Musculoskeletal Complications
In addition to peripheral neuropathy, there are several other complications of diabetes that may affect the musculoskeletal system and the extremities.
Frozen Shoulder
Frozen shoulder, or adhesive capsulitis, is a disorder of the connective tissue that limits the normal range of motion of the shoulder. In diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long-term hyperglycemia. It usually happens in one shoulder only, although it can occur in both.
Physical therapy focused on improving range of motion, along with anti-inflammatory medications, are usually the first line of treatment for frozen shoulder. Cortisone injections are sometimes used in treating frozen shoulder, but because of their propensity to raise blood glucose levels they may not be a preferred treatment.
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Conditions involving inflammation of the tendons or joints are sometimes treated with nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen. However, NSAIDs should be prescribed with care in patients with kidney disease and/or cardiovascular disease, as they have the potential to worsen these conditions.
Dupuytren's Contracture
Another condition that limits range of motion is Dupuytren's contracture, which causes the fiborous tissue under the skin of the hand, usually starting on the palm but also extending to the fingers, to thicken and contract or bend inward. The first signs are usually tender nodules felt on the palm. Over time, the fingers are permanently moved. Dupuytren's contracture can be treated with surgery and/or physical therapy.
Stenosing Tenosynovitis, or Trigger Finger
As its common name — trigger finger — suggests, the condition is characterized by pain, stiffness, and a “locking” of the index finger. The tendon in the finger becomes inflamed and the tendon sheath, or covering, is damaged. Flexing the finger becomes increasingly difficult, and eventually the finger may lock up in a “trigger pull” position. Again, anti-inflammatories and physical therapy may be prescribed. In some cases, surgery may be required to correct the condition.
What is stiff-hand syndrome, and how can I treat it?
Stiff-hand syndrome (digital sclerosis) is caused by a buildup of collagen under the skin. It generally doesn't cause pain, but it can affect your flexibility. A physical therapist can recommend hand-stretching exercises to relieve the stiffness. Paraffin wax is another treatment, but should only be applied by a professional because of the risk of burns.
Carpal Tunnel Syndrome
Often confused with or mistaken for peripheral neuropathy, carpal tunnel syndrome involves nerve entrapment rather than nerve damage. The medial nerve (a nerve that runs through the wrist) becomes compressed, or entrapped, in the ligaments that surround it (the carpal tunnel).
This can be caused by repetitive stress (such as that caused by typing at a keyboard or playing guitar), and is exacerbated by diabetes because high blood glucose can cause changes to the collagen in the ligaments, making entrapment more likely.
The result is tingling, “pins and needles,” and burning sensations similar to what you might feel in PN. In fact, your doctor may refer to it as a compression neuropathy because it causes these symptoms. The difference is that carpal tunnel usually affects just the first three fingers of the hand (thumb, index, and middle fingers), while PN involves the entire hand.
Carpal tunnel syndrome is treated with wrist splints and sometimes corticosteroid injections. In some cases, surgery may be required to relieve pressure on the medial nerve.
