Diabetes & Musculoskeletal Health

Diabetes may affect the musculoskeletal system in a variety of ways. The metabolic perturbations in diabetes (including glycosylation of proteins; microvascular abnormalities with damage to blood vessels and nerves; and collagen accumulation in skin and periarticular structures) result in changes in the connective tissue.

Musculoskeletal complications are most commonly seen in patients with a longstanding history of type 1 diabetes, but they are also seen in patients with type 2 diabetes. Some of the complications have a known direct association with diabetes

Hands

Hands are a target for several diabetes-related complications. Diabetic cheiroarthropathy, also known as diabetic stiff hand syndrome or limited joint mobility syndrome, is found in 8–50% of all patients with type 1 diabetes and is also seen in type 2 diabetic patients.

Shoulders

Diabetes can affect the shoulder in several ways. First, adhesive capsulitis, or frozen shoulder, has been reported in 19% of diabetic patients. This term refers to a stiffened glenohumeral joint usually caused by a reversible contraction of the joint capsule. Patients report shoulder stiffness, along with decreased range of motion. Therapy is largely conservative and involves minimizing overimmobilization (gentle stretching/range of motion exercises) and the use of analgesics and/or intra-articular injections.

Feet

Diabetic osteoarthropathy (also known as Charcot or neuropathic arthropathy) is a condition involving destructive, lytic joint changes. It is a severe, destructive form of degenerative arthritis resulting from a loss of sensation (brought on by underlying diabetic neuropathy) in the involved joints. It most commonly affects the pedal bones. Loss of sensation leads to inadvertent (and unnoticed) repeated microtrauma to the joints, which leads to degenerative changes.

Muscles

Diabetic muscle infarction is a rare condition. This spontaneous infarction, with no history of trauma, tends to affect patients with a long history of poorly controlled diabetes. It is seen more commonly in patients with insulin-requiring diabetes, and most affected patients have multiple microvascular complications (neuropathy, nephropathy, and retinopathy).

Skeleton

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by metaplastic calcification of spinal ligaments (diagnosed on lateral spine radiographs) along with osteophyte formation. However, disc spaces, apophyseal joints, and sacroiliac joints are unaffected. The thoracic spine is most commonly affected.

Osteoarthritis

Diabetes is not clearly a risk factor for osteoarthritis (OA). However, obesity is a risk factor for both conditions. Several studies have reported an association of early OA and diabetes. Both large and small joint OA have been reported to be increased in type 2 diabetes.