New Delhi, Jun 14 (PTI) As India grapples with one of the world’s largest diabetes burdens, doctors are reporting a less-recognised consequence of the disease — a rise in orthopaedic conditions ranging from frozen shoulder and trigger finger to nerve compression disorders and accelerated wear-and-tear of joints.
Experts said persistently high blood sugar can damage collagen, tendons, ligaments and nerves, increasing the risk of pain, stiffness and mobility problems that can significantly affect quality of life.
“We are increasingly seeing people in their 40s presenting with frozen shoulder, tendon problems and joint stiffness, conditions that were traditionally more common in older age groups. A major reason is the rising prevalence of diabetes and pre-diabetes at younger ages in India,” Dr Skand Sinha, professor, Sports Injury Centre, VMMC and Safdarjung Hospital said.
The formation of advanced glycation end products accumulate in tendons and capsules, making tendons less elastic, prone to degeneration and tearing. The smallest blood vessels are narrowed, reducing the blood flow needed to maintain healthy rotator cuff, he explained.
According to doctors, greater awareness among physicians and routine screening for metabolic disorders have also led to earlier detection of diabetes-related musculoskeletal complications.
Dr Abhimanyu Kumar, senior consultant, orthopaedics, at the Sitaram Bhartia Institute of Science and Research, said doctors are increasingly finding musculoskeletal complaints to be an early indicator of diabetes in some patients.
“We often see patients coming with frozen shoulder, trigger finger, chronic tendon pain or unexplained joint stiffness, and subsequent investigations reveal previously undiagnosed or poorly controlled diabetes. In many cases, the orthopaedic complaint becomes the first warning sign of an underlying metabolic disorder,” Kumar said.
He noted that diabetes-related musculoskeletal disorders are now being diagnosed at younger ages because Type 2 diabetes itself is occurring earlier in life.
“Chronic hyperglycaemia accelerates ageing of connective tissues. Excess glucose leads to the formation of advanced glycation end products that make collagen fibres thick, stiff and brittle, reducing flexibility of tendons and ligaments.
“Diabetes also impairs blood supply to these tissues and promotes low-grade inflammation, increasing the risk of frozen shoulder, trigger finger and tendon disorders,” he said.
According to Kumar, poor glycaemic control significantly worsens the severity and progression of orthopaedic conditions.
“Uncontrolled blood sugar accelerates cartilage degeneration, impairs tissue healing and increases the risk of complications after fractures or orthopaedic surgery. Patients with diabetes are more likely to experience delayed bone healing, infections and prolonged recovery,” he said.
Dr Sinha said injured tendons in people with diabetes generally heal more slowly and less effectively after injury.
Dr Sarvesh Pandey, joint replacement and arthroscopic surgeon, Indraprastha Apollo hospital, Delhi, said frozen shoulder affects an estimated 10-30 per cent of people with diabetes, compared with only 2-3 per cent of the general population, while trigger finger is also several times more common among diabetics.
Stressing the importance of early detection, he said timely screening can help identify musculoskeletal complications before they lead to significant disability.
“Many patients ignore mild shoulder stiffness, finger locking or joint pain, assuming these are age-related problems. However, early evaluation can help detect underlying diabetes or poor glycaemic control and allow treatment before permanent tissue damage occurs,” he said.
Dr Pandey said diabetes is associated with a range of orthopaedic complications beyond frozen shoulder and trigger finger. These include diabetic hand syndrome, which causes thickening of the skin and restricted finger movement; Dupuytren’s contracture, where scar tissue in the palm gradually pulls the fingers into a bent position; and Charcot arthropathy, a serious condition in which nerve damage leads to progressive destruction of joints, particularly in the feet and ankles.
He added that diabetes is also linked to osteoporosis, especially in people with Type 1 diabetes, and can accelerate osteoarthritis in those with Type 2 diabetes through metabolic and inflammatory changes.
“Good blood sugar control, regular foot examinations, maintaining a healthy weight and early physiotherapy or range-of-motion exercises are key to preventing disability and preserving mobility in people with diabetes,” he said.
“People with diabetes should not ignore persistent shoulder pain, stiffness or weakness. Medical attention should be sought if shoulder pain lasts for more than six weeks, causes night-time discomfort, results in loss of strength, or is accompanied by swelling or redness,” Dr Sinha said.
Most of these conditions can be managed effectively if diagnosed early.
Treatment options range from physiotherapy and targeted exercise programmes to ultrasound-guided hydro-dissection, growth factor concentrate (GFC) injections and, in selected cases, arthroscopic surgery, he said.
“Advances in orthopaedic care have significantly improved outcomes for patients with diabetes-related shoulder disorders,” Dr Sinha added. PTI PLB PRK
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