This week, our article will be discussing the impact that diabetes can have on shoulder pain. For access to the article and the information summarized and referenced in this post, please refer to the Resource section at the bottom of the page.

Diabetes has become a prevalent disease, which can cause some very harmful side effects to the body, if not properly managed. Many are not aware that diabetes can commonly cause pain and limitations with our musculoskeletal system (a.k.a. Our joints, muscles, tendons, ligaments, etc.). Shoulder pain is an example of this.

This brief, but informative, article talks about how diabetics have been noted to have a higher risk and incidence of developing shoulder pain. This will usually involve painful restrictions related to decreased shoulder range of motion (ROM) and strength. As a result, the person affected will have a more difficult time performing daily activities, such as reaching, lifting, dressing, etc.

According to the article, those with diabetes have a 27.5% higher chance of developing a shoulder issue compared to those without diabetes. That’s quite a bit!

We’re going to take a look at the primary shoulder issues those with diabetes are more likely to experience, as well as why there is a higher chance of these individuals developing these shoulder problems.

Most Common Shoulder Disorders Among Diabetics

The two primary shoulder issues that those with diabetes seem to be most susceptible to include the following:

1.   Frozen shoulder (a.k.a. Adhesive capsulitis)

2.   Rotator cuff disease

The article does an excellent job reviewing the basic differences between these two shoulder disorders.

Briefly, frozen shoulder is a gradual onset of pain, significant stiffness and limited ROM in the shoulder. It usually causes individuals to experience pain at night time, and certain shoulder directions will be more limited than others, especially the motion of external rotation.

The exact cause behind frozen shoulder still remains a bit of a mystery, but the general consensus is that there is an occurrence of excessive inflammation and the presence of fibroblasts.

Fibroblasts make collagen and other proteins necessary for our connective tissues. They are very important workers in the body; however, if they become a bit over-eager, they can cause some issues. With regards to frozen shoulder, too many fibroblasts can cause a build-up of scar tissue in and around a joint. This will lead to tightening and restrictions within the joint, hence why the shoulder would become “frozen.”

As mentioned above, the cause behind frozen shoulder is not well-known, but you can be at higher risk if you’ve had a recent injury, surgery, a period of shoulder immobilization, or may have something in your medical history that places you at a higher risk of developing it, such as diabetes.

Rotator cuff syndrome is a generally way of describing some type of issue specifically occurring in one or more of the four rotator cuff muscles. This could involve rotator cuff inflammation, a tear, or overuse issue. Those with rotator cuff syndrome will usually have pain in and around the rotator cuff muscles, along with decreased strength and ROM, as a result of pain.

While rotator cuff syndrome is commonly associated with specific injuries, such as with sports, a fall, or repetitive overuse, similar to frozen shoulder, a piece of your medical history could make you more likely to develop rotator cuff syndrome. This is, again, the case with diabetes.

How Diabetes Can Cause Shoulder Issues

While we won’t get into as much depth behind the science of why diabetes can cause these shoulder issues like the article does, let’s take a look at a brief overview of the potential issues diabetics might face.

The article discusses 3 primary ways in which diabetes can cause frozen shoulder or rotator cuff syndrome:

1.   Ongoing inflammation

2.   Poor circulation

3.   Advanced glycosylation end-products (AGEs)

High blood sugar, or hyperglycemia, is a driving force behind all of these issues and is a common complication with diabetes.

The article talks about how diabetes is affected by non-enzymatic glycosylation processes. In short, this is what happens when a sugar bonds to a protein or other molecule in the body. This process can then lead to the creation of AGEs (mentioned above in our list).

AGEs can cause our soft tissues, such as our tendons and ligaments, to become very stiff and weak. This happens because the AGEs can cause the collagen fibers in our body to cross link. Collagen is a very prominent protein in the body that helps to make our connective tissue strong, such as in our bones, muscles, tendons, etc. However, as mentioned above, cross linking of the collagen fibers can lead to problems with stiffness and tightness.

It’s important to note that AGEs can also lead to increased inflammation in the body. They’re just bad news all around!

Then, you have to take into account the poor circulation that diabetics often suffer from. Poor circulation won’t provide enough blood flow and oxygen to the surrounding tissues in the body. Our tissues absolutely need this in order to function properly.

Tying this altogether, the above complications that most diabetics will encounter in their bodies can lead to the following complications in the shoulder:

• Formation of fibrosis, or scar tissue, within the shoulder joint -> Frozen shoulder

• Advancing the natural degenerative process (a.k.a. Wear and tear) in the shoulder joint and soft tissues -> Rotator cuff syndrome

How to Manage Shoulder Pain with Diabetes

So, we’ve seen how diabetes can contribute to the onset of shoulder pain and dysfunction. Now, most importantly, what can be done about it?

First and foremost, if you have been given a medical diagnosis of Type 1 or Type 2 diabetes, proper medical management is crucial. If your diabetes is not controlled, you need to consult with your medical provider to get this taken care of ASAP. Proper management of your diabetes will help you to avoid onset of other subsequent issues, such as shoulder pain.

If you’ve done your best to keep your diabetes managed, but still develop shoulder pain, make sure to consult with your doctor sooner than later. They can check to make sure no changes have occurred with your diabetes that require further medical management. If the diabetes appears stable, they can then refer you to physical or occupational therapy.

The sooner you have your shoulder pain addressed with your overall medical and rehab team, the better your results will be. Your rehab specialist can also establish a long-term home program for you to optimize your shoulder mobility, flexibility and strength.

The key, as we always say, is proactivity!

Article Resource:

1.     Hsu CL, Sheu WH-H. Diabetes and shoulder disorders. Journal of Diabetes Investigation. 2016;7(5):649-651. doi:https://doi.org/10.1111/jdi.12491.