Diabetes Self-Management Blog

Did you know that diabetes can hurt, stiffen, and even disable your shoulders, wrists, fingers, and other joints? None of these conditions is well understood. So how can you prevent them and deal with them?

Of course, people without diabetes can have joint issues, but having diabetes raises your risk. All of these conditions seem to be related to thickening or stiffening of connective tissues — the ligaments and tendons that hold our bodies together. These tissues are mostly made of collagen, a protein that should have some give and flow to it, like a soft rubber ball. When collagen stiffens, joints start to hurt and don’t work as well.

Here are four of the more well known diabetes-related joint conditions:

  • Frozen shoulder, also known as adhesive capsulitis, is a condition in which the range of motion of the shoulder joint is severely restricted. According to the American Diabetes Association, it affects 20% of people with diabetes and 5% of the general population. It usually starts with shoulder pain and inflammation and can progress to stiffness and near-complete immobility. Then it starts to resolve, and is usually gone within two years, especially with treatment.
  • Diabetic stiff hand syndrome is a painless disorder caused by an increase in collagen in and just below the skin. It can sharply limit hand function.
  • Carpal tunnel syndrome (CTS) is a painful condition caused by pressure on the median nerve, which passes into the hand through a narrow “tunnel.” If this tunnel is squeezed by thickening of ligaments or other structures, severe pain can result. CTS is often associated with typing or other repetitive work that keep wrists in unnatural positions.
  • Trigger finger is a condition where one or more fingers curl up and are difficult to straighten. The tendons that bend and straighten fingers “catch” and then may suddenly “click” open again. Trigger finger can be painful and is usually worse in the morning. Repetitive gripping motions can bring it on or make it worse.

All of these conditions involve some combination of inflammation and stiffening. So what does diabetes have to do with it? Some think that high blood glucose changes the balance of proteins, stiffening the collagen. Or perhaps some other inflammatory process contributes to the diabetes and the joint disease. But either way, what are some strategies for preventing dealing with these conditions?

Prevention and Treatment
One thing all joint experts agree on is that prevention of these conditions is easier than treatment. Fortunately, there are things we can do for our joints at any state of health.

  • Stretching. Joint stiffness is a vicious cycle. A part hurts, so you don’t move it. So it stiffens up and hurts more, and you use it even less. It’s important to break that cycle by moving the joint, even if it hurts a bit (but not severely). “Inflammation should be taken into consideration…, but unless the shoulder is severely inflamed, you would want physical therapy” says Michael Mueller, PT, PhD, about frozen shoulder. You might want to apply heat to loosen a joint before stretching.

    You can see a video on frozen shoulder exercises here and read about them on this Web site.

    Orthopedists at the University of Oklahoma created this illustrated guide to stretches for carpal tunnel.

    Trigger finger stretching is mostly a question of pulling the finger into a straight position and holding it. See a video about it here.

  • Heat and cold applications. According to MedicineNet, heat relaxes stiff tendons, while cold reduces pain and swelling. You might want to alternate them or explore to see which works better for you.
  • Pain medicines. If needed, anti-inflammatory medicines like ibuprofen can help. Sometimes you need to take those to be able to stretch.
  • Massage. The University of Maryland Medical Center reports that “massage has been shown to calm pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood, and by flushing the area of chemical irritants that come from inflammation.” Massage should probably be avoided when joints are hot, swollen, or tender to touch.
  • Avoid straining. Bruce Anderson, MD, writes that “You should limit overhead positioning, reaching, and lifting. These restrictions can be eased as pain decreases and flexibility increases.”
  • Improve blood glucose control. This can’t hurt, and it probably helps.
  • Physical therapy. Therapists have an amazing variety of equipment and knowledge to help stiff and painful joints. These include ultrasound, fluid therapy, paraffin treatments, and many others.
  • Splinting (for trigger finger). If you wake with curled fingers, you might try sleeping in finger splints to keep them straighter.
  • I strongly advise adding joint care to your self-management routine. If a shoulder, wrist, fingers, or ankles are becoming stiff and/or painful, do some gentle self-massage and apply heat once in a while. Give yourself some strokes. It’s one form of self-care that feels good.

