder can take up to two years to go away on its own! So this is definitely not something to be ignored. If you need more proof not to mess around with shoulder pain, check out these conversations from patients over at DiabetesDaily who are dealing with frozen shoulder. One patient has been struggling with his frozen shoulder for 10 years!
Of course, shoulder pain does not automatically mean frozen shoulder. There are lots of different causes of shoulder pain, so it's important to ask your doctor why he or she is giving you a particular diagnosis, so you can make sure you're not needlessly suffering or undergoing treatments that aren't going to work. Tests of your range of motion or undergoing imaging exams, like X-rays or MRIs, can help rule out other causes of shoulder pain.
Once you have the diagnosis of frozen shoulder, heating pads and aspirin or ibuprofen can help with the pain that intensifies when you're moving. Ironically, experts say that keeping the shoulder moving with physical therapy — even with stiffness and pain — is actually crucial for recovering from frozen shoulder. Essentially, lack of use begats more lack of use and stiffness, so if possible, you need to work through the pain and keep your muscles moving.
"I think the best thing is finding a great physical therapist," writes Susie, a type 1 PWD sharing in the aforementioned DiabetesDaily thread. "Mine did some amazingly painful stretches, but they seem to help get the mobility back. Plus I constantly stretched at night and during the day."
Another option for patients is steroids injections, but steroids can cause a huge rise in blood sugars and some patients may find that it only offers temporary relief from the pain.
If all else fails, surgery might be in order. Shoulder arthroscopy is an outpatient procedure that removes scar tissue and frees ligaments, and afterwards, patients immediately undergo physical therapy. Some doctors are advocating the use of surgery as a first-line treatment, because they believe it can help speed up the healing process and restore mobility faster than physical therapy. Others say surgery should be used as a last resort, because frozen shoulder usually heals on its own... eventually.
In the online chats, one type 2 PWD says it's all about the sleep issue. Two doctors believed surgery was her best bet, and "the surgery was a piece of cake," she writes. "The post-op was not fun, but so worth it. I have 95% range-of-motion back and sleep like a baby. It is common with diabetics and yes, if you can wait it out, it can go away, but I couldn't go without sleep for another year and a half."
Because doctors don't really understand the causes of frozen shoulder, it can be difficult to prevent it in most cases. Keeping your blood sugars under control is always key to avoiding all complications. Doctors have also found that people who've suffered an injury to their shoulder or stroke are also at an increased risk of frozen shoulder, because of the immobility the other condition has caused.
If you have diabetes and have had a shoulder injury, talk to your doctor or a physical therapist about what kind of exercises you can do to make sure frozen shoulder doesn't happen to you.
OK, and we just had to share this goofy promo video for a doctor based in Scotland who treats diabetics with frozen shoulder. You've got to hand it to him for coming up with his own superhero:
Have you dealt with frozen shoulder? If you have any experiences with physical therapy or surgery, we'd love to hear your 2 cents!