The clinical picture of the painful diabetic shoulder--natural history, social consequences and analysis of concomitant hand syndrome.

Sixty diabetic patients with shoulder pain were followed in order to trace the natural history of the disease. The triad of painful shoulder, hand syndrome and restricted hip joint mobility was strongly correlated to the duration of diabetes and retinopathy. Painful shoulder with restricted mobility (58%) and tendinitis (28%) predominated. Hand syndrome was found in 62% and restricted hip joint mobility in 42%. Ninety percent of painful shoulders with restricted mobility had difficulties in the activities of daily living in the acute phase. There was functional limitation of shoulder mobility in 17% of painful shoulders with restricted mobility at the end of the study. The duration of diabetes and the duration of shoulder symptoms were correlated. In 25%, working capacity was affected by the painful shoulder. A serious risk of developing shoulder symptoms persisting for more than 2 years was associated with insulin treatment, diabetes lasting more than 10 years, proliferative retinopathy and painful shoulder with restricted mobility.