Looks more like "hot shoulder"
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.”
Prevention
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!
Great information. Thank you for posting. I first learned about frozen shoulder when Elizabeth Snouffer wrote about her case on Diabetes 24/7. http://www.diabetes24-7.com/?p=306. It’s a very helpful post.
Frozen shoulder is also very often the result of Hypothyroidism. If you have type 1 then the chances you get Hashimotos, Graves or hypothyroidism are greatly increased. The best way to find out is through a blood test to see where your TSH levels are at. If they are 4 and higher you are definitely elevated. My Endo likes my levels around 1 because I have both type 1 and Hypothyroidism. Correct your TSH levels and the chances you get rid of your frozen shoulder will greatly increase.
You’re absolutely correct that doctors don’t completely understand why frozen shoulder happens. My orthopedist mentioned that it is somewhat like chicken pox in that once you get it, you are very unlikely to get it again in the same shoulder. Once you’ve had it in each shoulder, you are very unlikely to get it again at all. Unfortunately PWD are more at risk for reoccurence.
This indicates that there is more than glucose involved in frozen shoulder. It may have an autoimmune component. Unfortunately it’s just not known.
About 10 years ago I had frozen shoulder in one shoulder following an injury. After that healed I got it in the second shoulder for no apparent reason. I keep my fingers crossed that my orthopedist is correct that it is unlikely that I will ever have frozen shoulder again.
A few years ago, my left shoulder froze. Getting a diagnosis was difficult. The pain would come and go, so they didn’t believe me. Eventually I was unable to raise my arm above my waist in the back, making getting dressed (fastening waistbands on skirts) particularly challenging. I was constantly taking asperin all day long. My doctors didn’t want to admit that it was frozen shoulder or a complication of my diabetes, because my bg numbers were better that most and complications are viewed as failure. It’s a box they don’t like to tick. Finally, I switched health care plans (this was only part of the reason; they were incompetent in other, more dangerous ways) and I found a doctor who actually cares. He sent me to PT and I got range of motion back.
I went through about 9 months of PT making little to no progress before deciding to have surgery. I do wish I had tried surgery either. Surgery is NOT a quick fix – you’ll be in PT for months post-op as well. After surgery I diligently did an hour of exercises and stretches a day.
Pre-op, I could only gain a few degrees of freedom in a PT session; post-op I’d make leaps and bounds which made it easier to stay the course.
If I could change what happened, I would have:
* gotten a steroid shot as soon as possible as it can stop the progression
* not listened when the first doc said it was not frozen shoulder; I should have fought for a PT prescription regardless of what the doc thought it was
* tried surgery earlier
The steroid shot affected my blood sugars for about a week. First day was 3X the insulin, last day I was back to 1X. My CGMS graphs show a nice linear falloff over those seven days.
I’m sorry to anyone else going through this!
I have almost full range of motion left – the only thing I cannot do is full external rotation, but that is not a very functional pattern of motion.
Well said Allison! As a massage therapist, I can tell when someone has diabetes because the connective tissue feels tougher. It feels thick and lacking elastic, almost like it is a buffer between the skin and the muscles, I’m trying to reach. What I have been told is that frozen shoulder among PWD is increased if they have lived with diabetes 15 years or more, or if they lack a bg sugar control.
I had a torn rotator cuff a few years ago, which developed into frozen shoulder. I still have a little limited range of motion, but no pain. However, this year I developed full blown frozen shoulder on the right side, which is not uncommon to have the other shoulder suffer the same. I’m actually about to begin a treatment called dry needling, which is similar to acupuncture, but done by physical therapists.
The last resorts should be cort. injections as there tend to make bones more porous over time and surgery adds scar tissue and limits range of motion again.
This article was very interesting and connects the dots for me as I’m a type 1 diabetic and have been for more than 40 years. I experienced frozen shoulder several years ago and thought it was the result of painting the walls in my living room…I vowed never again to paint another room. I tried pt for a short time along with a cortisone shot…all to no avail. I then opted for surgery and it was the best thing I could have done. Sure, the post-op pt was a little painful, but before I knew it, I had full range of motion. Now, my left shoulder is experiencing the same problem. I’m active playing tennis and really need the motion of my left arm, but I haven’t yet made the step towards surgery…but I will at some point in the near future. Thanks for an informative article, it made my day.
