Prevalence of Frozen Shoulder among Diabetes Mellitus Patients: a cross cut survey

Sufferings of frozen shoulder patients know no bounds. Adding diabetes with frozen shoulder make it more complicated. This short term cross cut survey was conducted to assess prevalence of frozen shoulder among diabetes mellitus patients. Diabetes was confirmed by checking diabetes book or medical records. Frozen shoulder was detected first in the outdoor and later during interview also. Average age of the patient’s was 53.16±11.39 years. Half of the patients were graduate. Service holder, businessman, housewife, retired, farmer and day labor were 28%, 24%, 20%, 16%, 8% and 4% respectively. Average monthly family income of the patients was 29908.00±13640.89 BDT. More than half of the patients (53.6%) earned ≤30000 BDT. Prevalence of frozen shoulder among diabetic patients was 14.40%.No statistical association was found between frozen shoulder and gender (p=0.488>0.05).So it is concluding that prevalence of frozen shoulder among diabetes patients is still high enough. Why frozen shoulder is increasing among diabetic patients -can be studied extensively in future.


Introduction
Frozen shoulder is a painful condition where pain increases during certain shoulder movement [1]. Affected in early age is rare but initiates after sixth decade of life [2]. Women suffered more than male [3]. It is evidence based that inactive shoulder is slightly more likely to be affected than active shoulder [4,5]. In our day to day practice observing that number of frozen shoulder patients is high among patients with diabetes mellitus. When I apply physiotherapy to them find difficulty to manage and progress is slow. Literature suggests that secondary frozen shoulder may be associated with diabetes mellitus [6]. The prevalence of FS in diabetes patients is reported to be 10%-36% [7,8]. But what is the scenario in our country Bangladesh need to be explored timely because of high rising tendency of diabetes mellitus patients. This cross cut study is an attempt to fill up this knowledge gap.

Materials and Method
This was a cross cut survey like study conducted at Sher-E-Bangla Nagar Orthopedic hospital among 125 pre-diagnosed diabetic patients attending outpatient department for treatment. After diagnosis data were collected when they were referred to physiotherapy department for physiotherapy. Diabetes was confirmed by checking diabetes book or medical records. Sample was conveniently selected at definite time period. Verbal consent was taken before initiation of interview. Assurance was given about confidentiality of information and freedom to withdraw any stage of interview. Rechecking of shoulder movement and radiological evidence was done to over confirm about diagnosis of frozen shoulder.

Figure 1: Gender distribution of the patients (n=125).
Male and female distribution was 48% and 52%.
Average age of the patient's was 53.16±11.39 years. Nearly half of the patients belonged to 35-50 years age group followed by 36% from 51-65 years of age and 16% from >65 years of age Orthopedics and Rheumatology Open Access Journal (Tables 1-3) (Figures 1-3). Results were published as number (%), χ2 test was performed and p<0.05 was level of significance. Half of the patients were graduate followed by HSC 36%, primary 12% and post-graduate 8%. Service holder, businessman, housewife, retired, farmer and day labor were 28%, 24%, 20%, 16%, 8% and 4% respectively. Average monthly family income of the patients was 29908.00±13640.89 BDT. More than half of the patients (53.6%) earned ≤30000 BDT per month and 42.4% family had monthly income 30001-50000 BDT. Prevalence of frozen shoulder among diabetic patients was 14.40%. No statistical association was found between frozen shoulder and gender (p=0.488>0.05).

Discussion
Diabetes has multiple complications on nerve, vessel and ultimately musculoskeletal system but how diabetes affect joint structures still it is unclear and researchable. The present study found 14.4% diabetic patients had frozen shoulder. Another study found that prevalence of frozen shoulder in diabetic patients was 17.2% [9] which is quite similar to this present study. Results was similar to study done by Gary S. et al who showed that the prevalence was 12% [10] and Nilüfer et al. [11] who showed that the prevalence was 24% and Richard et al. [1] who found that the prevalence was 19%.
Another study confirmed that the point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes was 59% and the lifetime prevalence was 76% [12]. So it is clear from the above findings that prevalence of frozen shoulder among diabetic patients is high in different parts of the world which is really a burning issue to discuss and intense study. The present study showed that male and female affected equally but Hussain et al. [9] found female are affected more than male but why it is happening need to be study in depth. As a cross sectional study design it was difficult to gather details information about associated diseases or complications but in future I will try to conduct case control or follow up study. If large scale can be done the result will be more precise.

Conclusion
It is concluded that prevalence of frozen shoulder among diabetic patients is high that means one among seven diabetic patients are suffering from frozen shoulder.