Frozen Shoulder or Diabetic Capsulitus
By Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S.
A common
condition that is probably associated with glycosylation of tendonous
or even muscular tissue, diabetic capsulitus is mentioned with some
frequency in the scientific literature.
What has not been described are the early signs and successful treatment.
Frozen shoulder is the end stage of many types of shoulder injury and
is well known to
physiatrists. The most common presenting signs for moderately severe
cases are pain and
limited range of motion upon abduction and internal rotation.
Typical complaints include, “I can’t put on a t-shirt or
reach for something in the back seat when I drive my car.” As
the affliction progresses the patient has difficulty putting on a jacket
and may require assistance in this task. Eventually, pain may be present
even when the arm is at rest – especially if the affected side
is adjacent to a cold window – as on a train or bus. Sleeping
may even be impaired because of the pain.
My physical examination of diabetic patients always includes checking
for capsulitis.
When present, the dominant side inevitably is more severely affected
than the non-dominant
side. Out of hundreds of cases with positive findings, I have seen only
one case where the non-dominant side was more disabled.
This condition can be elucidated in nearly all long term diabetics
even if they deny any of
the usual symptoms. My examination consists of comparing both shoulders
for range of motion
on internal rotation. I do not use goniometry because I find angle measurement
to be somewhat
subjective. Instead I ask the patient to try to scratch his/her back
from below, along the midline
and as high as possible.
We usually start with the dominant side and I put a small piece of
tape on the highest point that can be reached with any finger. We then
repeat the test with the nondominant shoulder and I measure and record
the distance between the two pieces of tape. If this distance is greater
than 5 cm, I consider it a positive diagnosis.
Frequently, I will test the nondiabetic spouse and find the ranges
of motion for both shoulders to be equal.
What about treatment? Years ago I tried stretching exercises, heat,
cold, diathermy,
ultrasound and differential electrical stimulation without long term
improvement.
Even near normalization of blood sugar does not work. What does work
is deep trigger-point massage. Frequently tender trigger points can
be found in the supraspinatus, infraspinatus, teres
major/minor, deltoid and trapezius muscles – usually at insertions
of tendon into bone. Other
trigger points can be found in the joint capsule and the biceps tendon.
These trigger points are
usually tender spots that feel like knots to the palpating finger.
Deep trigger point massage by a competent physiotherapist inevitably
cures the condition. The catch again is that symptoms will return if
blood sugars are not kept meticulously controlled.
Excerpt from www.diabetes-normalsugars.com
“Some
Long-Term Sequelae of Poorly Controlled Diabetes that are Frequently
Undiagnosed, Misdiagnosed or Mistreated”
Author’s Note
This link is not intended as a substitute for professional medical care.
The reader should regularly consult a physician for all health-related
problems and routine care.
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