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Comments
  1. David, thank you for your article on Diabetes and Your Hands. Personally I thought that I was going crazy with joint pains in one hand one day and the next day it would be my other hand or perhaps my sholder or wrists. I even woke up two weeks ago with what you called “trigger finger” all I could do was stare at my hand with one finger bent and wonder how I did it and then POP it straightened out! My doctor had nothing to offer for advice and then three days later I find your timely article. Thanks again!

    Posted by Lorrie Craven |
  2. David- I cannot thank you enough for this article! I have recently been struggling carpal tunnel and then I was just diagnosed with Frozen Shoulder Syndrome in both shoulders. My doctor said it was surprising and I was struggling to understand how I could have caused this. While I exercise regularly, I am not a weight lifter and I don’t play sports- but I have had diabetes for 24 years. Thank you for the explanation and the treatment recommendations!

    Posted by Marianne Schlosser |
  3. Hi David,
    I have had diabetes for 25 years. I have had both adhesive capsulitis (frozen shoulder) in both shoulders and the triggers finger in both hands. Surgery fixed the shoulder as well as physical therapy, but getting a cortisone shot in the worst finger helped it to quickly get better. The other one resolved on it’s own. I did a lot of the things you suggested and it did help also. These problems while not life threatening do cause limits to daily activities and the pain is not something that can be ignored. It was good to read and see the videos about these problems that diabetics can run into during their lives. Thanks for a great read.

    Posted by Linda Nelson |
  4. Thank you for addressing this issue. I would be interested in your comments concerning hip, knee, and ankle joints. Are these affected in the same way as the upper body joints? I was particularly interested in your comments on the ligaments and tendons. Is it possible for ligaments and tendons to become weakened and thus allow for unprotected movement in the joints? I have been wondering particularly regarding the knee joint for some time. My Dr. doesn’t seem to have an answer.

    Thank you!

    Posted by Carol Scherler |
  5. Many thinks for this wonderful information. it give me a sense that i can help or ease some of my joint problems. Rose

    Posted by Rose |
  6. I have had Type 1 for 39 years. I’ve had 2 carpal tunnel surguries and 10 trigger finger surguries. I figured that my diabetes had something to do with it after the 3rd or 4th finger. My orthopedic doctor didn’t think so until after the 6th finger.

    Posted by Jaci |
  7. I couldn’t find any reports of diabetes-related hip problems. Knees, maybe. Feet definitely, and I’ll be writing about that in the future.

    In general, the stiffening of tendons and ligaments that seems to cause the shoulder and hand problems may not be as much of a problem in the hips and knees, maybe because there is more space or the movements aren’t as complicated.

    Loosening and weakening of tendons/ligaments does contribute to knee pain, but whether diabetes is involved, I don’t know. I have that problem myself.

    Posted by David Spero RN |
  8. I’ve had two frozen shoulders (not at the same time) plus carpal tunnel. All of this happened before I was diagnosed as Type II.

    Posted by Donna |
  9. I use Dr. Franks spray and it does a good job on trigger finger and other joint problems

    Posted by George |
  10. “Improve blood glucose control”
    I would move that to the top of the list!

    Way back when both my shoulders were quite frozen (like in locked) so I couldn’t sleep on my side. I don’t like sleeping on my back (besides I snore that way and my wife has to beat me in the middle of the night :)

    After I saw the light (actually lots of study) and tried to bring my blood sugar readings as close to normal as possible, that pretty much disappeared after a few months… as well as a whole bunch of other problems.

