Frozen Shoulder: Diabetes Increases Risk | Learn Why And How To Avoid It

People with diabetes are 5 times more likely of developing frozen shoulder than non-diabetics. (1) Why is the combination of frozen shoulder + diabetes so common? 

Well, it has to do with how your body stores excess sugar. Some by-products of this storage process can make people with diabetes prone to frozen shoulder. You’ll learn all about it below.

Here are the topics we’ll cover. Tap on any of them to learn more:

• Why are people with diabetes prone to frozen shoulder?
• 7 treaments for diabetic frozen shoulder
• Other risk factors
• The 3 stages of frozen shoulder
• How to prevent frozen shoulder if you’re diabetic
• FAQs

So, let’s start with the basics:

Why is frozen shoulder so common in diabetic patients?

It has to do with a group of enzymes called “advanced glycosylation end products” (AGEs). They are by-products of having excess sugars (glucose) in your blood.

Now, people with diabetes have issues with insulin – a hormone that keeps the levels of glucose in check.

If this hormone isn’t working properly, the sugars stay longer in their bloodstream, thus increasing the levels of AGEs. (2)

The problem is that AGEs can attach to joint tissues.

Like collagen, tendon, and ligaments. If these enzymes accumulate on the joints, it can make them stiffer, weaker, and more prone to inflammation. (3)

This is what makes the shoulders of diabetics prone to frozen shoulder.

In summary, diabetics are prone to frozen shoulder because:

• The more sugar in your blood, the more AGEs accumulate.
• AGEs can adhere to joint tissues, causing inflammation, stiffness, and weakness.
• If they accumulate in the shoulder, they increase the risk of frozen shoulder.

But this doesn’t mean there’s nothing left to do:

7 treatment options for frozen shoulder in diabetes

Frozen shoulder tends to go away on its own – you’ll learn more about it further down.

Now, the treatment provides symptom relief while the condition goes through its natural process.

However, diabetics should also include strategies for controlling their sugar levels.

Here are 7 treatment options for diabetics suffering from frozen shoulder:

1) Change your diet

The Glycemic Index (GI) is an indicator of which foods elevate your blood sugars and how fast this happens. This means that foods with a high GI rating will raise your sugar levels very quickly.

That’s why it’s best to opt for foods with low GI. (4) This will make it easier for you to avoid excess AGEs in your blood. A few examples are: 

• Grains: Rice bran, barley, brown rice.
• Vegetables: Asparagus, broccoli, celery.
• Fruits: Apples, oranges, avocados.
• Dairy: Whole milk, soy milk, plain yogurt.
• Proteins: Peanuts, soybeans, lentils.

Related: Best diets for frozen shoulder management.

2) Do more exercise

You may be thinking: “I’m already in pain, why should I even consider exercise?” 

Well, that’s a good point especially if you’re in the initial stage of adhesive capsulitis. But the truth is that your condition will get worse if you don’t move your arm. 

For diabetics, exercise is like hitting two birds with one stone:

• It naturally lowers your sugar levels.
• It improves blood flow to your shoulder joint, thus helping with pain and stiffness.

Walking for 20 mins is a good foundational exercise you can do. You can progress to brisk walking or even running once you can tolerate it. 

Pro tip: These 2 free apps from the NHS can help you get started!

3) Corticosteroid injections

The truth is that some days the shoulder pain and stiffness may go out of hand. All you want is that sweet feeling of relief.

A direct cortisone shot to your joint capsule can help you get it. This is an anti-inflammatory medication with an effectiveness of up to 24 weeks. (5)

However, one side effect is that this medication can increase your blood sugar levels. (5) So, consult your doctor first – you may have to adjust your insulin dosage. 

4) Heat therapy

Heat therapy works by increasing blood flow around your shoulder joint. With this, it helps:

• Reduce pain and stiffness.
• Relax muscle spasms.
• Improve shoulder range of motion.

The application is simple. All you have to do is place a towel over your shoulder to prevent skin burns. Afterward, put a hot towel/bag over your shoulder and time it for 20 minutes.

Warning: Most diabetics have impaired skin sensation. If that’s you, check the skin around your shoulder every 5 minutes to avoid blisters and burns. 

5) Get a massage

If your skin is exceptionally sensitive to temperatures due to diabetes, massage can be a great substitute for heat therapy. The relaxation afterward will help you reduce shoulder pain and stiffness.

Also, the massage itself will promote blood flow to the area, which can facilitate recovery.

You can try massage therapy on your own with a tennis ball, working your way up around your shoulders and upper back. Or, you can make an appointment with a massage therapist. 

Further reading: Massage for frozen shoulder – benefits, self-massage techniques, and more.

6) Go to physical therapy

After frozen shoulder occurs, it resolves on its own. But to do so, it may need up to 2-3 years for it to completely heal. Going through physical therapy can help shorten that period. 

Your physical therapist will provide individualized treatment to manage your frozen shoulder, which is especially important in diabetic patients.

See, diabetics may need slightly different treatment needs, compared to people with a frozen shoulder without diabetes. These tweaks will make sure the treatment is safe and successful.

Your therapist will also teach you how to modify daily tasks to avoid worsening the condition – like how to sleep with a frozen shoulder.

7) Arthroscopic surgery

Usually, non-operative treatments are enough to recover from a frozen shoulder. But some opt for shoulder surgery to quickly relieve symptoms and regain their shoulder mobility.

The most common surgery is arthroscopy, a minimally invasive technique. This one leads to less connective tissue damage during the procedure, leading to a faster recovery. 

Learn more: Other surgeries for frozen shoulder.

