Adhesive Capsulitis of the Shoulder in Patients with Diabetes

Abstract

ABSTRACT Background Adhesive capsulitis of the shoulder is common in patients with diabetes. The exact etiology is unknown. The aim of this study is to evaluate the results of subacromial bursal corticosteroid injections and a home program of Codman's exercises in a cohort of diabetic patients with adhesive capsulitis. Materials and methods Twelve diabetic patients with adhesive capsulitis treated from November, 2011 to February, 2013 in an outpatient clinic were evaluated. The age range was 40 to 64 years with a mean age of 52. There were six males and six females. Six patients had involvement of the right shoulder, four had involvement of the left and two patients had bilateral shoulder involvement. The dominate upper extremity was affected in nine patients. There were 11 patients with type 2 diabetes and one with type 1 diabetes. All patients had an insidious onset of pain and stiffness in the affected shoulder. There was poorly localized tenderness about the shoulder with restricted abduction, forward flexion and internal rotation limited to the level of the buttocks or below. There were abnormal imaging studies in seven of the 12 patients. Five patients did not have imaging studies. Edema and thickening of rotator cuff tissue was the most frequent finding on magnetic resonance imaging (MRI). There was one small rotator cuff tear and one small labral tear. Patients were treated with a subacromial bursal space injection with 2 to 3 ml of 2% lidocaine and one milliliter of betamethasone sodium phosphate and sodium acetate (6 mg/ ml). Following the injection, passive stretching of the involved shoulder was done for a few minutes. The patients were instructed in Codman's exercises and wall climbing. Results Good pain relief was experienced by 11 patients with only fair relief in one. The average range of motion post-treatment was greater than 110° forward flexion and greater than 140° abduction. Internal rotation was possible to the L3 level. Two patients had a recurrence of symptoms at 6 and 12 months, and both were treated with reinjection and subsequent symptomatic improvement. There were no complications, though some patients had a transient rise in their blood sugar following injection. Conclusion Subacromial bursal injections coupled with Codman's exercises are effective in treating adhesive capsulitis of the shoulder in diabetic patients. Level of evidence IV Nasca RJ. Adhesive Capsulitis of the Shoulder in Patients with Diabetes. The Duke Orthop J 2014;4(1):24-26.