How Pancreatic Disease Can Cause Diabetes & Frozen Shoulder

The pancreas regulates blood sugar by producing insulin. When pancreatic disease or damage disrupts this function, insulin production can fall, leading to diabetes. Long-term high blood sugar affects connective tissue by increasing inflammation and collagen stiffness and these changes can reduce joint flexibility and impair circulation, particularly around the shoulder joint (Chan et al., 2017).

Individuals with diabetes are five times more likely to develop frozen shoulder which is a condition that causes pain and stiffness in the shoulder joint (Zreik et al., 2016, Kim et al., 2023). The tissues surrounding the joint become inflamed and thickened causing them to adhere to each other which restricts movement and can be extremely painful.

Three Risk Factors For Diabetes:

1.) Firstly, high levels of sugar in the blood can lead to inflammation throughout the body, including in the tissues surrounding the shoulder joint. This inflammation can cause the tissues to become thickened and adhere to each other, leading to frozen shoulder (Kim et al., 2023).

2.) Additionally, diabetes can cause nerve damage to nerves that control the muscles around the shoulder joint. When these nerves are damaged, it can lead to weakness and reduced range of motion in the shoulder joint, making it more likely for frozen shoulder to develop.

3.) Furthermore, individuals with diabetes are also more prone to developing conditions such as tendonitis and bursitis, which can contribute to the development of frozen shoulder. These conditions can cause further inflammation and damage to the tissues surrounding the shoulder joint, leading to stiffness and pain.

Management: 

Managing diabetes effectively is crucial in preventing complications such as frozen shoulder. This includes maintaining a healthy diet, exercising regularly, monitoring blood sugar levels and taking prescribed medications as directed by a healthcare provider.

If frozen shoulder does develop, treatment options may include physical therapy, anti-inflammatory medications, corticosteroid injections, and in severe cases, surgery. It is important for individuals with diabetes to work closely with their healthcare team to manage their condition and prevent complications such as frozen shoulder.

In conclusion, diabetes can increase the risk of developing frozen shoulder due to the inflammation, nerve damage, and other complications associated with the condition. It is important for individuals with diabetes to take proactive steps to manage their condition and prevent complications such as frozen shoulder. By maintaining a healthy lifestyle and working closely with healthcare providers, individuals with diabetes can reduce their risk of developing frozen shoulder and other related complications.

Referred Shoulder Pain From Heart Pathology

Certain heart conditions, especially reduced blood flow (myocardial ischemia) to the heart or a heart attack (myocardial infarction) don’t always cause pain in the chest,  instead pain can show up in places like the shoulder, arm, neck, or jaw which can be confusing and easy to misinterpret. This happens because the nerves that carry pain signals from the heart enter the spinal cord at the same levels as nerves from the shoulder and upper arm. Anatomically, visceral pain fibres from the heart travel alongside sympathetic nerves that enter the spinal cord at levels T1 to T5 which also receive sensory input from the shoulder and upper limb.

Since these nerve pathways overlap, the brain can struggle to pinpoint where the pain is really coming from and misinterpret cardiac pain as originating from somatic regions such as the shoulder or jaw due to this shared neural pathway, a phenomenon known as convergence-projection. As a result, it may “project” heart-related pain to the shoulder or arm even though nothing is wrong with those areas.

Because of this, shoulder pain, particularly on the left side, can sometimes be a warning sign of a heart problem even when there is no chest pain. Thus, referred pain may be the only presenting symptom of cardiac ischemia, especially in older adults, women, and individuals with diabetes.

References

1. Chan, J.H.Y., Ho, B.S.Y., Alvi, H.M., Saltzman, M.D., Marra, G. (2017) The Relationship Between Diabetes Mellitus and Adhesive capsulitis of the Shoulder. Journal of Shoulder and Elbow Surgery, 26(5), pp.867–873.
2. Kim, Y.S., Lee, H.J., Park, I., Im, J.H., Park, K.S. (2023) Association between type 2 diabetes mellitus and adhesive capsulitis: a nationwide population-based cohort study. BMC Musculoskeletal Disorders, 24, 771.
3. Pal, B., Anderson, J., Dick, W.C., Griffiths, I.D. (1986) Limitation of Joint Mobility and Shoulder Capsulitis in Insulin-Dependent Diabetes Mellitus. British Journal of Rheumatology, 25(2), pp.147–151.
4. Zreik, N.H., Malik, R.A., Charalambous, C.P. (2016) Adhesive Capsulitis of the Shoulder and Diabetes: a Meta-Analysis of Prevalence. Muscles, Ligaments and Tendons Journal, 6(1), pp.26–34.