IOH Diabetes Information about Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is a condition called "adhesive capsulitis." It may begin with shoulder pain from overuse or mild injury which causes a person to "favor" the shoulder, not moving or using it to avoid pain. But not using the shoulder makes this condition worse, not better.

While the reason is not known, diabetes is also a risk factor for frozen shoulder. Some scientists feel that it may be related to collagen, a substance in ligaments, that helps hold bones to joints. Because glucose molecules can attach to collagen, it is thought that people with diabetes may deposit abnormal amounts of collagen in cartilage and tendons of the shoulder.

About 20% of people with diabetes have frozen shoulder, a much higher percentage than is seen in the general population (about 5%). Also, those with diabetes may be less responsive to treatment than others so it is important to address this condition as early as possible.

Untreated, frozen shoulder can last from eight months to 17 months or more. Early treatment is important and includes physical therapy and anti-inflammatory drugs as needed.

It is estimated that 10-20% of all persons with diabetes will end up having problems with frozen shoulder. Most commonly affected are women under the age of 40. Even though frozen shoulder is becoming more common (increasing as the rate of diabetes increases) many physicians may still misdiagnose this condition as a torn or injured rotator cuff. If you have diabetes, it is important that you get proper diagnosis for frozen shoulder because early and proper treatment is key to limiting the length and severity of problems.

Many physicians now routinely check for frozen shoulder in patients with diabetes. It is most often seen initially in the dominant shoulder (if you are right-handed, for example, the right shoulder) but can be seen in either or both shoulders.

In the early stages of frozen shoulder, a shot of cortisone directly into the shoulder can prevent full-blown frozen shoulder. However cortisone is dangerous to diabetics as it can raise blood glucose (sugar) levels, so the treatment is typically used only for non-diabetics. Since this early treatment step may not be used in those with diabetes, it is all the more important you get an early and accurate diagnosis for frozen shoulder.

The best thing that you can do to avoid frozen shoulder is to simply keep your blood glucose levels in target range as much as possible. And, if you experience any shoulder or arm pain, or notice your range of motion becoming more limited, see your doctor immediately.

Stage	Length	Description of Symptoms	Treatment Focus
Stage 1 Initialization Stage (inflammatory stage)	0-3 months	Pain, even at rest; reduced ROM⁽¹⁾. Person may notice they cannot reach over head	To lessen pain and inflammation by use of NSAIDs⁽²⁾. Also, ROM exercises are prescribed.
Stage 2 Freezing Stage (fibrotic process)	3-9 months	Chronic pain and ROM⁽¹⁾ becomes worse.	X-rays will show decreased joint space. Treatments may consist of NSAIDs and corticosteroid injections.
Stage 3 Frozen Stage	9-14 months	Shoulder stiffens, significant loss of ROM⁽¹⁾, despite a minor improvement in pain from stage 2, but some pain episodes can still be extreme.	Treatment may involve surgery, physical therapy manipulation, aggressive stretching, and a home exercise program.
Stage 4 Thawing Stage	14-24 months	Minimal pain & progressive improvement in ROM⁽¹⁾. At this stage the pain & active fibor- plasia in the shoulder subsides.	Physical therapy for continued increase of ROM restoration using strength and conditioning exercises.

⁽¹⁾ ROM = Range of motion
⁽²⁾ NSAIDs = Nonsteroidal anti-inflammatory drugs, including aspirin

How frozen shoulder is treated can depend upon what stage you are in at the time of diagnosis (see chart above). But treatment may include:

Even with treatment there may be persistent stiffness and pain. If there is forceful manipulation of the shoulder during surgery, the arm can break. It is important that you have a physical therapist that understands how to treat frozen shoulder in order to prevent making problems worse.

As with many medical problems, the early frozen shoulder is detected, the more favorable the outcome. Keeping blood glucose (blood sugar) levels in check may help prevent further damage and speed recovery.

Frozen shoulder is a progressive disorder and seeing your doctor early may reduce the length of the disorder, as well as help minimize the discomfort and damage.


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		Islets of Hope disorders associated with diabetes