When assessing patients at Absolute Health and Wellness, we often see shoulder issues. We also commonly see patients with Diabetes or another type of blood sugar dysregulation. It’s important as practitioners, and patients alike, to realize there is a connection between shoulder issues and diabetes. Knowing how they relate helps provide our patients the best care and advice.
What is Diabetes?
There are two types of diabetes: type 1 and type 2. They relate to blood sugar management and have different causes and treatments. However, both are afflicted by high blood sugar, or hyperglycemia.
For more information on Diabetes, click here.
Shoulder Issues in Diabetes
There are actually numerous joint disorders associated with diabetes, but shoulder issues are observed quite commonly. As you’ll see below, there are a few main shoulder conditions associated with diabetes, and all are found more commonly in diabetics versus the general population .
Frozen shoulder, or adhesive capsulitis, is a painful loss of shoulder motion, which typically occurs in phases. It starts off with a painful period (lasting 2-6 months) of pain and stiffness. Then it evolves into a less painful period, where stiffness persists with complete loss of certain ranges of motion. It usually has spontaneous improvement in range of motion months to years after the onset.
Frozen shoulder is about 6 times more common in diabetics than non-diabetics . There are a few theories as to how this happens, including inflammation of the synovial fluid, an aligoneurodystrophic process, and fibrotic pathways .
Treatment if focused on pain management, exercise and range of motion as well as reducing inflammation and fibrosis.
The link to blood sugar is evident: it's more common the longer someone has diabetes, and it’s also associated with the extent of hyperglycemia. Frozen shoulder is more common in type 1 diabetics than type 2 .
Calcific Periarthritis of the Shoulder
This is an inflammatory process, defined by degeneration of a tendon (usually supraspinatous) followed by ischemia (reduced oxygen and blood flow). Mechanical strain may result in damage to the muscle or tendon, which results in an immune reaction.
Long term damage like this sees deposits of calcium and collagenous fibers on adjacent tissues. Calcium and collagen deposits can compromise the joint capsule, bicipital tendon and surrounding tissue.
Treating Shoulders In Diabetics
Overall, the treatment for these shoulder issues in diabetics is similar to non-diabetics. However, there are a few key areas we discuss with these patients.
- Blood sugar management: focusing on diet, inflammation, blood sugar, and insulin sensitivity are key to managing diabetics, especially those with shoulder issues
- Taking Things Slow: other research has associated tissue damage and healing in diabetics is slower than non-diabetics, which means our expectations are still positive, but timelines may need to be adjusted for return to activity.
- Integrative Approach: at Absolute Health, we collaboate with our team of health care providers, as they each have a unique approach to your unique case.
Naturopathy: focuses on diet, blood sugar, inflammation, fibrosis
Massage Therapy: focuses on lymphatic drainage, reducing inflammation, and soft tissue work
Acupuncture and Dry Needling can be helpful for a combination of pain management, tissue healing and mobilization. This service is offered by physiotherapists and naturopaths at Absolute Health.
Shoulder issues are more common in diabetics, and it has to do with blood sugar management. Having practitioners who understand the complexities of diabetes and how it affects your shoulder is important for ensuring your treatment plan is comprehensive and gives you the best outcomes. If you’re interested in working with our team, please click here.
About the Author - Sonia Gashgarian
Sonia Gashgarian is a registered physiotherapist who graduated with a Master of Science in Physical Therapy from the University of Toronto. Prior to this she completed her Bachelor of Science in Kinesiology with Honours from the University of Waterloo. Sonia has completed courses in sports taping and basic kinesio-taping, as well as the McKenzie Method of Mechanical Diagnosis and Therapy and Mulligan Concept. She also has her APTEI Acupuncture and Dry Needling Certification.
Sonia uses a variety of treatment techniques to help clients feel better and return to their regular activities as soon as possible. Her individualized treatments may include the following: education, joint mobilizations, exercise prescription, soft tissue release, trigger point release, taping, acupuncture and dry needling, cupping, and Gua Sha.
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