Chronic tendinopathies in diabetes

NewsBot · Oct 20, 2012

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Neoangiogenesis is reduced in chronic tendinopathies of type 2 diabetic patients.
Abate M, Schiavone C, Salini S.
Int J Immunopathol Pharmacol. 2012 Jul-Sep;25(3):757-61.

In diabetes, the prevalence of tendon degeneration is increased. As neoangiogenesis is impaired in several diabetic complications, the aim of this study is to evaluate the neovessel formation in tendinopathies. Patients aged more than 55 years were selected, and divided into two groups: a) type 2 diabetic patients, and b) non-diabetic subjects. In both groups, those with ultrasound features of tendinopathy were included, and intratendinous vascularisation was estimated by means of Power Doppler. Ultrasound features of tendinopathy were observed in 104 diabetic subjects and in 221 controls. Neovascularisation, with higher Power Doppler scores, was found more frequently in controls, while lower Power Doppler scores were prevalent in diabetic subjects. In subjects with diabetes, tendinopathic features are significantly higher than healthy controls, while the prevalence of neovascularization inside tendons is less represented.
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Admin2 · Oct 20, 2012

Related threads:
Other threads tagged with diabetic foot biomechanics
Tendon changes in diabetes
Diabetic neuropathy and lower limb stiffness

NewsBot · Aug 25, 2015

Real-time sonoelastography and ultrasound evaluation of the achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study
Berna Evranos, Ilkay Idilman, Ali Ipek, Sefika Burcak Polat, Bekir Cakir, Reyhan Ersoy
Journal of Diabetes and its Complications; Article in Press

Background
Diabetes mellitus(DM) is an endocrine disease characterized by metabolic abnormalities and long-term complications. The Achilles tendon (AT) plays an important role in foot biomechanics. We aimed to investigate the effect of DM on the Achilles tendon, which may contribute to long-term complications in the foot-ankle complex.

Methods
78 patients with diabetes, with (35 patients, Group I) or without (43 patients, Group II) foot ulcers were recruited from the endocrinology clinic. Thirty-three age-, gender-, and BMI-matched healthy individuals were selected as controls. All participants underwent ultrasonography and sonoelastography of their AT in order to evaluate Achilles tendon thickness (ATT) and stiffness (ATS). Each patient was also tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C) as a measure of diabetes control. Other chronic complications were also evaluated in all patients with diabetes.

Results
The AT was significantly thicker in Group I compared to Group II and the controls. HbA1C, FPG, and duration of diabetes were higher in Group I. We observed that ATT was positively correlated with neuropathy, retinopathy, nephropathy, peripheral arterial disease and coronary arterial disease in Group II while this correlation was not detected in Group I. ATS was reduced in Group I more than Group II and control groups.

Conclusion
Changes in the structure of the AT may precede foot ankle disorders in patients with diabetes. This is the first study that reported the results of sonoelastosonography of AT in patients with diabetes and revealed the correlation between ATT and other chronic complications of diabetes.
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NewsBot · Dec 1, 2016

Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes
Michael J. Mueller
Jnl AM Phys Ther Assoc

Medical professionals and laypeople alike understand the fact that people with diabetes are at increased risk for serious medical complications such as cardiovascular disease, kidney disease, peripheral neuropathy, and lower extremity amputations.1 However, I have observed that many people, including people with diabetes and the rehabilitation health providers treating them, are not aware of a large body of evidence linking diabetes with increased risk for numerous musculoskeletal impairments and complications.2 These impairments are apparent in type 1 diabetes (due to beta cell destruction, usually leading to absolute insulin deficiency) and type 2 diabetes (due to progressive loss of insulin secretion on the background of insulin resistance). The purpose of this point of view is to highlight the musculoskeletal impairments that are exacerbated, or potentially even caused, by metabolic disorders associated with diabetes. This article will focus on those musculoskeletal impairments most often encountered by physical therapists and other rehabilitation practitioners, describe the systemic condition of limited joint mobility, and briefly outline a likely mechanism for musculoskeletal impairments. Finally, the article will briefly provide clinical and research implications for those in rehabilitation working with this population.
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NewsBot · Jan 20, 2017

Tendinopathy in diabetes mellitus patients—Epidemiology, pathogenesis, and management
Pauline Po Yee Lui
Scandinavian Journal of Medicine & Science in Sports 20 January 2017

