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IJCRR - 13(13), July, 2021

Pages: 08-12

Date of Publication: 05-Jul-2021

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Adhesive Capsulitis in Diabetes Mellitus - An Observational Study

Author: Neha Mukkamala, Jitendra Lakhani, Lata Parmar

Category: Healthcare

Abstract:Background: Shoulder problems are the most disabling manifestation of musculoskeletal disorders in diabetes. Patients with diabetes are five times more likely to develop capsulitis compared to non-diabetic controls. Aim: The present study aimed to see the prevalence of adhesive capsulitis in patients with diabetes. Methodology: This was a cross-sectional study approved by the Institution Ethics Committee. Patients diagnosed with type I and type II diabetes, aged 18 years and above, having a complaint of shoulder pain (unilateral or bilateral) were included in the study. Those patients who had undergone surgeries, fractures around the involved shoulder and any neurological conditions of the upper limb were excluded. Demographic data, duration of diabetes, dominance, type of treatment for diabetes were taken for all the patients. Shoulder ranges and functional activities were assessed in detail. Results: A total of 243 patients with diabetes was enrolled in the study. 116 (47.74%) were females, 127 (52.26%) were males. Out of 243 patients with diabetes, 22 patients had adhesive capsulitis. The prevalence of adhesive capsulitis was 9.1%. A significant correlation (p< 0.05) was seen between adhesive capsulitis and the duration of diabetes. No significant correlation was found between adhesive capsulitis and age, gender, BMI, HbA1c, dominance and type of treatment (oral hypoglycemic, insulin or both). Conclusion: The prevalence of adhesive capsulitis in patients with diabetes was 9.1%. A significant correlation (p< 0.05) was seen between adhesive capsulitis and the duration of diabetes.

Keywords: Adhesive capsulitis, Diabetes mellitus, Frozen shoulder, Periarthritis, Hyperglycemia

DOI URL: http://dx.doi.org/10.31782/IJCRR.2021.131309

Full Text:

INTRODUCTION

India, with 65 million cases of diabetes, stands second only to China worldwide in the number of cases with diabetes.¹Musculoskeletal complications in diabetes are not very widely known.²

The hand and shoulder are the most commonly affected areas due to musculoskeletal complications in diabetes.^3,4Shoulder problems are described as the most disabling manifestation of musculoskeletal disorders.^5,6Several studies have shown the prevalence of adhesive capsulitis (AC)in diabetes to be around 10-30%, and 2-5% in the general population.^5,7-13A meta-analysis by Zreik et al (2016) has shown that patients with diabetes are five times more likely to develop capsulitis compared to non-diabetic controls. In the same study, the mean prevalence of diabetes mellitus in patients with AC was found to be 30%.⁹

Thus the present study aimed to know the prevalence of adhesive capsulitis in diabetes.

METHODOLOGY

This was a cross-sectional study that was approved by the Institutional Ethics Committee (Ethical clearance letter no: SVIEC/ON/205/15008). After taking a written informed consent, consecutive patients diagnosed with type I and type II diabetes, aged 18 years and above, who complained of shoulder pain (unilateral or bilateral) were approached to take part in the study. Patients with a history of surgery around the shoulder, rotator cuff tear, fractures of the upper limb on the involved side in the past one year, patients having radiating pain from the neck, rheumatoid arthritis, arthritis of glenohumeral joint and neurological deficits were excluded. The patients who gave written consent for inclusion in the study were assessed in detail.

Demographic features including age, gender and body mass index (BMI) were taken. Diabetes-related questions like a method of control (diet, oral hypoglycemic drugs or insulin) and duration of diabetes were taken. The dominance of the hand was noted. Adhesive capsulitis was confirmed as shoulder pain along with loss of active and passive range of the shoulder in the absence of a known shoulder disorder. Shoulder ranges were assessed with a goniometer and functional activities like combing the hair, taking the hand behind the back, wearing clothes were assessed.

Statistical analysis

Baseline characteristics are presented as means with standard deviation (SD), medians with range. Normality of the data was seen using the Shapiro Wilk test. As the data was non-parametric, Spearman’s correlation coefficient and Mann Whitney U test were performed. Statistical significance was kept at p < 0.05.

RESULTS

A total of 243 patients with diabetes was enrolled in the study.116 (47.74%) were females, 127(52.26%) were males.

Out of 243 patients with diabetes, 22 patients had adhesive capsulitis. The prevalence of adhesive capsulitis was 9.1%. Tables 1 and 2 show the demographic characteristics of patients without and with adhesive capsulitis respectively. Table 3 compares the different variables in patients with diabetes mellitus, with and without Adhesive capsulitis. Figure 1 shows the correlation of adhesive capsulitis with the duration of diabetes.

The duration of capsulitis varied from 01 months to 03 years in the present study. The most affected ranges were external rotation (average range-15⁰) and abduction (average range-100⁰). All patients complained of more pain during overhead activities like combing with the affected side which involves a combination of flexion, abduction and external rotation at the shoulder and wearing clothes with the uninvolved side first. Women complained of more pain in bringing the saree from behind which involves a combination of extension, adduction and internal rotation of the shoulder and men had more pain in removing the wallet from the back pocket which also involves the combination of extension, adduction and internal rotation.

