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Tendon Pain Linked to Diabetes

Aggressive or inappropriate exercise may be a factor in connection between type 2 diabetes and tendonitis.

Many rheumatological conditions may exacerbate the clinical course of diabetes mellitus; one such condition is tendonitis. Patients who have diabetes are much more prone to develop problems with tendons than those without diabetes, most likely due to the blood supply being more sparse to the tendons than normal. This means that very early diabetic changes in blood vessels may show up first in the tendons. Another plausible explanation for this is that high blood sugar may cause abnormal thickening of the tendons.The word “tendinopathy” itself refers to “injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements.” Common forms of tendon damage, which are more predominant in patients with diabetes and prediabetes, are carpal tunnel syndrome, tarsal tendon syndrome and frozen shoulder. Many physicians and healthcare providers are unaware of the link between diabetes and tendonitis. Unfortunately, improving blood glucose does not always have an immediate effect on improving the issue.

Past research has shown that patients with type 2 diabetes are more than three times as likely to develop some type of complication related to their tendons. A new study performed by Tom Ranger and associates looked further into the association between tendinopathy and diabetes; they performed a systematic review along with a meta-analysis of nine medical databases, which looked into patients with both diabetes and tendonitis.

The researchers had a total of 31 studies with 26 of them including people with diabetes and five with tendinopathy. What they found was that the patients with tendinopathy were more likely to have diabetes and other related issues. Luckily, more research has been conducted in the past 10 years looking further into the subject matter, not only observing the issue, but understanding the cause and possible treatments for patients with this condition.

One of the major issues for diabetes patients who are experiencing tendinopathy is exercise, which is a treatment for the condition. Despite the difficulties with movement due to the condition, patients are advised to exercise regularly in order to help preserve their bones and possibly avoid furthering the complication. To help those who have tendinopathy, healthcare providers should stress the importance of rest as constant movement and motion can aggravate the pain and make it worse.

Ice packs and stretching regularly are other known methods of prevention, along with seeking help from a sports physiotherapist. Dr. Martin Levy, director of the orthopedic surgery residency program at Montefiore Medical center in New York, commented on the study and said, “People sometimes launch themselves too aggressively into exercise programs and hurt themselves…any exercise that you take on, you should do it in a progressive manner. Start off gently and then increase in a rational way, and constantly observing results of your exercise to determine if in fact you are having any problems from the exercise program that you are on.”

Further research is necessary to explore the magnitude of diabetes amongst patients who experience tendon pain and vice versa. It is clear, however, that there is a link between the two conditions, which should be taken into consideration by healthcare providers when talking to patients about their exercise regimens.

Practice Pearls:

  • Studies show a clear association between tendon pain and type 2 diabetes.
  • Aggressive exercise is a primary cause of patients developing tendonitis when they have diabetes.
  • Tendinopathy is a serious problem faced by patients who have diabetes and management of the condition should be a concern for all healthcare professionals.

Researched and prepared by Javeria Fayyaz, Doctor of Pharmacy Candidate LECOM of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE

Lehman, Shereen. “Physio Works – Physiotherapy Brisbane.” Tendon Pain Linked to Type 2 Diabetes. N.p., 29 Jan. 2016. Web. 12 Feb. 2016.

Ranger, Tom A. “Is There an Association between Tendinopathy and Diabetes Mellitus? A Systematic Review with Meta-analysis.” British Journal of Sports Medicine 10 (2015): n. pag. Web. 12 Feb. 2016.