Shoulder pain and dysfunction in Type 2 diabetes mellitus: A cross-sectional study

Patients with diabetes mellitus (DM) often complain of musculoskeletal symptoms. Adhesive capsulitis (frozen shoulder), a debilitating complication of DM is preceded by progressive pain and dysfunction of the shoulder joint. We conducted a cross-sectional study to determine the prevalence of pain and shoulder dysfunction in patients with Type 2 DM.

We enrolled patients with Type 2 DM attending the Out Patient Department (OPD) at a tertiary care hospital. Those with known rheumatological disorders and trauma were excluded. We used three out of five measures (pain, function, and strength of forward flexion) from modified University of California at Los Angeles (m-UCLA) Shoulder Rating Score for assessing shoulder function. Using a goniometer, we measured the range of movement of each shoulder joint from the neutral position and compared it with normal range to determine restriction of movement.

One hundred patients with Type 2 DM completed the study. The male to female ratio was 56:44, and the median duration of diabetes was 6 years (0.5-25). The median hemoglobin A1c (HbA1c) was 7.55% (5.2-13.2). The prevalence of any microvascular complications and macrovascular complications was 59% and 29%, respectively. Using the m-UCLA score, pain and shoulder dysfunction were reported by 60% and 51% of patients, respectively. Using the goniometer, the restriction of range of motion was found in 58% of patients with abduction, flexion, and extension showing maximum restriction. Duration of diabetes was associated with higher scores of shoulder pain but not with scores of dysfunction. No association was found between scores of pain and shoulder dysfunction and degree of glycemic control as assessed by HbA1c.

In patients with Type 2 DM attending an OPD of a tertiary care hospital, more than fifty percent of patients had a mild to moderate degree of pain and shoulder dysfunction.