    That’s the short version of a long story…

    Posted by John_C |
  11. I can categorically say that while adhesive capsulitis is most common in the shoulders, it is also found (rarely) in the capsule of the hip joint. (As for me -2nd time hip, 2 frozen shoulders with 3 surgeries, and a bonus surgery for trigger finger and DeQuervains tendonitis of the thumb. I can’t even count the number of cortisone injections!!! It is also confirmed in medical literature that persons with diabetes have much worse outcomes from surgeries for adhesive capsulitis. While non-diabetics often see resolution of the problem in 1-2 years with or without treatment, less than 40% of diabetics see resolution. (Damned if you have surgery and damned if you don’t).

    Posted by myra |
  12. well thanks david for your info look i feell alot and alot that i have diabets but no one belive me and i sometimes get blure vizion and for some reason my hand hurtss alot alot and like 2 of my finger turn really red but then when i dont eat i doesent turn red but i also have to go to the bathroom more then i usualy do and i get really ichy and i sometimes dont feel my feet but i want to know more or something else about diabetes so i can also proff to my aunt i can mabe have a chance that i have it THANK YOU

    Posted by maria camila |
  13. I was diagnosed with diabetes in 2010. Prior to that i used to run a lot and also engaged in boxing…About 6 mos ago, i noticed that my back was hurting more than usual and for some reason i just did not have the same flexibility as before? Long story short, went to the doctor and he said that my diabetes was the cause of my stiffness. He mentioned something like glycosulated or something to that effect…Statred stretching more despite the pain and have noticed a greater range of motion. Am not totally back to before, but i feel better now.

    Posted by ernest pacheco |
  14. Why or when is surgery needed ofr trigger finger?

    Posted by Mary Jo |
  15. Get real. Stretch and pull? I am not into MORE PAIN.

    Posted by Marha |
  16. David

    Thank you for your column.It is reassuring, especially when my doctor gives me a bemused look, every time I report a new problem.

    I was diagnosed with Type 2 diabetes for the past 8 years - but have brought my sugar levels under reasonable control, with an HbAiC of 6.5-6.8%.

    For the past eight months, I have severe pain iat the base of my thumb and the base of palm ( above the wrist - on the little finger side)- is this what you mean when you refer to pain in the hands ?

    Also,for the past 3 months or so, I have severe itching in both palms - I am unable to isolate a trigger, which subsides in 20-30 min - have you heard of anyone else with this problem ?

    Thank you
    Rajani

    Posted by Rajani |
  17. Dear sir,
    I need Home remedies on my Left hand Pain
    I am 28 years old and Looking for your suggestions
    its pain me allot while i am doing work in office
    I don’t stretch or lift heavy but still it pain allot
    please suggest Home remedies on it

    I am taking my Diabetes Medicines on time and food also but this pain doesn’t leaving me.

    Hope you understand my pain
    looking for your help and suggestions

    Thanking you

    Regards,
    Unni
    India

    Posted by Unni |
  18. I stumbled upon this article as I researched wrist pain and diabetes. Ive had 8 trigger finger release surgeries and both carpel tunnel surgeries…now I am experiencing pain on the outer side of both wrists especially at night. The pain wakes me up…I just had both carpel tunnel surgeries done this year so Im dumbfounded as to what this new pain could be???

    Posted by Georgia |
  19. Ive had booth hands done carpal tunnel surgery done and a trigger thumb release as ive been diabetic for 14 years plus also ive had booth nerve release done on my elbows due to my diabetes im getting frustrated i get one thing resolved up pops another problem!!!

    Posted by betty jo |
  20. dear sir,

    Actual my mother is a diabetic past from 8 yrs, and from 8 months she is saying that pain in left shoulders we went to physiotherapy treatment for 15 days, the pain was relaxed for few days only but the pain is back she can’t sleep either, as per advice she doing the exercises but it is no use of it but my question is that why still their no permanent cure are any medicine for this frozen shoulders if their any treatment pls suggest me sir,

    Posted by shashidhar |

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