Musculoskeletal pain in diabetes

NewsBot · May 5, 2012

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Musculoskeletal pain in patients with type 2 diabetes
S. Molsteda, J. Triblerc, O. Snorgaard
Diabetes Research and Clinical Practice; Volume 96, Issue 2, May 2012, Pages 135–140

Aims
The aims were to investigate the prevalence of musculoskeletal pain in patients with type 2 diabetes and demonstrate possible associated factors.

Methods
Nine hundred fifty-one patients completed a validated questionnaire used in The Danish Health and Morbidity Survey and results were compared to data for 2923 matched subjects from the Danish population. Musculoskeletal pain was self-reported Pain in the shoulder and neck; Low-back pain; and Pain in the arm, hand, knee and/or hip.

Results
Compared to the age, gender and region matched controls patients reported musculoskeletal pain 1.7–2.1 times as frequent (p < 0.001). Pain was more frequently reported in women (p < 0.001). Low-back pain and Pain in the arm, hand, knee and/or hip was associated with body mass index (p < 0.005). Low-back pain was associated with a sedentary life style, impaired quality of life and reduced physical function (p < 0.05).

Conclusions
The prevalence of musculoskeletal pain was seriously increased in patients with type 2 diabetes. It was associated with body mass index, reduced quality of life, low physical function and the ability to be physical active. Focus on musculoskeletal pain in clinical practice is therefore of major importance in lifestyle interventions in type 2 diabetes.
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NewsBot · Nov 3, 2012

Musculoskeletal manifestations in diabetic patients at a tertiary center
Suzan M. Attar
Libyan J Med 2012, 7: 19162

Objectives: Diabetes mellitus is a major public health problem worldwide. Most diabetic patients will develop functional disabilities due to multiple factors, including musculoskeletal (MSK) manifestations. The purpose of this study was to determine the frequency of MSK in diabetic patients and to examine the possible predictors for its development.

Methods: We performed a cross-sectional study from June 1, 2010, to June 30, 2011, to evaluate MSK manifestations in adult diabetic patients at an outpatient clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Baseline variables were examined to determine predictors for the development of MSK complications. Analyses were carried out using the Statistical Package for Social sciences.

Results: We included 252 diabetic patients; 45 (17.9%) had MSK manifestations. Of these 45 patients, 41 (91.1%) had type 2 diabetes. The most common manifestations were carpal tunnel syndrome (n=17, 6.7%), shoulder adhesive capsulitis (n=17, 6.7%), and diabetic amyotrophy (n=12, 4.8%). A significant association was found between the development of MSK manifestations and manual labor, overweight, and vascular complications. On logistic regression analysis, the presence of vascular complications in general (B-coefficient=1.27, odds ratio=3.57, P<0.05, 95% confidence interval=1.31–9.78), and retinopathy in particular (B-coefficient=1.17, odds ratio=3.21, P<0.05, 95% confidence interval=1.47–7.02) can predict the development of MSK manifestations in about 82% of the cases.

Conclusion: Musculoskeletal manifestations are under recognized in adult diabetic patients, occurring in 18% of the cases. Physicians should consider examining the periarticular region of the joints in the hands and shoulders whenever a diabetic patient presents with MSK symptoms.
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NewsBot · Nov 9, 2012

Rheumatological manifestations occurring in patients with diabetes mellitus
S Bañón, DA Isenberg
Scandinavian Journal of Rheumatology (in press)

Objectives: In this review we focus on the evidence for an association between musculoskeletal (MSK) manifestations and diabetes mellitus (DM).

Method: A systematic literature review was performed using the PubMed database for articles that have been published in the past 8 years (from January 2003 to August 2011) for keywords referring to MSK manifestations and DM. Where possible we have distinguished between manifestations that occur in type 1 as opposed to type 2 DM. However, this was not easy because many reports do not make the distinction.

Results: MSK manifestations of DM are relatively common. The duration of DM is often linked to the onset of some MSK features.

Conclusions: Patients with DM have been reported to have an increased prevalence of several MSK manifestations. It is important to be aware of MSK complications of DM. A better control of the glucose level may be useful.
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NewsBot · Nov 15, 2012

Diabetic Musculoskeletal Complications and Their Imaging Mimics.
Baker JC, Demertzis JL, Rhodes NG, Wessell DE, Rubin DA.
Radiographics. 2012 Nov;32(7):1959-1974.

