Shoulder Periarthritis and its Imaging Features in Patients with Type 1 Diabetes Mellitus

Abstract

Aim: There is limited information on periarthritis/adhesive capsulitis of the shoulder (ACS) in patients with type-1-diabetes mellitus (T1D). We assessed the prevalence and characteristics of ACS in patients with type-1-diabetes mellitus. Methods: Consecutive 267 patients attending 'Diabetes of Young Clinic' were screened for ACS. Those with clinical features of ACS were further assessed by 'shoulder pain and disability index' (SPADI), radiograph and MRI of the shoulder. The average glycemic status (HbA1c) during preceding 2 years was assessed in patients with and without ACS. Controls were age and sex matched healthy subjects (1:1 ratio). Results: Sixteen of 267 patients (6.0%) with type-1-diabetes had clinical features of ACS, unlike none of the healthy controls (P < 0.001). Internal and external rotation of the shoulders was the most frequently restricted movements in ACS. Thickened coracohumeral ligament and axillary pouch obliteration was characteristic MRI feature, present in 80.0% in 73.3% cases, respectively. Though 14/16 type-1-diabetes patients with ACS were symptomatic, they never reported these complaints in diabetic clinic with the treating physicians. On regression analysis (odds ratio; 95% CI), duration of diabetes (1.1; 1.03-1.17, P < 0.01), retinopathy (3.6; 1.05-12.52, P = 0.04), and limited joint mobility (6.4; 1.88-21.95, P < 0.01) were independent predictors for presence of ACS in type-1-diabetes. The mean HbA1c and lipid levels were comparable in patients with or without ACS. Conclusions: Six percent of patients with type-1-diabetes had ACS, which can be detected on clinical screening and confirmed by imaging to help initiate early treatment.

Keywords

• type1 diabetes
• complications