The document discusses musculoskeletal manifestations of diabetes mellitus. It notes that diabetes is a multi-system disease that can affect connective tissue in various ways, leading to issues like neuroarthropathy, hyperostosis, osteoporosis, and more. Specific conditions addressed include carpal tunnel syndrome, which affects 1/3 of diabetic patients, adhesive capsulitis or "frozen shoulder" which impacts shoulder movement, and tenosynovitis. The conclusion emphasizes that clinicians should be aware of these potential musculoskeletal disorders in order to best treat and care for patients with diabetes.

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
11/17/2020 www.drgspatnaik.com 2

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
11/17/2020 www.drgspatnaik.com 3

4. Diabetes Mellitus
 Variety of alterations
in Locomotor system
 Neuroarthropathy
 Hyperostosis
 Osteoporosis
 Cheiroarthropathy
 Limited joint mobility
 Muscular infarctions
11/17/2020 www.drgspatnaik.com 4

5. Musculoskeletal Manifestations
 Carpal tunnel
syndrome
 Diabetic stiff hands
syndrome
 Neuropathic joints
 Calcific tendinitis
 Complex Regional
pain syndrome
 Diabetic Muscle
Infarctions
11/17/2020 www.drgspatnaik.com 5

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
11/17/2020 www.drgspatnaik.com 6

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
11/17/2020 www.drgspatnaik.com 7

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
11/17/2020 www.drgspatnaik.com 8

9. Frozen Shoulder
 Therapy is largely
conservative
 Mobilization of
shoulder joint
 Physical therapy
 Gentle stretching
and range of motion
exercises
 Analgesics
 Intra-articular
injection
11/17/2020 www.drgspatnaik.com 9

10. 11/17/2020 www.drgspatnaik.com 10

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
11/17/2020 www.drgspatnaik.com 11

12. Tenosynovitis
 Primary treatment
include rest, ice,
compression,
elevation (RICE)
 Local Hydro
corticosteroids
Injection
 Surgery in chronic
conditions resistant to
medical conditions.
11/17/2020 www.drgspatnaik.com 12

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
11/17/2020 www.drgspatnaik.com 13

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
11/17/2020 www.drgspatnaik.com 14

15. Diabetic osteoarthropathy
Treatment
 Challenging
treatment
 Good Glycemic
control
 Splinting and
bracing to protect
foot from weight
bearing
 Debridement
 Amputation
11/17/2020 www.drgspatnaik.com 15

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.
11/17/2020 www.drgspatnaik.com 16

17. Suggested Readings
www.drgspatnaik.com
11/17/2020 www.drgspatnaik.com 17

18. www.drgspatnaik.com drgspatnaik@gmail.com
11/17/2020 www.drgspatnaik.com 18

19. 11/17/2020 www.drgspatnaik.com 19