ADHESIVE CAPSULITUS (Frozen Shoulder) & Diabetes

Diabetes Complications and other Conditions Other Conditions
#1

I have not seen this discussed yet. Last March, I started to have pain in my shoulder with certain movements. Last May, any sudden movement caused me extreme pain. Last June I could not move my left shoulder and last July I thought I was dying a slow painful death. I had several appointments with an orthopedic doctor but it took months of canceling from his office and an ER visit before they rescheduled with another doctor. I had so much inflammation from frozen shoulder that it was shooting pain through my neck and other arm. I was told I had 'frozen shoulder' and I had to go through painful therapy. I was told it is more common in diabetics. I thought I would ask everyone or anyone's opinion...
--Is there any information as to if it is insulin dependency related?
--Is it more common in those with oral medications?
-- Celebrex made mine better but I still have deep pain in the shoulder a year later. What medicines worked for others out there?

--How did you or ones you know, handle the depression of being in terrible pain all the time and immobility on top of being a diabetic?

Maybe there will be something here to help others cope who may encounter this beast.

#2

My understanding is that over time the high blood sugars cause thickening in the tendons as well as inflammation in the joints. And over time that can cause frozen shoulder as well as other things like shoulder impingement (which is the pain you had down your arm). There is a lot of debate on the treatment, clearly steroids have serious side effects. I've heard good things about active release techniques (this is usually performed by a chiro certified in the practice). I've not had frozen shoulder but I have had impingement and the thing that really helped me was exercises. And exercises seem to be a way of preventing recurrence.

#3

I too have had frozen shoulder (in both shoulders, not at same time).

Unlike the microvascular complications, there's no indication that high bg's are a risk factor for frozen shoulder. Biggest risk factor seems to be number of years with diabetes. There is some research that shows correlation between lower average bg's and frozen shoulder, but that may just be a byproduct of the fact that diabetics with very high average bg's don't always live for so long that they develop frozen shoulder.

Frozen shoulder happens in both T1's and T2's. It is more common in insulin dependent diabetics, but that might just be a byproduct of the early age that T1 often starts and the fact that number of years with diabetes is the biggest risk factor. It is less common in T2's on oral meds, but still not rare. Some of those "T2's on insulin" might actually be T1's that were not correctly categorized at diagnosis. One of the better recent studies, I think removes the "misdiagnosed as T2" effect in statistics by including the insulin dependent T2's with the T1's.

Some references on the statistics I cite above:
http://orthojournalhms.org/html/pdfs/manuscript-14.pdf
http://www.ncbi.nlm.nih.gov/pubmed/22617920
http://www.hkmacme.org/course/2008BW03-03-00/CNSCS0308.pdf

Note the last reference above, like many earlier references, finds that frozen shoulder is slightly more common in those with lower A1C's than with higher A1C's.

That anti-correlation with A1C's, combined with my suffering from frozen shoulder!, sparks my belief (no scientific paper to back me up) is that frozen shoulder is a kind of auto-immune inflammation which is not too different than the immune system attacks that destroy the pancreas in T1's or work against the efficacy of insulin in T2's.

Physical therapy eventually helped. My experience... there's certainly a sharp spiky pain in the inflammation stage. Eventually the inflammation dies down and physical therapy helps helps break up the scar tissue from the inflammation. The soreness that comes from physical therapy after the inflammation is gone, is a different kind of soreness (not so bad).

I had steroid shots into the joint and for me those steroid shots really marked the turning point towards getting better. Yes, the steroid shots also drove my bg's up and I had to compensate with more insulin. The orthopedist who did the steroid shots specifically chose a steroid mix and dose and administration that minimized effects on my bg's but those effects were still there. I strongly feel that the steroid shots were worth it, they reduced the inflammation and let the physical therapy break up the scar tissue in the joint.

