Prevalence and Determinants of Frozen Shoulder in Patients with Diabetes: A Single Center Experience from Pakistan

Comparative effectiveness of low-level laser therapy versus muscle energy technique among diabetic patients with frozen shoulder: a study protocol for a parallel group randomised controlled trial

BACKGROUND

Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage  this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy.

OBJECTIVES

To evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder.

METHODS

This is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up.

DISCUSSION

This will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice.

TRIAL REGISTRATION

Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022.

Role of Platelet-Rich Plasma in the Treatment of Adhesive Capsulitis: A Prospective Cohort Study

Background

A glenohumeral (GH) joint disease, such as adhesive capsulitis, causes the shoulder capsule's fibrosis and adhesion to restrict mobility. Collagen and growth factors can be produced by platelet-rich plasma (PRP), which promotes stem cells and, as a result, improves the healing process. This study was done to determine the role of PRP injection in the treatment of adhesive capsulitis in terms of improvement in pain.

Methodology

This prospective cohort study was conducted at the Department of Orthopedics, Mayo Hospital, Lahore, Pakistan, from February 2022 to July 2022. A total of 305 patients were enrolled through the outpatient department. Basic demographic and clinical details, including the visual analog scale (VAS) pain score, were noted. First, 20 ml of the patient’s blood was drawn from the superficial saphenous vein by double syringe. After processing, the PRP was collected and injected in the subacromial bursa and intra-articular space adopting the anatomical approach. Then, the process was repeated at weekly intervals for four weeks. In this phase, PRP was injected only in the joint. The pain was assessed before and after six weeks of treatment and improvement in pain as per VAS was noted.

Results

In a total of 305 cases, the mean age was 60.47±11.55 years. There were 164 (53.8%) male and 141 (46.2%) female cases. The mean pain VAS scores before and after treatment were 6.56±1.79 and 2.42±1.71, respectively, and the mean reduction in pain after treatment was 64.57±19.40%. In 267 (87.5%) cases, an improvement of ≥ 50% was observed while 38 (12.5%) cases had an improvement of <50%.

Conclusion

The PRP can be used for the treatment of adhesive capsulitis to reduce pain. This non-operative method of treatment may help reduce the hospital burden of patients suffering from adhesive capsulitis.

Upper-Extremity Musculoskeletal Disorders and Their Associated Factors Among Diabetes Mellitus Patients Attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: Cross-Sectional Study

BACKGROUND

Globally, diabetes mellitus (DM) is a major public health, causing functional disability among those affected. Among the common diabetes mellitus-related complications, musculoskeletal disorders had a significant negative impact on the social health quality of life and productivity of individuals. Evidence in this regard, however, is scarce in Ethiopia. Therefore, this study aimed at determining the prevalence of musculoskeletal disorders and identifying factors associated in people with diabetes in Felege Hiwot Comprehensive Specialized Hospital, northwest Ethiopia.

METHODS

A cross-sectional study design was employed at Felege Hiwot Comprehensive Specialized Hospital from June 01 to August 30, 2020, among 413 participants. A systematic random sampling was employed to select the study participants. A structured, pretested questionnaire was used to collect data on socio-demographic, clinical, and lifestyle characteristics. Musculoskeletal disorders were assessed through clinical and physical examination. A logistic regression model was used to explore factors associated with musculoskeletal disorders.

RESULT

The prevalence of musculoskeletal disorders among diabetes mellitus patients was 24% (95% CI 20, 28.3). In logistic regression, factors such as being female, older age, occupation (farmer, merchant, and retired), and long duration of diabetes were significantly associated with musculoskeletal disorders.

CONCLUSION

Nearly one quarter of the study participants had musculoskeletal disorders. Special attention should be given for those individuals living with diabetes mellitus, particularly for those who are female, are older, and had a prolonged history of diabetes mellitus.

Shoulder pain and functional disability in type 1 diabetic patients: A cross-sectional survey

Objective

To assess the prevalence of shoulder pain and functional disability (SPFD) in Type-1 diabetic patients, and to explore its association with duration of the disease, age and gender.

Methods

A cross-sectional survey was carried out on previously diagnosed patients with Type-1 diabetes mellitus between April 2019 and March 2020. Data was collected from six hospitals including three tertiary care hospitals of Islamabad and Rawalpindi. Three hundred and twenty-eight patients were recruited through convenience sampling. Shoulder Pain and Disability Index was used to determine SPFD among participants. Point-biserial and Pearson correlation coefficients were calculated to find out the correlation between the variables. Independent t-test was used to determine the difference in the mean scores between the variables.

Results

The prevalence of SPFD was found 85.7%. A significant correlation was found of the SPFD with age (r = 0.332, p < 0.001), duration of the diabetes mellitus (r = 0.154, p = 0.005) and gender (r_pb = 0.171, p = 0.002). A significant difference was found in SPFD mean scores between female and male patients (female patients = 43.42±22.80, male patients = 35.31±22.91, p = 0.002).

Conclusion

SPFD seems prevalent among Type-1 diabetic patients. Increasing age, long history of diabetes mellitus and female gender appear the associated risk factors for the shoulder pain and disability.

Is it necessary to screen patient with adhesive capsulitis of shoulder for diabetes mellitus?

BACKGROUND

Idiopathic adhesive capsulitis of shoulder is common cause of pain and restriction of shoulder motion between the ages of 30 and 65. The prevalence of adhesive capsulitis is as high as 10% to 22% in diabetes mellitus as compared normal population which is 02% and 04%. Therefore, the doubt arises whether patients developed adhesive capsulitis are at greater risk to develop diabetes mellitus and should be screen for diabetes so that it can be detected early.

PURPOSE

To compare the prevalence of prediabeties and diabetes mellitus among patients with features of idiopathic adhesive capsulitis of shoulder who are otherwise healthy.

METHODS

Patients between 30-65 years of age who attended Orthopaedics OPD with features of idiopathic adhesive capsulitis of shoulder were included. Participated underwent a 2 hour long oral glucose tolerance test and based on fasting and 2-hour plasma glucose levels, patients were diagnosed as normal glucose tolerance, prediabetic, or diabetic and the results were matched with previous published data.

RESULTS

135 patients as participated and completed the test. 21 (15.5%) patients with idiopathic adhesive capsulitis of shoulder were found to be prediabetic, and 37 (27.4%) patients were found to be diabetic. However, 31 patients had family history of diabetes.

CONCLUSION

Based on our study, we can recommend that patients with features of idiopathic adhesive capsulitis of shoulder should be screened at least for fasting and post prandial blood sugar so that diabetes can be detected early.