Diabetes-related hand and shoulder problems are being missed until disability takes hold

Frozen shoulder, trigger finger and nerve entrapment are up to three times more common in people with diabetes, yet delayed recognition can leave pain and loss of function entrenched.

Upper-limb complications of diabetes are common, often overlooked and frequently undertreated, according to a narrative review in Diabetes Care and an accompanying presentation at the European Association for the Study of Diabetes annual meeting. The conditions range from frozen shoulder and trigger finger to carpal tunnel syndrome, ulnar nerve entrapment, Dupuytren disease and limited joint mobility, and they can cause persistent pain, stiffness and disability that erode day-to-day function.

Lars B. Dahlin, a hand surgeon at Lund University and Skåne University Hospital in Malmö, told the meeting that people with diabetes are more likely to develop these problems, especially when they are older, have had diabetes for longer, smoke, carry excess weight or have poor blood glucose control. The Diabetes Care review found that several of these disorders occur about two to three times more often in people with diabetes than in those without the condition, and that they can be slower to improve and more likely to return. That makes routine screening and earlier recognition important, the authors argued, because many cases are only addressed after symptoms have become entrenched.

Treatment usually starts conservatively, with pain control, stretching and early physiotherapy aimed at preserving movement and limiting further loss of function. However, Dahlin cautioned that common anti-inflammatory medicines should be used carefully in this population because of possible kidney and cardiovascular risks, while corticosteroid injections can temporarily raise blood glucose and may require closer monitoring or short-term insulin changes. Surgery can be appropriate for selected patients, but diabetes is associated with a greater risk of infection and slower wound healing, so decisions need to be individualised.

The best approach depends on the condition. For frozen shoulder, early-stage steroid injection and physiotherapy may help, with mobilisation under anaesthesia or arthroscopic capsulotomy considered later if symptoms persist. For trigger finger, Dahlin said steroid injections can fail frequently in diabetes, particularly in type 1 diabetes with poor glycaemic control, making surgical release a more practical first option in some cases. Carpal tunnel syndrome may begin with ergonomic measures and splints, but persistent symptoms can warrant median nerve decompression; Dahlin said steroid injections into the carpal tunnel are not recommended in patients with diabetes. Similar stepwise treatment applies to Dupuytren disease, ulnar nerve entrapment and thumb-base osteoarthritis, or rhizarthrosis, where more invasive procedures may be needed when pain and functional loss are severe.

A systematic review published this year also suggests that rehabilitation may offer meaningful benefit for upper-limb function in adults with type 2 diabetes, particularly when programmes combine strength, aerobic and sensorimotor training and are delivered in a supervised setting rather than as unsupervised home exercises. Taken together, the research points to a broader need for multidisciplinary care involving diabetologists, rheumatologists, surgeons and rehabilitation specialists, as well as greater attention to upper-limb symptoms during routine diabetes follow-up.