#4

I also have had frozen shoulder, both sides, one right after the other. So, I can relate to your pain. I did do a lot of reading during my frozen shoulder process and recovery and I can't remember if insulin had been pointed to as a culprit. What I do know is that elevated blood sugars and the duration of diabetes has a lot to do with it. Similar to the tendinopathies many diabetics get like trigger finger, carpal tunnel, etc... My experience of doing everything from PT, steroid injections, ultrasonic medications and even with surgery, twice, is that this is an inflammatory process and it will run its course. Mine did very clearly run through the given stages of freezing, frozen, and thawing.

Anti inflammatory meds and properly placed steroid injections took the edge off sometimes. But ice became my best friend.

The immobility was the primary source of my depression during this time. I am a nurse, active outside, have a husband and 3 large dogs and all of my activities including work had to be modified or eliminated. My poor husband had to insert all of my pump sets and CGM sensors because I lacked the reach. The pain and immobility ( I use that term lightly now, as I broke my ankle a week ago and realize that immobility of a lower extremity is far worse than for an upper, IMHO)really affected me and I started taking antidepressants and seeing a counselor because it began to affect my diabetes management. Good support and understanding from your family and friends is also very important. In retrospect, time and patience I think are the major things to keep in mind. That has been my mantra for the last week. Be grateful for the things that you can do and you do have.
Good Luck!

#5

Tim,
After reading your reply I have to agree with your assessment of frozen shoulder being an autoimmune inflammatory response. Thank you for validating what I had tried to get my endo, pcp and surgeon to understand but no avail. I had surgery on both shoulders, different times and different stages of the "frozen" shoulder process. In retrospect, long after I had recovered from both I realized that with the first surgery I was already in the thawing process and it was a huge success. Not realizing there may be a different outcome depending on the stage of the process, I proceeded with the second shoulder based on the success of the first, about 3 months after symptoms appeared. Immediately upon waking up from anesthesia I knew something had not been the same compared to the first surgery. The inflammatory process continued through it's 3 stages and only until I got to the thawing stage for that shoulder did things improve.

#6

Tim gave you an excellent review of frozen shoulder. I'll just add my personal experience. I developed it in my left shoulder a few years ago, about 35 years after T1 diagnosis. I had pain only when my arm was in certain positions - e.g. trying to put on a coat (arm behind me) was very painful and I couldn't lift my arm above shoulder height. Mine resolved fully with time and by doing stretching exercises - mostly standing next to a doorway or wall and extending your arm up as much as you can - find the details online.

I did not have any steroids, pain meds, surgery, chiropractic or even physical therapy - so I would recommend you try to be patient and work with the stretches before committing yourself to anything more invasive.

#7

I've had frozen shoulder twice. The first time it wasn't as bad and it went away on its own after about a year or so.

The second time, well, I have it right now. This time it is very bad and it was caused by open heart surgery I had last year. I have yet to see my doctor about it ( I have been dealing with other problems first) so I don't know what I am headed for as far as medical treatment. On my own I am doing stretches and exercises of my shoulder, arm, and neck. These help a lot but if I don't keep up with them the pain and stiffness comes back quickly.

Good luck to you; and I would suggest to be careful about what a doctor recommends. I am told by many people who have gone through this that doctors like to jump to surgery that may not be needed, and the surgery doesn't really help sometimes. I would suggest trying all other options first before going with surgery. But I am no expert and definitely not a doctor.

#8

I have recently had frozen shoulder. I had surgery on my shoulder but not just because it was frozen. I had other issues with my shoulder that contributed to it being frozen.

Frozen shoulder by itself was not enough for my doctor to recommend surgery but there were other issues that made me a surgery candidate. During surgery the adhesions were cut that caused it to freeze and other problems were addressed.

As others have said frozen shoulder is possible in Type 2s. I have been T2 for 25 years and insulin dependent for almost 3.

#9

I had shoulder impingement due to computer mousing (I had an ergo assessment and have a whole new setup). At first I thought it was adhesive capsulitus, but it turned out not to be. I saw a trigger point therapist, who I fondly called my torture therapist. It hurt but it was really effective. I recommend The Frozen Shoulder Workbook: Trigger Point Therapy for Overcoming Pain and Regaining Range of Motion by Clair Davies as a less expensive option.