DISCUSSION

The present study was undertaken to know the prevalence of adhesive capsulitis in patients with diabetes. The prevalence of adhesive capsulitis was found to be 9.1% in the present study, which is slightly lower than the prevalence in other Indian states: Mathew et al. -16.45%, ¹⁴Bhat et al.-13.1%, ¹⁵Gupta et al.-29.61%, ¹⁶Kumar et al.-45.31%. ¹⁷The prevalence of capsulitis in other countries was:Yian et al.- 0.65 %, ¹⁸Ramchurn et al.-25%, ¹⁹Majjad et al.-12.5%, ²⁰Kidwai et al.-10.9%, ²¹Hassan et al.-13%, ²²Attar S-6.7%. ²³Fasika et al. found a 16.6% cumulative prevalence of hand and shoulder disorders, ²⁴and Shah et al. found a 63% prevalence of shoulder pain and/or disability. ²⁵Lower prevalence in our study could be because most of the population (70% in the present study) that comes to our hospital comes from the villages in and around Vadodara as well as rural areas of the neighbouring state of Madhya Pradesh. The prevalence of diabetes is lesser in rural areas compared to urban areas. ^6,26

The prevalence of capsulitis in diabetes can be attributed to the high glucose levels in patients with diabetes which leads to 1) abnormal collagen deposition in the connective tissues and 2) an increase in advanced glycation end products (AGEs), which causes stiffness of connective tissue. ^3,4,27

All 22 patients with AC had type 2 diabetes. Capsulitis was present in 08 patients on the left side, 10 patients on the right side and bilaterally in 04 patients. ^12,27Sixty four per cent had it on the dominant side and 36% had on the non-dominant side. This shows more involvement on the dominant side which is similar to Gupta et al’s study¹⁶and contrary to Le et al’s study. ¹⁰ Also 81.8% had unilateral involvement which is consistent with other studies.^6,27

A significant correlation was found between AC and duration of diabetes showing that patients with AC had a longer duration of diabetes. The prevalence of AC was 7.4%, 17.1%, 20% and 0% in patients with duration of diabetes of 10 years, 20 years, 30 years and 40 years. This is in agreement with several studies.^12,18,22According to Yian et al. (2012) patients whose treatment for diabetes lasted longer than 10 years had an odds ratio of 1.85 to develop AC vs an odds ratio of 1.40 for those with 5-10 years of treatment.¹⁸Inayat et al. did not find a correlation with the duration of diabetes. ⁶ However the number of patients with diabetes and with or without capsulitis in all the groups was not similar.

There was no significant correlation seen between AC and age and BMI.^6,12Arkkila et al. showed a significant correlation between age and AC but not between BMI and AC. ²⁸

Also, no significant correlation was seen between AC and gender, both genders were equally affected. ¹²According to some studies, females are,1.27 to 2.66 times, more commonly affected than males.^6,9,18

None of the three patients with type 1 diabetes had capsulitis. This could probably be because all three of them were young (<37 years) and their duration of diabetes ranged from 1.5 months to 4 years which was very less. Doria et al (2017) and Arkkila et al. (1996) have shown an association of age and duration of diabetes with AC in type 1 diabetes.^12,28

There was no significant relationship between glycated haemoglobin (HbA_1c) and the prevalence of AC. Previous studies have also shown no correlation between AC and HbA_1c.^11,12,18,28According to Chan et al. singular HbA_1cis only a measure of short-term blood sugar control, reflecting an average of only 3 months’ disease which might not portray total diabetic disease burden.¹¹

In the present study, out of 22 patients with AC, 05 patients were on insulin, 14 were on oral hypoglycemic drugs and 03 were on a combination of drugs and insulin. There was no significant correlation seen between the type of treatment for diabetes (medications, insulin or both) and AC which is in agreement with several studies.⁹These findings are in contrast to Yian et al’s (2012) findings that patients on insulin along with or without oral hypoglycemics were 1.93 times more likely than those not on insulin to have AC. ¹⁸Those on oral hypoglycemic drugs were1.5 times more likely to develop AC than those who did not take oral hypoglycemic drugs or use insulin.^6,18

One of the limitations of the present study was that HbA_1c was not taken for all the patients. But studies say that HbA_1c is not a true marker for diabetes as it gives only average values of the past three months. Also, it is an expensive test. It is not possible to test all patients with diabetes with this.

CONCLUSION

Screening for adhesive capsulitis in patients with diabetes should be done by physicians/diabetologists. Awareness and education about AC should be created in all patients with diabetes so that an earlier diagnosis and treatment may prevent progression to chronic, treatment-resistant AC and improve the quality of life. Screening, prevention, and rehabilitation strategies for shoulder dysfunction should be included in diabetic care programs.

ACKNOWLEDGEMENTS: The authors are grateful to the patients who participated in the study as well as Sumandeep Vidyapeeth trust.

CONFLICT OF INTEREST: The authors declare no conflict of interest.

FUNDING: This was a self-funded project.

AUTHORS’ CONTRIBUTION

Neha Mukkamala- 1) conception and design, analysis and interpretation of data; 2) drafting the article, revising it critically for important intellectual content; and 3) final approval of the version to be published.

Dr Jitendra Lakhani- 1) conception and design 2) revising the article critically for important intellectual content; and 3) final approval of the version to be published.

Dr Lata Parmar- 1) drafting the article, revising it critically for important intellectual content; and 2) final approval of the version to be published.

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A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020

A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"

A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13

A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for Vol 12 issue 12

A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for Vol 12 issue 11

A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for Vol 12 issue 10

A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for Vol 12 issue 09

A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for Vol 12 issue 08

A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for Vol 12 issue 07

A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20

A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR

A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13

A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR

A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR.

A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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