Chronic tendinopathy is a frequent and disabling musculo-skeletal problem affecting the athletic and general populations. The affected tendon is presented with local tenderness, swelling, and pain which restrict the activity of the individual. Tendon degeneration reduces the mechanical strength and predisposes it to rupture. The pathogenic mechanisms of chronic tendinopathy are not fully understood and several major non-mutually exclusive hypotheses including activation of the hypoxia-apoptosis-pro-inflammatory cytokines cascade, neurovascular ingrowth, increased production of neuromediators, and erroneous stem cell differentiation have been proposed. Many intrinsic and extrinsic risk/causative factors can predispose to the development of tendinopathy. Among them, diabetes mellitus is an important risk/causative factor. This review aims to appraise the current literature on the epidemiology and pathology of tendinopathy in diabetic patients. Systematic reviews were done to summarize the literature on (a) the association between diabetes mellitus and tendinopathy/tendon tears, (b) the pathological changes in tendon under diabetic or hyperglycemic conditions, and (c) the effects of diabetes mellitus or hyperglycemia on the outcomes of tendon healing. The potential mechanisms of diabetes mellitus in causing and exacerbating tendinopathy with reference to the major non-mutually exclusive hypotheses of the pathogenic mechanisms of chronic tendinopathy as reported in the literature are also discussed. Potential strategies for the management of tendinopathy in diabetic patients are presented.
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NewsBot · Jan 2, 2018

Pattern of Musculo-Skeletal Disorders in Diabetic and
Non-diabetic Patients Attending in a Tertiary Care
Hospital in Dhaka
Khan MSZ et al
BIRDEM Med J 2018; 8(1): 68-71

Background: Disorders of the musculoskeletal (MSK) system affect all ages and ethnic groups. This study was
done to see the pattern of MSK disorders in diabetic and non-diabetic patients at a tertiary care hospital.
Methods: This cross-sectional study was done between period of June 2016-Feb 2017 in the Department of
Physical Medicine and Rehabilitation of a tertiary care hospital in Dhaka. Six hundred individuals were
included in the study, 300 in diabetic and 300 in non-diabetic group.
Results: Diabetic group consisted with 95 (31.67%) males, 205 (68.33%) females. Non-diabetic group consisted
with 176 (58.67%) males and 124 (41.33%) females. Osteoarthritis knees (CoA of (101, 33.67%), degenerative
lumber disc disease (69, 23%), frozen shoulder (60, 20%), degenerative cervical disc disease (42, 14%) and
non-specific back pain (22, 7.3%), were common among diabetic patients. Among non- diabetic patients nonspecific
back pain (55, 18.33%), degenerative lumbar disc disease (52, 17.33%), degenerative cervical disc
disease (41, 13.66%), OA of knees (38, 12.60%), prolapsed lumbar inter- vertebral disc (PLID) (30, 10%)
were common.
Conclusion: Degenerative, non-inflammatory abnormalities comprised the major bulk of problems. Soft tissue
rheumatism was common in diabetic patients. Frozen shoulder was present in higher percentage in diabetic
patients.
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NewsBot · Dec 4, 2018

Tendinopathy in type 2 diabetes: a condition between specialties?

NewsBot · Feb 21, 2019

Acoustic Radiation Force Impulse Elastography and Ultrasonographic Findings of Achilles Tendon in Patients With and Without Diabetic Peripheral Neuropathy: A Cross-Sectional Study.
İyidir ÖT et al
Exp Clin Endocrinol Diabetes. 2019 Feb 20

AIMS:
We aimed to evaluate the elastographic features of Achilles tendon with Acoustic Radiation Force Impulse in patients with and without diabetic neuropathy.

METHODS:
According to the presence of peripheral neuropathy, 45 patients with type 2 diabetes were divided into 2 subgroups. Those with peripheral neuropathy were defined as group I (22 patients) and those without peripheral neuropathy were defined as group II (23 patients). A total of thirty age-, gender-, and body mass index-matched healthy individuals were selected as controls. All participants underwent both ultrasonographic and Acoustic Radiation Force Impulse elastographic examination in order to evaluate Achilles Tendon thickness and stiffness.

RESULTS:
Achilles tendon thicknesses were similar between groups (p=0.991). Achilles tendon thicknesses of both patient groups were significantly higher than the control group (group I vs control p=0.01; group II vs control p=0.006). Stiffness values of Achilles tendons were similar between the control group and group II (p=0.993). Shear Wave Velocity was significantly lower in group I than group IIand control group (p<0.001).

