title: Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes.
abstract: BACKGROUND
  An increased prevalence of musculoskeletal disease is recognised in diabetes and is a common source of disability. It is known to predominantly affect the upper limbs especially the hand and shoulder. The relationship with other complications of diabetes and glycaemic control is uncertain. We designed this study to clarify these relationships, and to assess differences between types 1 and 2 diabetes.
  
  
  METHODS
  We identified a group of 96 people with established diabetes and examined them for the presence of locomotor disease focussing on the upper limbs. We recorded the mean HbA1c and the presence of diabetic complications, together with the health assessment questionnaire (HAQ) score. We explored correlations between locomotor disease and these variables using logistic regression. We compared data between type 1 and type 2 diabetics and contrasted the amalgamated data with that of a matched control population of medical out patients using Students t tests.
  
  
  RESULTS
  Locomotor disease was present in 75% of diabetics with the upper limb the commonest site for abnormalities. This prevalence was significantly higher than that seen in the controls (53%) [p=0.02]. Shoulder capsulitis (25%), carpal tunnel syndrome (20%), tenosynovitis (29%), limited joint mobility (28%) and Dupuytrens contracture (13%) were the most frequent findings and were much commoner than in controls. Capsulitis usually coexisted with other upper limb abnormalities and best predicted the presence of retinopathy and/or neuropathy. The mean HbA1c was significantly higher in patients with combined shoulder and hand problems (9.1%) than in those with no upper limb problems (8.0%) [p=0.018]. The pattern of results was similar in type 1 and type 2 diabetes, although the prevalence of abnormalities and mean HAQ were significantly greater in type 2 patients, which may be in part a function of their greater mean age.
  
  
  CONCLUSIONS
  Upper limb locomotor abnormalities are very common in diabetes and are associated with worse glycaemic control and more diabetic complications. Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications.
authors.affiliation: Department of Rheumatology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom.
authors.forename: Navdha
authors.initials: N
authors.lastname: Ramchurn
authors.forename: Chiedza
authors.initials: C
authors.lastname: Mashamba
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Leitch
authors.forename: Vijayaraman
authors.initials: V
authors.lastname: Arutchelvam
authors.forename: Kilimangalam
authors.initials: K
authors.lastname: Narayanan
authors.forename: Jola
authors.initials: J
authors.lastname: Weaver
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hamilton
authors.forename: Carol
authors.initials: C
authors.lastname: Heycock
authors.forename: Vadivelu
authors.initials: V
authors.lastname: Saravanan
authors.forename: Clive
authors.initials: C
authors.lastname: Kelly
mesh_terms: D001132:Arm; D002349:Carpal Tunnel Syndrome / Q000453:epidemiology / Q000378:metabolism; D048909:Diabetes Complications / Q000453:epidemiology* / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D004185:Disability Evaluation; D004387:Dupuytren Contracture / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology* / Q000378:metabolism; D007592:Joint Diseases / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009068:Movement; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000378:metabolism; D015995:Prevalence; D013717:Tenosynovitis / Q000453:epidemiology / Q000378:metabolism