Shoulder Pain in T2D Patients Most Likely Due to Subacromial Disorders

According to results from a prospective, cross-sectional study published in the Journal of Clinical Medicine, patients with type 2 diabetes (T2D) who had pain in their shoulder most frequently presented with subacromial shoulder disorders.

Patients (N=66) with T2D who had shoulder pain were recruited in the Netherlands in 2018. Participants were assessed by questionnaire for prevalence of upper extremity musculoskeletal disorders, underwent ultrasound of the shoulder, and had a physical examination of the shoulder and hands and a neurologic examination of the feet.

Patients had a mean age of 63.0 (±6.9) years, 28.8% were women, average BMI was 28.5 (range, 16-41.5) kg/m², diabetes had been diagnosed 9.0 (±5.5) years previously, 56.1% had subclinical polyneuropathy, 51.6% had osteoarthritis, 42.4% had stiff hand syndrome, 40.9% had bilateral shoulder pain, and 12.5% had rheumatoid arthritis. More patients reported their shoulder pain onset was gradual (79.7%) than sudden (19.7%).

Stratified by symptoms of pain, symptomatic (n=93) and asymptomatic (n=39) shoulders were diagnosed during ultrasound with subacromial disorders (90.3% vs 76.9%), osteoarthritis of the acromioclavicular (59.1% vs 43.5%), and glenohumeral disorders (8.6% vs 0%), respectively.

Stratified by subacromial disorders, symptomatic shoulders exhibited rotator cuff disorder (90.3%), dynamic impingement (15.1%), subacromial bursitis (14.0%), and long head of biceps tendon disorder (10.7%).

During physical examination, subacromial pain syndrome was found among 66.6% (95% CI, 51.6-72.0) of shoulders. During ultrasound examination, subacromial disorders were diagnosed among 90.3% (95% CI, 81.9-95.2; P <.0001) of shoulders.

Few patients (n=2) were diagnosed with neuropathic shoulder pain, indicating this may be a relatively uncommon condition among patients with T2D.

This study was limited by not including palpation of the acromioclavicular joint, which would have allowed for acromioclavicular disorder diagnoses, usually osteoarthritis.

The study authors concluded patients with T2D who presented with shoulder pain most frequently had subacromial pain syndrome. This disorder was successfully detected by physical examination among two-thirds of patients; however, in situations with ambiguity, ultrasound imaging should be considered for accurate diagnosis.

Reference

Alabdali LAD, Jaeken J, van Alfen N, Dinant GJ, Borghans RAP, Ottenheijm RPG. What is the diagnosis in patients with type 2 diabetes who have a painful shoulder? results from a prospective cross-sectional study. J Clin Med. 2020;9(12):4097. doi:10.3390/jcm9124097