Health: Musculoskeletal Complications of Diabetes Mellitus

Diabetes is a disease that causes multi organ damage in the body.The muscles and skeletal parts are also not spared by diabetes over a period of time. 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 also affect the muscle tissue and contribute to musculoskeletal damage. At least about 40% diabetics suffer from these problems sooner or later. The longer the duration of diabetes, the greater are the chances of these problems developing. Hands are the worst affected due to diabetes. Diabetic stiff hand syndrome is characterized by thickening of the skin of the hands along with stiffness and limited mobility. The patient also finds it difficult to join the hands together. Flexing the fingers becomes painful due to inflammation of the synovial membranes of the flexor tendons of the hands. There may be thickening and contracture of palm, more so in the middle 2 fingers, causing disability. Carpal tunnel syndrome which occurs due to entrapment of the median nerve is also more common in diabetics.This results in pain, tingling and other abnormal sensations in the hands. Frozen shoulder syndrome is said to be more common in diabetics as compared to non diabetic individuals. Here there is stiffness of the shoulder joint due to likely inflammation of the capsule. 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 which 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, e.t.c., 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 affections 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, i.e. 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. The author is a specialist in Internal medicineRuhengeri HospitalE-mail-rachna212002@yahoo.co.uk