Other risk factors for developing frozen shoulder

Aside from diabetes, here are a few other things that can influence your risk of developing a frozen shoulder (6): 

• Family history of frozen shoulder.
• Being female.
• Over 40 years of age.
• Previous acute injury to your shoulder joint.
• Prolonged immobilization of your arm.
• Thyroid disease.

Further reading: Why menopausal women are prone to adhesive capsulitis?

The stages of frozen shoulder

A frozen shoulder progresses through 3 phases. Compare your symptoms with this guide to have a rough estimate on how much time will it take to fully recover:

1) Freezing stage

Here, the main symptom is shoulder pain. At first, it’s mostly present at rest. But it ramps up slowly, so by the end of this stage, the shoulder is painful with all movements. This can last between 10 to 36 weeks. 

2) Frozen stage

In this second stage, the shoulder pain starts to subside while the stiffness settles in. You’ll likely have little to no pain, but a very limited range of motion on your shoulder joint. This lasts for 4 to 12 months.

3) Thawing stage

The final stage, where shoulder movement starts to increase until it’s back to normal. You’ll probably feel like your joint is more responsive to exercises as well. This lasts from 10 months to 42 months.

Learn more: Complete guide on frozen shoulder stages + treatments for each

How to prevent frozen shoulder if you’re diabetic

Sadly, diabetics have a 38% of suffering from frozen shoulder again. Research shows that it can occur on the opposite shoulder, and even on both. (7)

However, there are several things you can do to reduce the risk of having frozen shoulder again:

Quit smoking

Apart from its well-known effects, smoking increases your risk of developing both diabetes and frozen shoulder. It also makes you more prone to joint pain and stiffness compared to non-smokers. (8, 9)

A few ways to help you quit are:

• Nicotine patches and gum.
• Talking with a psychiatrist for individualized strategies.
• Support apps like QuitGenius.

Do not miss any follow-up appointments with your doctor

Diabetes management is not a one-and-done consultation with your doctor. There will be follow-up blood tests to track how well your body is responding to your medications and lifestyle. 

Sticking with your scheduled appointments also helps with the early detection of other conditions, like frozen shoulder.

Include shoulder exercises in your daily routine

Part of risk reduction is being proactive with your joint health. Here are some simple exercises you can do in the comfort of your own home:

Crossbody stretch

• Cross your affected arm horizontally towards your healthy shoulder.
• Use your good arm to grab a hold of your elbow, keeping it straight.
• Pull your arm towards your chest.
• You should feel a stretch from the back of your affected arm.
• Hold this for 30 seconds. Repeat for 3 times.

Finger walk 

• Stand in front of a wall at about half an arm’s length distance.
• Place your hand on the wall at waist level.
• From there, raise your arms by “walking” your fingers from the wall.
• Once you reached the highest you can go, slowly lower your arm back to starting position.
• Repeat for 10 times.

Outward isometrics

• Stand facing a doorframe with your elbow bent at a 90-degree angle.
• Make a fist and place the outer part of your hand against the doorframe.
• Gently push your fist against the doorframe and hold for 10 seconds.
• Repeat for 10 repetitions.

Inward isometrics

Same starting position as above, but place the inner part of your hand against the doorframe.

This will help: 12 exercises to prevent adhesive capsulitis.

FAQs

Conclusion: Frozen shoulder and diabetes

Having high blood sugar produces enzymes that increase the inflammation in your shoulder joint, easily leading to adhesive capsulitis.

Fortunately, there are several things you can do for treating frozen shoulder.

Follow your doctor’s advice on your medications to keep your blood sugar levels at bay. Also, physical therapists are used to treating frozen shoulders – they can help you recover faster from this condition.

Resources:

1. Dyer, Brett P et al. “Diabetes as a Prognostic Factor in Frozen Shoulder: A Systematic Review.” Archives of rehabilitation research and clinical translation vol. 3,3 100141. 14 Jul. 2021, DOI: 10.1016/j.arrct.2021.100141
2. Vlassara, Helen, and Jaime Uribarri. “Advanced glycation end products (AGE) and diabetes: cause, effect, or both?.” Current diabetes reports vol. 14,1 (2014): 453. doi: 10.1007/s11892-013-0453-1
3. Goldin, Alison et al. “Advanced glycation end products: sparking the development of diabetic vascular injury.” Circulation vol. 114,6 (2006): 597-605. DOI: 10.1161/CIRCULATIONAHA.106.621854
4. Zafar, Mohammad Ishraq et al. “Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis.” The American journal of clinical nutrition vol. 110,4 (2019): 891-902. DOI: 10.1093/ajcn/nqz149
5. Koh, Kim Hwee. “Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials.” Singapore medical journal vol. 57,12 (2016): 646-657. doi: 10.11622/smedj.2016146
6. Le, Hai V et al. “Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments.” Shoulder & elbow vol. 9,2 (2017): 75-84. doi: 10.1177/1758573216676786
7. Whelton, C, and C A Peach. “Review of diabetic frozen shoulder.” European journal of orthopaedic surgery & traumatology : orthopedie traumatologie vol. 28,3 (2018): 363-371. DOI: 10.1007/s00590-017-2068-8
8. American Diabetes Association; Smoking and Diabetes. Diabetes Care 1 January 2004; 27 (suppl_1): s74–s75. https://doi.org/10.2337/diacare.27.2007.S74
9. Bishop, Julie Y et al. “Smoking Predisposes to Rotator Cuff Pathology and Shoulder Dysfunction: A Systematic Review.” Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association vol. 31,8 (2015): 1598-605.  DOI: 10.1016/j.arthro.2015.01.026