#10

Thank you for the articles Tim. It was very hard to make people understand the pain I was going through and I remember crying in the MRI tunnel as they x-Rayed me. My husband was deployed in a combat zone and I had no one, but pain was my companion. After they found out what it was then a long recovery period was forecast. If I go 2 days without my Celebrex, I hurt...but it is not daily and unbearable like it once was.
I agree, Ice helped me, Voltaren gel helped me and Celebrex helped me the most. What I initially thought was just a pinched nerve or pulled muscle, became frozen shoulder that lingers 1 year later.

This happened within a year of me being insulin dependent. Maybe if we all compile our data some good will come of it. I know I am not the only one.
#11

God Bless your husband for keeping by your side and caring for you...as well as your critters. The inflammation for me was terrible because my initial appointments were cancelled for over a month. Two months later I could not move at all.
Lower body, yes, that devastates your walking ability so I see your perspective clearly. I have had broken bones, tail bone, foot bone and all were painful. My frozen shoulder episode and infected bicuspid root canal was the most extreme I have experienced.

Frozen shoulder I was told was more common among diabetics. Why is that? It is good to discuss to see the common threads and see if there is help for others. Immobility-- is horrible for us independent onecs. :-(

#12

Try putting on your bra normally or try putting on your seat belt. I could not.

#13

A shot in the joint from the longest needle in the nation did not raise my glucose levels nor seem to do much good. I like to think it did though. Celebrex, the first day, did wonders. Therapy helped me too but it hurt like the devil!

#14

Please go to an ortho doctor. My ortho doctor correctly diagnosed me but it was a spinal doctor that said that inflammation was the biggest problem I had. I feel for you.

#15

I was told pool exercise was the best exercise. I am glad my husband wants a pool. :-)

#16

Thank you so much Melitta! I will look for this book or article.

#17

I have had frozen shoulder on both sides about five years apart. The first time it happened I saw a sports medicine doctor who told me that there wasn’t any quick fix for it and that it would get better by itself but it was going to take two years. TWO YEARS!?! This was a little disheartening to hear but everything the doctor said was true. It did get better by itself and it took two years. When it happened to the other shoulder I knew what to expect and it wasn’t so bad.
People with diabetes are in a higher risk category but so are women more than men and people in their 40s. I was a classic candidate if ever there was one. Both of my shoulders are fine now with full range of motion and absolutely no pain. The doctor had given me a sheet of exercises to do at home, which I did. When It happened to the second shoulder I didn’t even seek any treatment. I just started up with the exercises again.

#18

Awe! I wished there was a fav for you that worked wonders. Funny, how my body reacted. The injection did not seem to do much for me. I only had one because they did not want to give me another due the risk of increased glucose. It did not happen to me though. Ibuprofen never did touch my pain at 800 mg every 4-6 hrs. Tramadol never took much of an edge off my pain and I was taking 100 mg every dose. Valium, for me worked wonders though. It eased up the intense constant spasms I had ( which I think was inflammation related too). I could not stay on that med though due to the addictive qualities. Ice helped some. Therapy helped a lot but took time.

Yer not a looser Eucritta. You just know what works best for you and that is a good thing.

#19

2 years? Well I have one year behind me. I do not wish my pain I had on any human nor beast! I thought it was interesting though as I was given the specs on it-
No one knows the cause. I was told the common factors as well.
I had been on insulin for about a year when it happened to me. I had been a diagnosed diabetic for 5-6 years. I also had a terrible stressful time with the death of my dog and my husband being deployed to Afghanistan so wonder if stress plays a part.
This happened in my non-dominate arm which they said was uncommon.

#20

I had bursitis and couldn't move my shoulder/arm about 1-2 years pre diagnosis no insulin- a shot of steroids gave me dramatic improvement and then a few weeks of therapy. Then after diagnosis, the other shoulder acted up but not as bad. More therapy helped. I try to stay as active as possible plus certain exercises and red wine, tens/heat as needed seem to help me.