Understanding impact of diabetes on muscles, joints

Diabetes is a chronic metabolic disorder causing multi-organ damage in the body. The eyes, heart, nerves, and kidney problems caused by diabetes are well known but generally, people are unaware of the musculoskeletal problems. The muscle and skeletal complications of diabetes occur due to multiple causes. Blood supply to the muscles, as well as bones and nerves, is interrupted due to damage to the blood vessels supplying blood to them. The metabolic changes due to diabetes affect the muscles and contribute to musculoskeletal damage. About 40 per cent of diabetic people suffer from these problems sooner or later. The longer the duration of diabetes, the greater the chances of developing these problems. The hands are most affected by diabetes. Diabetic stiff hand syndrome is characterised by the thickening of the skin of the hands along with stiffness and limited mobility. It becomes difficult to join hands together. Flexion of the fingers becomes painful. There may be thickening and contracture of the palms, more so in the two middle 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, the shoulder joint becomes stiff. The affected person finds it difficult to lift 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 and 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 nerve damage in diabetes lead to deformities of the joints with indolent ulcers and wounds, more so in the feet. These occur due to repeated trivial injuries that a person is not able to perceive and treat due to a 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 imbalances caused due to diabetes. This can also occur in other bones like the 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 painkillers regularly. When taken over some time, painkiller drugs cause inflammation of the stomach resulting in burning pain in the abdomen, nausea, and vomiting. Moreover, these drugs are toxic to the liver and kidneys. Hence, it is not wise to take these drugs very often. 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 issues with 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 the aggravation of diabetes and its related problems. Every diabetic person should be aware of these problems and make efforts to prevent them. Thus, they can have a good quality of life. Dr Rachna Pande is a specialist in internal medicine.

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Understanding impact of diabetes on muscles, joints