Garcilazo Cintia, Cavallasca Javier A, Musuruana Jorge L
Section of Rheumatology and Autoimmune Diseases, Hospital JB Iturraspe, CP 3000, Santa Fe, Argentina.
Curr Diabetes Rev. 2010 Sep;6(5):334-40. doi: 10.2174/157339910793360824.
The musculoskeletal system can be affected by diabetes in a number of ways. The shoulder is one of the frequently affected sites. One of the rheumatic conditions caused by diabetes is frozen shoulder (adhesive capsulitis), which is characterized by pain and severe limited active and passive range of motion of the glenohumeral joint, particularly external rotation. This disorder has a clinical diagnosis and the treatment is based on physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections and, in refractory cases, surgical resolution. As with adhesive capsulitis, calcific periarthritis of the shoulder causes pain and limited joint mobility, although usually it has a better prognosis than frozen shoulder. Reflex sympathetic dystrophy, also known as shoulder-hand syndrome, is a painful syndrome associated with vasomotor and sudomotor changes in the affected member. Diabetic amyotrophy usually affects the peripheral nerves of lower limbs. However, when symptoms involve the shoulder girdle, it must be considered in the differential diagnosis of shoulder painful conditions. Osteoarthritis is the most common rheumatic condition. There are many risk factors for shoulder osteoarthritis including age, genetics, sex, weight, joint infection, history of shoulder dislocation, and previous injury, in older age patients, diabetes is a risk factor for shoulder OA. Treatment options include acetaminophen, NSAIDs, short term opiate, glucosamine and chondroitin. Corticosteroid injections and/or injections of hyaluronans could also be considered. Patients with continued disabling pain that is not responsive to conservative measures may require surgical referral. The present review will focus on practice points of view about shoulder manifestations in patients with diabetes.
肌肉骨骼系统会以多种方式受到糖尿病的影响。肩部是常受影响的部位之一。糖尿病引发的风湿性病症之一是肩周炎（粘连性关节囊炎），其特征为疼痛以及盂肱关节主动和被动活动范围严重受限，尤其是外旋。这种病症有临床诊断方法，治疗基于物理治疗、非甾体抗炎药（NSAIDs）、皮质类固醇注射，而在难治性病例中则采用手术解决。与粘连性关节囊炎一样，肩部钙化性肩周炎会导致疼痛和关节活动受限，不过通常其预后比肩周炎要好。反射性交感神经营养不良，也称为肩手综合征，是一种与患侧血管舒缩和汗腺分泌变化相关的疼痛综合征。糖尿病性肌萎缩通常影响下肢周围神经。然而，当症状累及肩胛带时，在肩部疼痛病症的鉴别诊断中必须考虑到它。骨关节炎是最常见的风湿性病症。肩部骨关节炎有许多风险因素，包括年龄、遗传、性别、体重、关节感染、肩部脱位史和既往损伤，在老年患者中，糖尿病是肩部骨关节炎的一个风险因素。治疗选择包括对乙酰氨基酚、NSAIDs、短期阿片类药物、氨基葡萄糖和软骨素。也可考虑皮质类固醇注射和/或透明质酸注射。持续存在致残性疼痛且对保守措施无反应的患者可能需要转诊进行手术。本综述将从实践角度关注糖尿病患者肩部表现的相关要点。
