Prof. G.S.Patnaik presents a review of musculoskeletal manifestations of diabetes mellitus. Diabetes is a multi-system disease that can affect connective tissue in various ways, resulting in a variety of alterations to the locomotor system including neuroarthropathy, hyperostosis, osteoporosis, and limited joint mobility. Common orthopedic issues seen in diabetes include carpal tunnel syndrome, adhesive capsulitis, tenosynovitis, Dupuytren's contracture, and Charcot's arthropathy. Treatment depends on the condition but may include splinting, injections, physical therapy, and surgery in resistant cases.

1. Prof. G.S.Patnaik
MBBS;MS (ortho) FAOI(USA),FACS, PhD
Consultant Orthopedic Surgeon

2. Musculoskeletal
Manifestations of Diabetes Mellitus:
Orthopedic and Rheumatologic afflictions in Diabetes
Mellitus A review
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3. Dibetes Mellitus
 Multi-system
disease
 Persistent
Hyperglycemia
 Acute and chronic
biochemical and
anatomical sequel
 Can affect the
connective tissue in
a variety of ways
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4. Diabetes Mellitus
 Variety of alterations
in Locomotor system
 Neuroarthropathy
 Hyperostosis
 Osteoporosis
 Cheiroarthropathy
 Limited joint mobility
 Muscular infarctions
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5. Musculoskeletal Manifestations
 Carpal tunnel
syndrome
 Diabetic stiff hands
syndrome
 Neuropathic joints
 Calcific tendinitis
 Complex Regional
pain syndrome
 Diabetic Muscle
Infarctions
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6. Carpal Tunnel Syndrome
 1/3rd of diabetic patient
 Prevalence increases
with duration of disease
 Diabetes induced
connective tissue
changes, including
sclerosis and collagen
degradation.
 Diagnosis based on
history and clinical
findings
 Burning,Paraesthesia or
sensory loss in median
nerve distribution
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7. Carpal Tunnel Syndrome
 EMG/nerve conduction
studies can confirm the
diagnosis
 Conservative treatments
include medications,
splints, change of
working environment
 Local Corticosteroid
injection
 If no significant relief
then surgery is an
option
 Safe surgery
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8. Adhesive capsulitis
 20% of diabetic cases
 Stiffened
glenohumeral joint
caused by thickening
and contraction of
joint capsule
 Shoulder stiffness,
decreased range of
movement and pain
 Abduction and
external rotation worst
affected
 Internal rotation is
affected least
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9. Frozen Shoulder
 Therapy is largely
conservative
 Mobilization of
shoulder joint
 Physical therapy
 Gentle stretching
and range of motion
exercises
 Analgesics
 Intra-articular
injection
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11. Tenosynovitis
 Flexor Tenosynovitis
(trigger finger)
frequent complication
of diabetic hand
 Catching or locking
episodes
 Palpable nodule and
thickening along the
affected flexor tendon
sheath overlying
palmer aspect of MP
joint
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12. Tenosynovitis
 Primary treatment
include rest, ice,
compression,
elevation (RICE)
 Local Hydro
corticosteroids
Injection
 Surgery in chronic
conditions resistant to
medical conditions.
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13. Dupuytrens’s contracture
 Affects palmer
fascia
 Causes flexion
contractures of
fingers
 Usually the 4th finger
 1/3rd of diabetic
patients
 Local H.C. injections
 Surgical intervention
in severe cases
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14. Diabetic Osteoarthropathy
 Charcot’s or neuropathic
arthropathy is a
condition involving
destructive , lytic joint
changes
 Severe destructive form
of degenerative arthritis
 Most commonly affects
pedal bones
 Classical radiographical
findings
 CT and MRI scans
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15. Diabetic osteoarthropathy
Treatment
 Challenging
treatment
 Good Glycemic
control
 Splinting and
bracing to protect
foot from weight
bearing
 Debridement
 Amputation
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16. Conclusion
 D.M. associated with variety of musculo
-skeletal disorders
 Most commonly seen in Type 1 but Type
2 are not immune
 Clinicians should be aware to intervene
and provide best care for affected
patients
 Ask patients for symptoms rather than
wait for him to speak.
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17. Suggested Readings
www.drgspatnaik.com
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18. www.drgspatnaik.com drgspatnaik@gmail.com
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