Diabetes mellitus is increasingly prevalent and results in various clinically important musculoskeletal disorders affecting the limbs, feet, and spine as well as in widely recognized end-organ complications such as neuropathy, nephropathy, and retinopathy. Diabetic muscle ischemia-a self-limited disorder-may be confused with infectious or inflammatory myositis, venous thrombosis, or compartment syndrome. The absence of fever and leukocytosis, combined with the presence of bilaterally distributed lesions in multiple and often noncontiguous muscles in the legs, including the thighs, is suggestive of ischemia; by contrast, the presence of well-defined intramuscular abscesses with rimlike enhancement favors a diagnosis of infectious pyomyositis. In the diabetic foot, an ulcer, sinus tract, or abscess with an adjacent region of abnormal signal intensity in bone marrow favors the diagnosis of pedal osteomyelitis over that of neuropathic arthropathy. Contrast material-enhanced magnetic resonance imaging is important when planning the treatment of foot infections in diabetic patients because it allows the differentiation of viable tissue from necrotic regions that require surgical débridement in addition to antibiotic therapy. Subtraction images are particularly useful for visualizing nonviable tissue. Dialysis-associated spondyloarthropathy characteristically occurs in diabetic patients with a long history of hemodialysis. Intervertebral disk space narrowing without T2 signal hyperintensity, extensive endplate erosions without endplate remodeling, and facet joint involvement are suggestive of spondyloarthropathy instead of infectious diskitis or degenerative disk disease. Although the clinical features of these conditions may overlap, knowledge of the patient's medical history, coupled with recognition of key imaging characteristics, allows the radiologist to make a prompt and correct diagnosis that leads to appropriate managemen
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NewsBot · Aug 6, 2014

Histological and biomechanical analysis of the effects of streptozotocin-induced type one diabetes mellitus on healing of tenotomised Achilles tendons in rats
Zhaleh Mohsenifar et al
Foot and Ankle Surgery; Volume 20, Issue 3, September 2014, Pages 186–191

Background
Tendon healing is impaired in patient with diabetes mellitus. The effects of streptozotocin-induced type 1 diabetes (STZ-D) on the healing of the transected Achilles tendon in rats was studied.

Methods
In the experimental group, type one diabetes was induced via administration of STZ. The right Achilles tendon of all the rats was transected 30 days after the STZ administration. The Achilles tendons were examined for biomechanical and histological examinations.

Results
The statistical analysis showed that Young's modulus of elasticity and stress tensile load of the control group were significantly higher than those of the experimental group, and inflammation in the experimental group was significantly higher than that in the control group. At the same time, fibrosis in the experimental group was significantly lower than that of the control group.

Conclusion
Induction of type 1 diabetes by STZ significantly delayed the healing of the transected Achilles tendon in rats.
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NewsBot · Sep 4, 2014

Prevalence of Rheumatological Manifestations in Diabetic Population from North-West India
RP Agrawal et al
Journal of the association of physicians of india • vol 62 • 1st september, 2014

Introduction: An increased prevalence of rheumatological manifestations is recognised in diabetes and is
a common source of disability. The relationship with other risk factors and glycaemic control is uncertain.
We designed this study to find out the prevalence of rheumatological manifestations, association with
various risk factors and to assess differences between type 1 and type 2 diabetes.
Material and Methods: The study was conducted from Jan 2010 to Dec 2011 at tertiary care hospital. We
recorded type of diabetes, various risk factors viz age, duration of diabetes, glycaemic control (HbA1C)
and BMI and noted prevalence of various rheumatological manifestations by clinical examination, X-ray
and if needed CT scan/MRI. We explored correlation between rheumatological manifestations and these
variables using logistic regression.
Results: The prevalence of rheumatological manifestations was estimated at 570 per 1000 population.
The manifestations were more common in type 1 diabetes (62.7%). The various complications observed in
the present study were DISH (13%), Frozen Shoulder (20%), Dupuytren’s Contracture (7.2%), Osteoarthritis
(36.1%), Neuroarthropathy (2.9%), Chieroarthropathy (22.6%) and Flexor Tenosynovitis (8.1%). Among
various risk factors, duration of diabetes (odd ratio: 5.127), BMI (odd ratio: 7.429) and age (odd ratio:
4.731) were common risk factors. Poor glycaemic control was also associated with increased prevalence
of rheumatological manifestations.
Conclusion: Rheumatologic manifestations are very common in diabetics and are associated with poor
glycaemic control, BMI, duration of diabetes and age of the patients.
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NewsBot · Apr 30, 2015

Biomechanical Properties of Achilles Tendon in Diabetic vs. Non-diabetic Patients.
Guney A, Vatansever F, Karaman I, Kafadar IH, Oner M, Turk CY
Exp Clin Endocrinol Diabetes. 2015 Apr 28

Background/objectives: Structural and functional impairments of the Achilles tendon in diabetic patients has the potential to contribute to ulcer formation through altered foot mechanics. This study aimed to examine the biomechanical and histopathological alterations in Achilles tendon specimens from diabetic vs. non-diabetic individuals.

