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Musculoskeletal Issues

The musculoskeletal system is comprised of the bones, muscles, joints, and tissues in and around the joints. Blood glucose that is poorly controlled for too long can affect the functioning of the musculoskeletal system resulting in a variety of disorders.

Carpal Tunnel Syndrome

Up to 20% of people with diabetes are at risk of developing carpal tunnel syndrome, also known as median nerve entrapment. The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains nerve and tendons. The median nerve runs from the forearm into the hand. Thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed.

Symptoms of carpal tunnel syndrome include:

• Sleep interruption due to numb hands
• Waking up with numb hands and pain
• Pain in hand and wrist
• Weakness in hand and wrist
• Pain radiating up the forearm
• Poor circulation, hands falling asleep
• Cold hands, warm forearms
• Loss of hand grip strength
• Loss of feeling in fingers/thumb
• Dropping objects, clumsiness
  

Symptoms usually start gradually and as they worsen, grasping objects can become difficult. Treatment includes resting the hand, splints, pain and anti-inflammatory medicines, and surgery.

Charcot Foot

Charcot foot is a sudden softening of the bones in the foot that can occur in people who have neuropathy. The bones are weakened enough to fracture and, with continued walking, the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a convex shape, giving it a rocker-bottom appearance, making it very difficult to walk.

Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation.

The symptoms of Charcot foot can appear after a sudden trauma or even a minor repetitive trauma, such as a long walk. A sudden trauma includes dropping something on the foot, or a sprain or fracture of the foot.

The symptoms of Charcot foot are similar to those of infection. Although Charcot foot and infection are different conditions, both are serious problems requiring medical treatment.

Charcot foot symptoms may include:

• Warmth to the touch (the foot feels warmer than the other)
• Redness in the foot
• Swelling in the area
• Pain or soreness
  

It is important to follow your doctor’s plan for treating charcot foot as further complications could lead to amputation. Possible treatment includes improvement and monitoring of blood glucose levels; immobilization via splinting/bracing until bones can repair themselves; custom shoes and bracing; modification of activities until healing takes place; or surgery.

Diabetic Stiff Hands Syndrome

Diabetic stiff hands syndrome, also known as diabetic cheiroarthropathy or limited joint mobility, affects up to 50% of all people with type 1 diabetes and is also seen in those with type 2 diabetes. It is, however, more prevalent in patients with diabetic neuropathy than in those without.

Diabetic stiff hands syndrome is characterized by thick, tight, waxy skin. People with limited joint mobility are unable to completely bring their two palms together.

There is currently no specific treatment for this complication except the close monitoring of blood glucose levels and therapy to help maintain as much pain-free motion as possible.

Frozen Shoulder

Frozen shoulder is a painful restriction of shoulder movement. It affects 11 to 30% of people with diabetes, as opposed to 2 to 10% of people who don’t have diabetes. Frozen shoulder is also known as adhesive capsulitis, shoulder periarthritis, or obliterative bursitis. The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, the shoulder bones are unable to freely move within the joint.

The main symptom of frozen shoulder is pain and, as result, stiffness sets in. Over time and/or with treatment, mobility can slowly return. Treatment often includes non-steroidal anti-inflammatory medications (NSAIDs), steroid injections, and physical therapy. People with diabetes who are treated with steroid injections may experience increased blood sugar levels over 24 to 48 hours after receiving the injection.

In people without diabetes, frozen shoulder can present itself about the age of 50. For people with diabetes, this condition can occur in those as young as 40, sometimes younger. While frozen shoulder is usually less painful for those who are afflicted at a younger age, treatment may not be as effective and the condition may last a longer time. Tight control over blood sugar levels helps in the prevention of frozen shoulder.

Trigger Finger

Trigger finger is associated with how long a person has had diabetes, not with age – e.g. a 30-year-old who has had diabetes for 20 years has a higher risk of developing trigger finger than a 40-year-old who has had diabetes for 10 years.

Trigger finger, also known as flexor tenosynovitis, is an irritation of the sheath that surrounds the flexor tendons, sometimes causing the tendon to catch and release like a trigger. The flexor tendons are muscles, which move your fingers but are located in the forearm, not the fingers.

Trigger finger may start as stiffness or there may be a clicking sound when you move the finger. There may also be a bump or tenderness at the base of the affected finger in your palm, which is where the tendon is likely catching. As trigger finger progresses, the finger may catch in a bent position and then suddenly pop straight. Eventually, the finger may not fully straighten.

Treatment of trigger finger includes injecting corticosteroids into the tendon sheath. If this is not successful, a visit with orthopedic hand surgeon may be required.

Tight blood sugar control and regular visits with your doctor are key factors in preventing musculoskeletal disorders but it is also important to seek medical help the moment you notice any problems developing.


Sources:
1 – British Journal of Sports Medicine. “Musculoskeletal Manifestations of Diabetes Mellitus.” PDF article downloaded from www.bjsm.bmj.com, accessed 7/26/07.

2 – The Journal of the Canadian Chiropractic Association. “The Musculoskeletal Effects of Diabetes Mellitus.” PDF article downloaded from www.pubmedcentral.nih.gov, accessed 7/24/07.

3 – Clinical Diabetes. “Musculoskeletal Complications of Diabetes Mellitus.” PDF
article downloaded from http://clinical.diabetesjounals.org, accessed 7/26/07.

4 – MedlinePlus. Nlm.nih.gov

5 – FootPhysicians.com. “Charcot Foot.” http://www.footphysicians.com/footankleinfo/charcot-foot.htm#1. Accessed 11/9/07

6 – National Institute of Neurological Disorders and Strokes. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Accessed 12/28/07.