By Sheri Colberg, Ph.D., FACSM
The most common problems affecting the arms and shoulders are carpal tunnel syndrome (wrist), tennis elbow (lateral epicondylitis), rotator cuff tendinitis in the shoulder, and frozen shoulder (i.e., adhesive capsulitis). Most, but not all, involve tendinitis, which occurs more commonly in people with diabetes because of glycation of collagen structures in joints that limits their mobility and results in minor swelling and inflammation of tendons. Others involve impingement syndromes or inflammation of other joint-related structures.
Carpal tunnel syndrome results from a squeezing of the median nerve, which runs from your forearm down into the palm of your hand. That nerve controls sensations to your thumb and most fingers, as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel is a narrow passageway that contains ligaments, tendons, and the median nerve. When the area becomes inflamed from overuse, the nerve is compressed, resulting in pain, weakness, or numbness in your hand and wrist that can radiate up your arm.
Symptoms often first appear in one or both hands during the night because sleeping with flexed wrists aggravates the condition. Your grip strength will suffer. Forming a fist, grasping small objects, or doing other things with your hands may become more difficult. Carpal tunnel syndrome is more common in the dominant hand and more common in women because their carpal tunnel area is smaller. Contributing factors include trauma or injury to your wrist that causes swelling, mechanical problems in your wrist joint, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause, among others. Carpal tunnel problems can be treated by wearing a wrist brace (to prevent wrist flexion), by icing the area, by taking NSAIDs, and sometimes by having surgery when pain lasts longer than six months. Stretching and strengthening exercises can help prevent its recurrence.
Technically known as lateral epicondylitis, this overuse injury is literally a pain in your elbow, mainly where your forearm muscles attach to the bony prominence on the outside (the epicondyle). Some of the symptoms are pain that radiates from the outside of your elbow into your forearm and wrist (especially if you touch or bump that area) or that occurs when you extend your wrist, a weak grip (not good for your tennis game!), and discomfort in that area when you shake hands or turn a doorknob. Repeatedly contracting the forearm muscles can cause it, as can playing tennis and using poor technique with your backhand stroke; if you use a two-handed backstroke, you’re much less likely to develop tennis elbow. But it’s not just tennis that you have to worry about. You can get tennis elbow from repeatedly twisting a screwdriver, hammering, painting, raking, weaving, playing string instruments, and more. The typical treatments apply, including rest, ice, and use of NSAIDs to reduce pain and inflammation. Many athletes find that wearing an adjustable strap or brace around the top of the forearm helps keep the pain from coming back again. You’ll also want to do stretches and strengthening exercises after the pain is gone as a preventive measure.
Shoulders can experience a variety of problems resulting from athletic pursuits, such as rotator cuff tendinitis, bursitis, and impingement syndrome. These conditions have similar symptoms and often occur together. For instance, if the rotator cuff and bursas are irritated, inflamed, and swollen, they may become impinged, or squeezed, between the head of the humerus (the long upper-arm bone) and the acromion process (a bony structure in the shoulder). Repeated motion involving the arms over many years may also irritate the tendons, muscles, ligaments, and surrounding tissue.
In tendinitis of the shoulder, the rotator cuff and biceps tendons can become inflamed, usually as a result of being pinched by surrounding structures. When the rotator cuff tendon becomes inflamed and thickens, it may become trapped under the acromion process. If squeezing occurs, impingement syndrome results. Tendinitis and impingement syndrome are often accompanied by inflammation of the bursa sacs that protect the shoulder, or bursitis. Sports that involve overuse of the shoulder and occupations that require frequent overhead movements are other potential causes of irritation to these structures and may lead to inflammation and impingement.
Slow onset of pain in the upper shoulder or upper arm and difficulty sleeping on that shoulder are symptoms, as is pain when you try to lift your arm away from your body in particular directions or overhead. Treatment normally includes rest, ice, and anti-inflammatory meds, but it can also involve physical therapy, gentle stretching, and exercises to strengthen the muscles surrounding your shoulder joint. If you don’t experience improvement in 6 to 12 months, your physician may recommend arthroscopic surgery to repair damage and relieve pressure on the tendons and bursas.
This condition usually results from inflammation, scarring, thickening, and shrinkage of the capsule that surrounds your shoulder joint. Any injury to your shoulder can lead to frozen shoulder, including tendinitis, bursitis, or rotator cuff problems. Unlike those overuse injuries, however, frozen shoulder usually limits the ability to move your shoulder in all directions, not just specific ones.
Frozen shoulder usually involves three stages. Initially, the pain increases with movement and is usually worse at night, much like you get with rotator cuff tendinitis. But you will likely experience a progressive loss of motion around your shoulder joint in all directions, with increasing pain for 2 to 9 months. Stage 2 involves diminishing pain and more comfortable movement of your arm, but the tradeoff is more limited range of motion (ROM) for 4 to 12 months. Finally, in the last stage, most people experience gradual restoration of motion over the next 12 to 42 months, although some may need surgery to restore more normal ROM.
Treating a frozen shoulder often involves a combination of anti-inflammatory medications, cortisone injection, and physical therapy. If you don’t treat it aggressively, a frozen shoulder can be permanent. Physical therapy is often the key and includes treatments like ultrasound, electrical stimulation, icing, and ROM and strengthening exercises. Months of physical therapy may be required for full recovery, depending on the severity of the scarring of the tissues around your shoulder. You should also try not to reinjure your shoulder during its rehabilitation by avoiding sudden, jerking motions or heavy lifting.
In my next column, you’ll learn more about specific knee and shin injuries.
This column is excerpted from Diabetic Athlete’s Handbook (2009), which contains essential exercise-related information and examples for Type 1, Type 1.5, and Type 2 diabetic exercisers of all ages. More information is available at www.shericolberg.com.