Short answers: adhesive capsulitis, aka frozen shoulder, is a painful
condition that limits motion in one shoulder or both. It's not found
exclusively in conjunction with diabetes, but occurs sufficiently more often
with diabetes to be considered a diabetic complication. Don't be surprised,
though, if your doctor isn't aware of this connection. Avoid surgery (which
seldom helps) and cortisone (which plays havoc with blood glucose control);
take physical therapy seriously; expect to take about two years to recover.

Lee Boylan <lboylan(AT)cisco.com> wrote:

   There are three treatments usually offered for frozen shoulder: surgery,
   cortisone shots and exercises. Surgery offers the best transfer of money to
   a surgeon but the patient ends up needing to do exercises anyway.

   Cortisone offers quick pain relief but not full shoulder relief, so the
   patient is told to do exercises. Also, a DMer has drastically changed
   insulin requirements after taking a cortisone injection.

   Exercise, with alternating hot and cold packs and optional NSAIDs, offers
   slow and sometimes painful therapy that gets full or nearly full
   restoration of movement. Just don't let it discourage you, because
   improvement comes slowly. Keep at it! Eventually, you will have pain-free
   motion in your arm.

And I'll re-emphasize what Lee says: DON'T TAKE STEROIDS LIGHTLY. Including
cortisone. This warning should not be necessary, but unfortunately some
doctors are unaware of what steroids do to blood glucose. If your doctor
doesn't understand how serious a problem this is, insist on including an
endocrinologist in your medical team.

Lyle Hodgson <lyle(AT)world.std.com>, who has been through adhesive
capsulitis in both shoulders, wrote:

   I suggest anybody who really wants to know about it who can visit Boston go
   to see Dr. Gordon Lupien, who used to be an orthopedic surgeon at Joslin
   and, according to a couple doctors I asked, knows more about adhesive
   capsulitis in diabetics than anyone else, period.

   Factoids:

   o Diabetics get "frozen shoulder" more than non-diabetics.

   o Women get "frozen shoulder" more than men.

   o Everybody I talked to who had ever treated "frozen shoulder" said that
     every patient they'd seen with it got over it in two years, no matter
     whether they did the exercises or not.

   o The exercises and ESPECIALLY PHYSICAL THERAPY help tremendously in
     retaining what range of motion you still have and in keeping the pain
     (which can be incredible) to a minimum.

   o The exact cause and pathology is completely unknown, but often adhesive
     capsulitis follows an untreated injury, or bursitis or tendonitis or even
     a period of no stretching exercises.

   o Adhesive capsulitis is often mis-diagnosed as a torn rotator cuff, which
     may well be involved but which will heal without the surgery most
     orthopedic surgeons prescribe for it. What's more, an often undiscussed
     side-effect of the surgery is permanently reduced range of motion,
     because tendons are snipped and resewn, and thus shortened.

   o If the exact pathology is unknown, it is certain that it involves
     scarification of the tissues in the shoulder "capsule", and from what I
     understand scar tissue is at least partly caused by  glycosulation of
     tissues, so good control is (once again) the best prevention .

   o Cortisone is often prescribed for non-diabetic patients, and only for
     diabetic patients by doctors unfamiliar with the dramatic effect
     cortisone has on bloodsugar levels. Dr. Lupien told me cortisone doesn't
     even really have any long-term effect except to reduce the pain for
     awhile, and should be avoided completely since it could also permanently
     screw up how your body deals with cortisone.

   o Recommended treatment: daily exercises, biweekly physical therapy, daily
     (if possible) swimming, and acetaminephen (Tylenol). Extensive use of
     non-steroidal anti-inflammatories is not recommended. These include
     aspirin, ibuprofen (Advil/Motrin), and naproxen.

   Here's a sort-of-a- self test for adhesive capsulitis:

   1. Lay on the floor on your back. Can you raise your arm over your head in
      a 180-degree arc and rest it on the floor without pain or *too* much
      stretching?

   2. Stand sideways next to a wall, and walk your fingers up the wall until
      you can't reach any more. Can you almost press your armpit to the wall?

   If either of these gives you significant trouble -- you can't quite reach
   the floor behind your head, you can't touch the wall with your elbow, and
   either or both gives you pain -- you may (MAY, MAYBE, MIGHT) have adhesive
   capsulitis.

   Two doctors and one physical therapist told me that shoulders tend not to
   get the regular stretching that other joints get: a person can go for long
   periods of time without moving the shoulder much out of its usual hanging
   position, and then often the movement doesn't count for much. Hips are
   stretched at least a little several or many times a day, even  with
   sedentary types who only sit, stand, sit, stand, walk a little, sit, etc.:
   the tissues are still fairly regularly manipulated so that it is much
   harder for them to freeze up.

   Lyle, who is always interested to hear what else anyone has learned about
   this little-studied, little-mentioned condition