title: A quantitative assessment of limited joint mobility in patients with diabetes. Goniometric analysis of upper extremity passive range of motion.
abstract: OBJECTIVE
  The syndrome of limited joint mobility is a common but not widely recognized musculoskeletal complication of diabetes. The purpose of this study was to further characterize this syndrome using quantitative goniometric measures.
  
  
  METHODS
  Cross-sectional analysis of a sample population was performed to establish the prevalence, location, and severity of limited joint mobility and to determine its relationship to extraarticular manifestations and complications of diabetes. Passive range of motion of both upper extremities was measured by goniometry in 70 adult patients with insulin-dependent diabetes mellitus and 70 nondiabetic controls who were group-matched for age, sex, and general activity level. Joint mobility was assessed by both individual joint motions and a composite scoring technique.
  
  
  RESULTS
  Analysis of individual joints and composite scores revealed significant differences between dominant and nondominant extremities in both the control and the diabetic groups. Diabetic patients were generally less flexible than nondiabetic subjects throughout the arm, especially in shoulder and finger joints. In the full study population, multivariate analysis revealed that advanced age, male sex, and the presence of diabetes were associated with decreased passive range of motion for a majority of joints (P < 0.05). In the diabetes group, passive range of motion was significantly correlated (P < 0.05) with age, sex, duration of diabetes, and to a variable extent, glucose control, but was not correlated with the presence of clinically significant neuropathy, retinopathy, nephropathy, or peripheral vascular disease, with activity level, or with hand dominance. Stepwise regression analysis failed to identify single key joint motion(s) to serve as possible screening tests in predicting generalized limited joint mobility of the upper extremity. Finally, the effect of limb usage on range of motion in flexion may differ in diabetic and nondiabetic subjects.
  
  
  CONCLUSIONS
  Limited joint mobility is a generalized phenomenon occurring throughout the upper extremities of many diabetic patients. It is significantly related to age, sex, and to a variable extent duration of diabetes and glucose control. It is not related to the standard complications of diabetes as defined in this study.
authors.affiliation: Department of Rehabilitation Services, New England Deaconess Hospital, Boston, MA 02215.
authors.forename: L
authors.initials: L
authors.lastname: Schulte
authors.forename: M S
authors.initials: MS
authors.lastname: Roberts
authors.forename: C
authors.initials: C
authors.lastname: Zimmerman
authors.forename: J
authors.initials: J
authors.lastname: Ketler
authors.forename: L S
authors.initials: LS
authors.lastname: Simon
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D005260:Female; D005544:Forecasting; D007839:Functional Laterality; D006801:Humans; D007231:Infant, Newborn; D007596:Joints / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009038:Motion; D009068:Movement; D012016:Reference Values; D012044:Regression Analysis