Diabetes is a chronic disease causing multi organ damage in the body. People commonly know about the eye, heart and kidney problems caused by diabetes but are unaware of the musculoskeletal problems. The musculoskeletal complications of diabetes occur due to multiple reasons. Damage to the small blood vessels causes reduced blood supply to the muscles as well as bones and nerves, damaging them. Damage to the nerves also affects the musculoskeletal system. The metabolic changes occurring due to diabetes affect the muscles and contribute to musculoskeletal damage. About 40 per cent diabetics suffer from these problems sooner or later. The longer the duration of diabetes, the greater the chances of developing these problems. Hands are the parts worst affected by diabetes. Diabetic stiff hand syndrome is characterised by thickening of the skin of the hands along with stiffness and limited mobility. The patient finds it difficult to put the hands together. Flexion of the fingers becomes painful due to inflammation of the coverings of the flexor tendons of the hands. There may be thickening and contracture of palms, more so in the middle two fingers, causing disability. Carpal tunnel syndrome which occurs due to entrapment of the median nerve is also more common in diabetics. This manifests as pain, tingling and other abnormal sensations in the hands. Frozen shoulder syndrome is more common in diabetics as compared to non-diabetic individuals. Here, there is stiffness of the shoulder joint. The affected person finds it difficult to elevate the shoulder as it is painful. Small tasks like combing or buttoning at the back become difficult in severe cases. Diabetic myopathy is yet another troublesome condition for the sufferer. Mostly, the thigh muscles are involved. One feels pain in the thighs. In the initial stages, the pain occurs while climbing a hill or stairs. Later on it may come with any movement. Impaired sensations due to diabetes lead to deformities of the joints (Charcot’s joints) with indolent ulcers and wounds, more so in the feet. These occur due to repeated trivial injuries which a person is not able to perceive and treat due to lack of pain sensation in the feet. Another complication, though not so common, is increased bone formation from the thoracic to lumbar spine in diabetic patients. This is due to hormonal imbalance caused due to diabetes. This can also occur in other bones like skull and pelvis causing pain and stiffness. Obese persons are more prone to develop this complication. In elderly people this problem is augmented by lumbar and cervical spondylosis. Thus, they suffer from chronic bone and joint pain. There is no root cure for any of these problems, once they start. Symptoms are aggravated by exposure to cold weather and exertion. A person is doomed to take pain killers regularly. When taken over a time, pain killer drugs like brufen, aspirin, diclofenac, and etcetera, cause inflammation of the stomach resulting in burning pain in the abdomen, nausea and vomiting. Moreover, these drugs are toxic to the liver and kidney. Hence, it is not wise to take these drugs very often. It is advisable that these drugs should be taken only when the pain is severe. Regular physiotherapy to keep the affected joint supple and pain-free is a better option. It is better to prevent these kinds of problems of muscles and bones. Good control of diabetes helps in preventing these problems. Even if they occur, the pain and disability would be minimal. Regular physical exercise is very useful in diabetic patients. It helps in better control of diabetes, reduces weight in obese people and keeps the limbs and joints flexible, avoiding stiffness and pain of musculoskeletal complications. Alcohol should be avoided as it contributes to aggravation of all, that is, diabetes, obesity and musculo-skeletal problems. Every diabetic should be aware of these problems and make efforts to prevent them. Thus, he or she can have a good quality of life. Dr Rachna Pande, Specialist, internal medicine rachna212002@yahoo.co.uk