Materials and methods: 42 Achilles tendon samples obtained from patients treated with below-knee or above-knee amputation for chronic diabetic foot ulcers (n=21) or for non-diabetic conditions (n=21) were included. A tensile test was performed for each tendon and a stress vs. strain graft was obtained to calculate following biomechanical parameters: elasticity (Young modulus), load, stiffness, toughness, energy, strain, elongation and tenacity. Groups were also compared with regard to histopathological findings (inflammatory cell infiltration, collagen organization, and degeneration).

Results: Non-diabetic tendons exhibited a superior biomechanical profile over diabetic tendons with regard to the following biochemical parameters: elasticity, maximum load, stiffness, toughness, load, energy, strain and elongation at break point, tenacity, and strain at automatic load drop (p<0.05 for all comparisons). Diabetic tendons had mild impairment of collagen organization and focal collagen degeneration, whereas neither diabetic nor non-diabetic tendons had inflammatory cell infiltration.

Conclusion: The structural and functional alterations associated with diabetes adversely affect the biomechanical properties of the Achilles tendon, potentially acting together with neuropathy and ischemia in the development of diabetic foot ulcers.
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NewsBot · May 31, 2015

Musculoskeletal manifestations of diabetes mellitus.
Merashli M, Chowdhury TA, Jawad AS
QJM. 2015 May 28

The prevalence of type 1 and type 2 diabetes are increasing significantly worldwide. Whilst vascular complications of diabetes are well recognised, and account for principle mortality and morbidity from the condition, musculoskeletal manifestations of diabetes are common and whilst not life threatening, are an important cause of morbidity, pain and disability. Joints affected by diabetes include peripheral joints, and the axial skeleton. Charcot neuroarthropathy is an important cause of deformity and amputation associated with peripheral neuropathy. A number of fibrosing conditions of the hands and shoulder are recognised, including carpal tunnel syndrome, adhesive capsulitis, tenosynovitis and limited joint mobility. People with diabetes are more prone to gout and osteoporosis. Management of these conditions requires early recognition and close liaison between diabetes and rheumatology specialists.
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NewsBot · Sep 28, 2016

Musculoskeletal disorders in diabetes mellitus patients in a Physical Medicine and Rehabilitation department.
Salah S et al
Ann Phys Rehabil Med. 2016 Sep;59S:e115-e116. doi: 10.1016/j.rehab.2016.07.261.

OBJECTIVE:
The objective of this study was to assess the musculoskeletal disorders (MSD) of diabetes mellitus (DM) patients in a Physical Medicine and Rehabilitation (PMR) department.
MATERIAL/PATIENTS AND METHODS:
We carried out a retrospective study (January-December 2013) in which we enrolled 193 patients with DM. General (epidemic and clinical) characteristics were measured. Statistical analysis was performed using the statistical software SPSS 16.
RESULTS:
The participants' median age was 58 years (20-86), 98 men (50.8%) and 95 women (49.2%). The median DM duration was 10 years and the median follow up period was 8 months. DM was managed by diet in 3.6% of cases, by oral antidiabetic drugs in 48.7% of cases and by insulin therapy in 47.7% of cases. A quarter of patients consulted for shoulder pain, adhesive capsulitis was the most common diagnosis (14.8%). Knee osteoarthritis and low back pain were reported respectively in 22.2% and 12.9% of DM patients. Carpal tunnel syndrome was found in 50% of cases. More than half of the studied population (76.2%) was followed for diabetic foot and transtibiale amputation. DM patients were managed by rehabilitation in 35.1% of cases. Equipment for lower limb amputee was prescribed in all cases but only 14.3% received their orthesis. Functional improvement was obtained in 73.4% of cases.
DISCUSSION-CONCLUSION:
Our results suggest that MSD were prevalent in diabetic patients seen in PMR department. The most common problems were diabetic foot and lower limb amputation which are frequent complications of this metabolic disorder. Carpal tunnel syndrome and shoulder pain (adhesive capsulitis) are frequent also. An appropriate and personalized rehabilitation program should be prescribed for each patient. The main objectives of care are to guarantee a good functional outcome and to improve the patients' quality of life.
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