I have had this in both shoulders. It is painful and debilitating, but it does seem to heal completely. It’s been over three years since my second shoulder went through this and I can’t feel any difference in either one. It is a long two years however.
Interestingly, my golf game was improved when my left shoulder was frozen, and completely impossible when my right shoulder was frozen.
i am suffering with a frozen left shoulder. it has been about 2years now, and they say that it should “thaw” on its own in about this time. i have gone through months of PT to no avail. also steriod shots, which accomplished nothing. my right shoulder was frozen in 1998/99 or so, and i did physio and steroids, and what finally “thawed” it was working in a grocery store, as a cashier and using that repetetive cross swinging motion to scan groceries! unfortunately that wont work this time, as i scan from right to left LOL! however, after watching your video, i noticed another video on something called Trigenics, and i am looking into this further. i am going to call the Clinic here in Toronto and see what it is all about. it looks promising. i will let you all know!
It’s important to be aware that adhesive capsulitis can also affect the hips. I had it in both shoulders (at the same time!) ten years ago, and now have it in my left hip. Only cure I’ve found is a good therapist and constant stretches and yoga.
I’ m type 2 & I’ ve pain in left shoulder. I get relief with PT & sometimes I take a mild pain killer. I think I don’t need surgery at this stage.
Zack Niv did his DPT thesis on adhesive capsulitis. His research findings indicate that manual PT is extremely effective in resolving adhesive capsulitis. HOWEVER (and I am sorry to say this) other research has shown that 35% of adhesive capsulitis in diabetics DOES NOT RESOLVE. Not through surgery or multiple cortisone shots or physical therapy…it gets better or worse but not cured.
Myra Susan Shoub Ph.D.
I am in the middle of dealing with this painful syndrome. I have been seeing an orthopedist who is very knowlegable in frozen shoulder and we have both elected to forego physical therapy for my condition. The reasons are that the lastest research is showing that comparing those who seek physical therapy versus those who don’t, there is no difference in the recovery times or the range of motion that is recovered. Movement, however is important and I have some very easy at-home exercises that I use. Great article on a little known condition of diabetes
I am a Massage Therapist and am constantly amazed that with a number of conditions, including Frozen Shoulder, Massage is overlooked as a beneficial treatment. I have found Therapeutic Massage is very helpful, in conjunction with Physical Therapy, in reducing pain, and increasing mobility, by increasing circulation and clearing trigger points. It makes those painful stretches easier to bear.
Sooo, if she had frozen shoulder, I wouldn’t expect her to lift her arms that high… not being mean, just having experience……
Direction of movement not altitude. Problem isn’t over the shoulder but up from behind, raising the other arm to meet that hand. Arm reaching may not be side that’s frozen but the opposite side. This causes problems when managing fastenings in the back of clothing (zippers, waistbands, etc.) or trying to wash one’s back.
I HAVE HAD THIS FROZEN SHOULDER FOR 4 YEARS, AND I SUFFERING SO MUCH WITH IT, BEEN TO PT HAD THE SHOTS, CAUSED MY SUGAR LEVELS TO FLY. HAVE SEEN 3 SPORTS DOCTORS, AND NONE OF THEM WANT TO TOUCH ME? SO I FIND A DOCTOR WHO WANTS TO TRY BUT SAYS HE CANNOT PROMISE ME THE GOOD OUT COME, ITS 50/50 HE SAYS. I BELIVE I WILL TRY IT AND HOPE FOR THE BEST. HAS ANYONE HAD THERE SHOULDER CLEANED OUT AND BONE SHAVING? AND DID IT WORK OUT FOR YOU? THANK YOU CA.
I had frozen shoulder on my left side for about 3 years. I tried EVERYTHING (acupuncture, massage, chiropractors, pt, yoga, cotisone, other therapeutic things I can’t remember the name of) and it still took 3 years to clear up. Nothing seemed to work until I tried PRP (platelet rich plasm) injections. They worsened the stiffness for a short while but completely aleviated the pain. I now have it in my right shoulder (20%) of people get it on both sides. I am doing very extensive pt and will get another PRP shot if the pain still continues at this unbearable level. Yoga has been extremely helpful as well. It bides me about 12 hours of no pain. Lastly, 10 years ago I had frozen hips. I think it was not as bad a stage shoulder because you have no choice but to use your hips most of the day.
Has anyone tried magnesium oil? I have heard it works for frozen shoulder (I have not been dx’d but I think that is what I have0 and am going to buy some.