CONCLUSION:
Diabetic patients with neuropathy have thicker and softer Achilles tendon while the elasticity of Achilles tendon in diabetic patients without neuropathy is similar to the healthy controls. Softening of the Achilles tendon may be an early sign of diabetic foot and reveal the patients with a risk of diabetic foot.
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NewsBot · Jun 7, 2019

The Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing
Anne E.C. Nichols Irvin Oh Alayna E. Loiselle
Jnl Ortho Res: 05 June 2019 https://doi.org/10.1002/jor.24388

Over 300,000 tendon repairs are performed annually in the United States to repair damage to tendons as a result of either acute trauma or chronic tendinopathy. Individuals with type II diabetes mellitus (T2DM) are four times more likely to experience tendinopathy, and up to five times more likely to experience a tendon tear or rupture than non‐diabetics. As nearly 10% of the US population is diabetic, with an additional 33% pre‐diabetic, this is a particularly problematic health care challenge. Tendon healing in general is challenging and often unsatisfactory due to the formation of mechanically inferior scar‐tissue rather than regeneration of native tendon structure. In T2DM tendons, there is evidence of an amplified scar tissue response, which may be associated with the increased the risk of rupture or impaired restoration of range of motion. Despite the dramatic effect of T2DM on tendon function and outcomes following injury, there are few therapies available to promote improved healing in these patients. Several recent studies have enhanced our understanding of the pro‐inflammatory environment of T2DM healing and have assessed potential treatment approaches to mitigate pathological progression in pre‐clinical models of diabetic tendinopathy. This review discusses the current state of knowledge of diabetic tendon healing from molecular to mechanical disruptions and identifies promising approaches and critical knowledge gaps as the field moves toward identification of novel therapeutic strategies to maintain or restore tendon function in diabetic patients.
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NewsBot · Feb 5, 2021

Musculoskeletal manifestations among diabetic patients in Saudi Arabia
Laura I AlOayan et al
J Family Med Prim Care. 2020 Nov 30;9(11):5597-5600

Context: Diabetes mellitus (DM) is one of the most common diseases worldwide. Patients with DM are prone to develop multiple musculoskeletal (MSK) manifestations, which may lead to disability and an impact on patients' quality of life. These manifestations include but not limited to, adhesive capsulitis, shoulder hand syndrome, diabetic hand syndrome, diffuse idiopathic skeletal hyperostosis, Dupuytren's contracture.

Aims: The aim of this study is to assess the prevalence of MSK manifestations in diabetic patients in Saudi Arabia.

Settings and design: The study was carried out in NGHA hospital and PHC in Saudi Arabia.

Methods and materials: This is a retrospective study carried out between 2015 and 2019 where all patients with DM type II between the age of 18 and 65 and were diagnosed with MSK manifestations included in the study.

Statistical analysis used: Statistical Package for the Social Sciences (IBM-SPSS) software (Version 23).

Results: A total of 208 patients were found to have MSK manifestations. The average age of patients was 53 years old ranging from (31-63). The mean reading of A1C was 8%. A total of 34.1% were controlled and 65.9% were uncontrolled. Carpal tunnel syndrome (CTS) was found in 10%. Adhesive capsulitis in 2.4%. Septic arthritis in 1%. Trigger finger was found in 7.2%. Osteomyelitis was found in 0.5%. Plantar fasciitis was found in 4.8%. Osteoarthritis (OA) was found in 149 subjects (71.3%). Two subjects had ankle OA, one hand OA, nine shoulder OA, one hip arthritis. The rest had knee OA. Rotator cuff tendonitis was found in 1%. No significant correlation between age, A1c and all the MSK manifestations that were mentioned above (P value >0.05).

Conclusions: MSK manifestations are common among diabetic patients. OA was the most frequently seen disorder. Physicians should be aware of the high prevalence and the huge impact on patients when treating patients with type II DM.
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NewsBot · Apr 27, 2022

Main Musculoskeletal Complications Secondary
to Diabetic Neuropathy
Source

Diabetes mellitus is a chronic metabolic disorder that affects blood glucose levels
causing high levels of it (hyperglycemia) associated with a dysfunction in the
production and action of insulin that leads to a deficiency of is thus leading to
a deficit in metabolism; There are different types of diabetes that are diabetes
mellitus type 1, type 2 and gestational diabetes, which are differentiated by different
characteristics; This pathology presents different clinical manifestations and multiple
chronic complications, which are divided into: a) macro vascular (equivalent to
arteriosclerosis), b) micro vascular, which include retinopathy, nephropathy and
neuropathy, and c) diabetic foot, which manifests itself in consequence of neuropathy
or vascular affection of macroangiopathic origin, which can lead to affecting several
systems of the organism such as the musculoskeletal system.
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