title: Upper extremity impairments, pain and disability in patients with diabetes mellitus.
abstract: OBJECTIVE
  To determine the severity of, and relationships between, upper extremity impairments, pain and disability in patients with diabetes mellitus, and to compare upper extremity impairments in patients with diabetes with non-diabetic controls.
  
  
  METHODS
  Case-control, cross-sectional design.
  
  
  METHODS
  University-based, outpatient diabetes centre and physical therapy research clinic.
  
  
  METHODS
  Two hundred and thirty-six patients with diabetes attending an outpatient diabetes clinic completed the Shoulder Pain and Disability Index (SPADI) questionnaire. A detailed shoulder and hand examination was conducted on a subgroup of 29 volunteers with type 2 diabetes, and 27 controls matched for age, sex and body mass index.
  
  
  METHODS
  None.
  
  
  METHODS
  SPADI score, passive shoulder range of motion (ROM) and strength, grip strength, hand sensation, dexterity and limited joint mobility of the hand.
  
  
  RESULTS
  Sixty-three percent (149/236) of patients with diabetes reported shoulder pain and/or disability [median SPADI score 10.0 (interquartile range 0.0 to 39.6)]. Compared with the control group, the subgroup of patients with diabetes had substantial reductions in shoulder ROM, shoulder muscle strength, grip and key pinch strength (P<0.05). Patients with diabetes had a greater prevalence of decreased sensation (26/27 vs 14/27) and limited joint mobility of the hand (17/27 vs 4/27) compared with the control group. Total SPADI score was negatively correlated (P<0.05) with shoulder ROM (r=-0.42 to -0.74) and strength measures (r=-0.44 to -0.63) in patients with diabetes.
  
  
  CONCLUSIONS
  Upper extremity impairments in this sample of patients with diabetes were common, severe and related to complaints of pain and disability. Additional research is needed to understand the unique reasons for upper extremity problems in patients with diabetes, and to identify preventative treatments.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA. Electronic address: kshamata16@gmail.com.
authors.forename: K M
authors.initials: KM
authors.lastname: Shah
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Clark
authors.affiliation: Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine in St. Louis, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: McGill
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA; Department of Radiology, Washington University School of Medicine in St. Louis, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mueller
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004185:Disability Evaluation; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D026741:Physical Therapy Modalities; D015995:Prevalence; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D020069:Shoulder Pain / Q000209:etiology* / Q000534:rehabilitation*; D034941:Upper Extremity
keywords: Diabetes mellitus; Hand; Shoulder; Upper extremity