Frozen Shoulder and Diabetes: What’s Really Going On?

If you've ever dealt with frozen shoulder, or know someone who has, you know just how frustrating it can be. Known medically as adhesive capsulitis, frozen shoulder is marked by stiffness, pain, and a serious reduction in shoulder movement. The condition tends to show up in three stages: pain, stiffness, and finally a "thawing" period when movement gradually returns. It can take months to years to fully recover, and in more severe cases, the pain and stiffness stick around for quite a while.

But what about the link between frozen shoulder and diabetes? Turns out, if you have diabetes, your chances of getting frozen shoulder jump up significantly – in fact, people with diabetes are up to five times more likely to experience this condition than those without. Let’s dive into why that’s the case, what the research says, and how diabetes might change your approach to managing frozen shoulder.

Why Does Diabetes Increase Frozen Shoulder Risk?

Researchers are still pinning down the exact “why” behind this connection, but there are some compelling theories based on studies from institutions like Mayo Clinic and Johns Hopkins.

One reason could be glycation, a process where high blood sugar leads to sugar molecules binding to proteins like collagen. This can make collagen fibers in your body – including those in the shoulder – thicker and less flexible, according to Mayo Clinic researchers​.

Given that frozen shoulder happens when the shoulder’s capsule tightens and forms adhesions, this process might explain why people with diabetes are more likely to develop it.

Another factor is inflammation. People with diabetes often have higher levels of systemic inflammation, which can add to the risk of musculoskeletal issues. Researchers suggest that chronic inflammation may irritate the shoulder joint’s tissues, contributing to stiffness and pain​.

Finally, there’s poor healing. Diabetes can lead to reduced blood flow and delayed healing. This can make it more likely that small injuries or strains in the shoulder don’t heal properly, increasing the chances of frozen shoulder. For example, if you’ve had a shoulder injury or surgery, the slower healing that often comes with diabetes could set the stage for adhesive capsulitis to develop.

How Frozen Shoulder Shows Up in Diabetic vs. Non-Diabetic Patients

Frozen shoulder tends to be a bit more challenging in people with diabetes. For starters, it’s more persistent, often taking longer to move through the three stages of freezing, frozen, and thawing. Diabetic patients are also more likely to experience more intense symptoms, meaning it can take additional time and effort to manage.

While frozen shoulder usually affects just one shoulder, it’s not uncommon for people with diabetes to experience it in both shoulders at some point, a situation that’s both painful and restrictive. It also tends to resist typical treatments, like physical therapy or anti-inflammatory medications, compared to cases in people without diabetes​.

Treatment Options: What's Different for Diabetics?

The general treatment path for frozen shoulder in diabetic patients isn’t too different from what’s used for non-diabetics, but there are some special considerations.

Physical Therapy
Movement and stretching exercises are central to recovering from frozen shoulder, whether or not you have diabetes. But given the tendency for the condition to stick around longer in diabetic patients, consistency in physical therapy is particularly crucial. Regular movement helps break up adhesions and maintain the shoulder’s range of motion. Studies show that early intervention in physical therapy can help reduce stiffness and speed up recovery, although the process is often slower in diabetic patients.

Corticosteroid Injections
Corticosteroids can reduce inflammation in the shoulder joint, easing pain and restoring some mobility, especially in the early stages. However, because corticosteroids can temporarily spike blood sugar levels, doctors typically advise people with diabetes to use them cautiously and monitor their glucose levels closely. Although effective for many patients, steroids may lose effectiveness over time, and frequent injections can weaken tendons and other joint tissues​.

Hydrodilatation
For cases that don’t respond well to physical therapy or injections, some patients find relief through a procedure called hydrodilatation. This involves injecting a sterile saline solution into the shoulder joint capsule, which expands the tissue and helps break up adhesions. This approach has shown promising results in some diabetic patients, with studies indicating improved range of motion and less pain.

Surgery
Surgery is usually a last resort for frozen shoulder, but it’s sometimes considered if a person has gone through months of non-surgical treatment with minimal results. Procedures like capsular release aim to loosen the tight shoulder capsule by removing adhesions or other restrictive tissue. However, the risks are slightly higher for people with diabetes, as their slower healing rates can make post-operative recovery a bit more challenging. For these patients, a carefully managed rehab plan is essential to get the best results.

Preventing Frozen Shoulder in Diabetics

While there’s no guaranteed way to prevent frozen shoulder, there are some proactive steps you can take, especially if you have diabetes.

Keep Blood Sugar Levels in Check
Maintaining stable blood sugar levels not only helps reduce the likelihood of glycation (where sugar binds to proteins and thickens tissue), but it also minimizes inflammation. This is one of the best ways to reduce your risk of frozen shoulder.

Stay Active
Regular movement and stretching, especially for the shoulders, can help maintain flexibility and may prevent adhesions from forming. If you have a desk job or spend a lot of time seated, taking breaks to stretch your shoulders and arms can help.

Watch Out for Shoulder Injuries
Since poor healing can lead to complications, it’s particularly important for people with diabetes to treat shoulder injuries or strains with care. Early intervention with physical therapy after a minor injury can go a long way toward preventing frozen shoulder down the line.

Final Thoughts

Frozen shoulder is a complex and frustrating condition, and if you have diabetes, it’s one that may be a bit more difficult to manage. However, early intervention, targeted treatment, and proactive shoulder care can make a significant difference. By working closely with your healthcare provider, keeping your blood sugar levels stable, and staying consistent with physical therapy, you can improve your chances of a smooth recovery and even prevent frozen shoulder from developing in the first place.

References

• Mayo Clinic. "Frozen Shoulder (Adhesive Capsulitis): Risk Factors and Management." Mayo Clinic
• Johns Hopkins Medicine. "Diabetes and Frozen Shoulder: Understanding the Link." Johns Hopkins Medical Resources
• TUESDAY Q & A: “Frozen shoulder” develops slowly and can take months to heal. Mayo Clinic News Network.