Author: Erika Kruger Massage therapists are very familiar with the signs and symptoms of adhesive capsulitis (AC), the chronic fibrosing condition of the shoulder joint capsule, also known as frozen shoulder, shoulder periarthritis, or obliterative bursitis. But what is not readily known is that diabetes mellitus is one of the risk factors for this condition. In fact according to Dr Gordon Cameron, “(s)ome experts think that shoulder problems in diabetics are so common that they should be regarded as a complication of diabetes and not a coincidental event”. A variety of conditions involving contractures in joints and peri-articular soft tissue and accompanying joint mobility limitations have been identified in diabetic patients (Friedman 1989). In young, insulin-dependent diabetics it involves mostly the small joints of the hands and is usually less painful while in older diabetics, the large joints of the upper extremities also develop contractures. (Friedman 1989, Smith, Burnett & McNeil 2003:30) The most disabling of the common musculoskeletal problems in diabetics, is AC. The condition is characterised by progressive, painful restriction of shoulder movement. It develops in up to 20% of diabetic patients (Cameron) and is seen in especially insulin dependent diabetics with type 1 diabetics. According to Walk, the numbers may exceed 35%. Patients with diabetes are also more difficult to treat, take longer to heal and may be left with some residual trouble even with treatment. Furthermore there is a link with the duration of diabetes and the age of the patient (Smith et al 2003:30). Causes and Risk Factors AC is usually classified as either a primary condition or a secondary condition. Primary or idiopathic AC refers to cases where there are no significant and specific reasons for the pain and immobility. It arises spontaneously with no obvious preceding trigger factor. The secondary type of frozen shoulder develops after trauma, surgery or illness. Patients presenting with diabetes as well as a number of other medical conditions such as hyper- and hypothyroidism, cardiovascular disease, tuberculosis and Parkinson’s disease, appear to be predisposed to develop secondary AC. The natural history of the disease is characterised by three distinct phases: painful, adhesive, and resolution phases (Smith et al 2003:30). The painful phase starts with the gradual onset of an aching shoulder developing into a widespread pain pattern often worst at night and when lying on the affected side. This phase can last anywhere between 2-9 months. During the next phase stiffness starts to become a problem although pain level usually does not alter. The affected shoulder starts to interfere with daily tasks such as dressing, preparing food, carrying bags and working. Muscle wastage may be evident due to lack of use. This stage can last between four to...
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