Full Length Article| Volume 35, ISSUE 4, P597-604, October 2022

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Proportion and distribution of upper extremity musculoskeletal disorders and its association with disability in type 2 diabetes mellitus

Published:April 13, 2021DOI:


      • Approximately half of type 2 diabetes mellitus individuals suffer from upper extremity musculoskeletal disorders.
      • Musculoskeletal disorders are prevalent bilaterally in thirty-two percent of individuals.
      • Limited joint mobility and frozen shoulder are the most prevalent disorders.
      • The proportion of limited joint mobility was more than frozen shoulder.
      • Amongst all disorders, frozen shoulder leads to maximum disability, followed by limited joint mobility and trigger finger.


      Study design



      Globally, diabetes is a leading cause of disability with an increased prevalence rate in the past three decades. Chronic diabetes has been shown to affect collagenous tissue which often leads to subsequent musculoskeletal complications. Despite increasing prevalence of musculoskeletal disorders, the proportion and distribution of types of upper extremity musculoskeletal disorders resulting in disabilities is poorly understood.

      Purpose of the study

      This cross-sectional study aims to gather data on the prevalence, proportion and distribution of upper extremity musculoskeletal disorders among individuals with Type 2 Diabetes Mellitus. Further, this study examines the relationship between common upper extremity disorders and the resulting disability among individuals with Type 2 Diabetes Mellitus.


      170 individuals diagnosed with Type 2 Diabetes Mellitus were recruited at a tertiary care hospital. Routine upper extremity assessments were performed to identify the presence of Frozen Shoulder (FS), Limited Joint Mobility (LJM), Trigger Finger, Carpal Tunnel Syndrome (CTS), and Dupuytren's Contracture. Disability was measured using the Disabilities of arm, shoulder, and hand (DASH) questionnaire. Descriptive statistics, one-way analysis of variance, Tukey's test, and Pearson's test were used to examine the prevalence, proportion and distribution of musculoskeletal disorders and disabilities among individuals with type 2 Diabetes Mellitus.


      83(48.9%) participants had one or a combination of multiple musculoskeletal disorders of the upper extremity. The proportion of LJM, FS, CTS, Trigger Finger, and Dupuytren's Contracture were n = 46(27.1%); n = 43(25.3%); n = 16(9.4%); n = 8(4.7%); n = 5(2.9%) respectively. Disability scores on the DASH were 25.8 ± 14.5, 10.3 ± 11.9, and 10.6 ± 10.4 respectively for individuals with FS, LJM and Trigger Finger. DASH scores were highest in individuals with both CTS and FS, 29.8 ± 19.3. Duration of diabetes was significantly associated (r = 0 .19; P < .01) with the disability scores on DASH.


      The prevalence of musculoskeletal disorders in people with type 2 Diabetes mellitus remains high despite advances in medical management over the last two decades. The overall prevalence of hand disorders (LJM, CTS, Dupuytren's contracture, Trigger Finger) was higher than shoulder disorders (FS), e.g. frozen shoulder. People with a diabetes that had a diagnosed upper extremity conditon had more upper extremity disability, than those with diabetes but no diagnosed hand condition, Disability was highest for frozen shoulder and lowest for Dupuytren's diagnoses. Carpal tunnel syndrome was the most disabling hand condition. People with diabetes should be screened for upper extremity diagnoses that could limit their function. Poeple with disability resulting from hand disorders was lower than the shoulder disorders. A combination of hand and shoulder disorders resulted in greater disability.


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      JHT Read for Credit

      Quiz: # 884

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        Chronic diabetes often contributes to musculoskeletal disorders because it
        • a.
          deposits sugar crystals in joints
        • b.
          alters blood flow to muscles
        • c.
          affects collagenous tissue
        • d.
          affects skin flexibility
      • # 2.
        Disability was highest among those with
        • a.
          frozen shoulder
        • b.
        • c.
          lateral epicondylitis
        • d.
          pronator syndrome
      • # 3.
        Screening examinations noted
        • a.
          trigger finger
        • b.
          frozen shoulder
        • c.
          carpal tunnel syndrome
        • d.
          all of the above
      • # 4.
        Which pathology was the most disabling
        • a.
          swan neck
        • b.
        • c.
        • d.
          cubital tunnel
      • # 5.
        Disability was lowest for patients with Dupuytren's
        • a.
          not true
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.