Pain in my Neck (Shoulder, Arm): Is Diabetes to Blame?

Do you suffer from a stiff neck, or frozen shoulder? Is your upper body mobility (reaching for a glass on a top shelf, putting on a jacket, lifting a child up) compromised and causing you to yelp OUCH! Do you also have either Type 1 or Type 2 diabetes? Are you assuming that it could be related? Be careful, because you may be wrongly blaming diabetes as the cause. Conversely, you may be blaming 1. an uncomfortable mattress 2. hunched shoulders/computer screen syndrome 3. the current economic crisis and healthcare debacle, when your aching stiff shoulder IS a diabetes complication. What do we blame, when we don't understand the cause?

I believed that having diabetes for 35 years was the cause of all my neck and shoulder pain. This was recently validated when The New York Times Health section printed a recent snippet about diabetes and its association with frozen shoulder (The Claim: Diabetes Can Lead to 'Frozen Shoulder'). I considered my pain as a sign that the number of random high blood sugars had taken a toll on my joints and frozen shoulder (adhesive capsulitis) was the result. I decided to take action and find out the awful truth. The pain was waking me up in the middle of the night and making me extremely irritable during the day. After a consultation with my endocrinologist, an orthopedic surgeon, two x-rays, one MRI, and finally, a meeting with a well known sports therapist - I am finally better informed. I have been diagnosed with extremely stiff (and weak) muscles. Even though I play tennis (3Xs a week), swim equally as much and rarely drive in Hong Kong (I walk everywhere), I believed I was in good shape. Now I know I have not been properly stretching out before I do any exercise and I am in front of the computer or rather hunched over the computer in a straight-back painted chair (form over function) without taking adequate breaks. Here is what I learned:

Apparently, the muscle that is most at fault is the scalenus, often so stiff and hard it can feel like wood. This is the muscle responsble for most all neck and shoulder pain in the workplace today. Further pain can come from the neck if the scalenus (nifty neck muscle chart here) is pushing a cervical spin nerve such as C4 (which can then give a hollow imprint of pain down the arm). See Neck Pain Support Blog for more information about the cervical nerves and here to read the Top 10 reasons for Neck Pain and How to Correct Them. The impact of one very tight or stiff muscle can then impair and inflame other muscles such as your delphoids, biceps and your rotator cuff. In fact, what I have found after three weeks of physiotherapy is the only pain that now remains is the source - my tight and wood-like scalenus muscle!

What is my prognosis? Recovery is promised if I work at it. I attend physiotherapy twice a week for intense (often pinching or painful massage), and do routine stretching exercises 5 X's a day. I should overcome my shoulder/neck pain if I improve my back posture while sitting in front of the computer screen AND if I continue to stretch. I am also reorganizing my schedule for some yoga. (I'll need to find an ergonomic chair too). If I hadn't taken the time to read, research and consult the number of professionals above - I would still have the idea that the cause for my trouble was diabetes. (It wasn't this time.) For those of you who are experiencing joint (or muscle) pain in the hands, arms, shoulders or neck - and want to know more about the most common disorders associated with Type and Type 2 diabetes - here is a list. A great deal of research is still needed to better understand pathology and treatment.

Frozen shoulder is a condition characterized by shoulder pain and limited range of motion. The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. In other words scar tissue forms restricting movement and causing pain. However, there may also be a microvascular connection as reduced blood supply to connective tissue may also be the link to this condition and diabetes. MDGuidelines Mayo Clinic Website

Decreased range of motion is key here. According to one physiotherapist I have spoken to - if you have some range of movement - then your condition can't really be classified as "frozen shoulder" - for example, if you can put your arm above your head, below and either pull or push minimal weight downwards, and bend your arm backwards toward your lower spine - you probably don't have this condition.

Diabetic hand syndrome, also called cheiroarthropathy, is a disorder in which the skin on the hands becomes waxy and thickened. Eventually finger movement is limited. This can also cause a symptom called trigger finger where your middle finger is so stiff you may have trouble straightening the joint.

Dupuytren contracture is a deformity in which one or more fingers are bent toward the palm. It's caused by thickening and scarring of connective tissue in the palm of the hand and in the fingers and it is common in people who have a long history of diabetes, perhaps due to the metabolic changes related to diabetes. If you put the palms of your hands together and cannot lay them flat against each other - this is a symptom (likewise, if you can't lay your hand completely flat against a hard surface.)
Not Associated with Diabetes Complications
Carpal Tunnel Syndrome: Carpal tunnel syndrome (CTS) is a condition in which thickened tendons or ligaments in the wrist compress the median nerve that runs from the forearm to the hand. Excessive typing or computer work was in the past suspected by clinicians to have contributed to the risk of CTS. MDGuidelines
Bottom Line
Seek professional help from a multitude of sources and consider a referral for a physiotherapist before considering cortisone injections or any surgery.