title: Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes.
abstract: OBJECTIVE
  People with type 2 diabetes (T2DM) have a high incidence of musculoskeletal disorders thought to be influenced by high non-enzymatic advanced glycated end-products (AGEs). The goals of this study were to determine differences in shoulder activity level and AGEs in people with T2DM compared to matched controls, and to determine factors associated with shoulder pain and disability.
  
  
  METHODS
  Eighty-one participants, T2DM (n=52) and controls (n=29), were examined for magnitude and duration of shoulder activity (measured using accelerometers), skin intrinsic florescence (SIF) as a surrogate measure of AGE level, and the Shoulder Pain and Disability Index (SPADI) as a self-report of shoulder pain and disability.
  
  
  RESULTS
  Compared with controls, T2DM participants had 23% less shoulder activity (p=0.01), greater SIF level (3.6±1.7 vs 2.7±0.6AU, p=0.01), less shoulder strength (p<0.05), and the duration of their shoulder activity was moderately associated (r=0.40; p<0.01) with reported shoulder pain and disability. Shoulder pain and disability were not related to SIF level.
  
  
  CONCLUSIONS
  Persons with T2DM have higher SIF levels and shoulder symptoms and disability indices than controls. Research is needed to determine if a shoulder mobility intervention to increase strength and mobility can help decrease shoulder pain and disability.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO. Electronic address: sorensenc@wustl.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sorensen
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Lang
authors.affiliation: Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Janet B
authors.initials: JB
authors.lastname: McGill
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: B Ruth
authors.initials: BR
authors.lastname: Clark
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Bohnert
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mueller
mesh_terms: D061725:Accelerometry; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D005453:Fluorescence; D017127:Glycation End Products, Advanced / Q000032:analysis / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D012782:Shoulder / Q000503:physiopathology*; D020069:Shoulder Pain / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology*; D012867:Skin / Q000737:chemistry / Q000378:metabolism; D012879:Skin Physiological Phenomena
chemical_list: D017127:Glycation End Products, Advanced
keywords: Accelerometers; Advanced glycation end products; Shoulder limited joint mobility; Skin intrinsic fluorescence; Type 2 diabetes