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Diabetes and Upper-Limb Conditions

Why diabetes makes frozen shoulder, trigger finger, carpal tunnel syndrome and Dupuytren's more common, and how it affects healing and surgery.

73 citationsUpdated Oct 2026

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Overview

Diabetes mellitus is a systemic condition that significantly impacts the upper limb, with musculoskeletal impairments that have traditionally been underappreciated but are now gaining attention [12]. The prevalence of these disorders remains high despite advances in medical management over the last two decades [5]. Upper extremity impairments are both prevalent and significant in patients with diabetes mellitus [7], and shoulder pain and disability are common and persistent in this population [6]. Consequently, the evaluation of patients with diabetes should include a search for other complications and an estimate of glycaemic control [1]. Examination of the hands and shoulders is a necessary component of this assessment [4].

Specific upper-limb pathologies are strongly associated with diabetes. The condition is linked to stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility [18]. Insulin-dependent diabetic patients exhibit a higher incidence of multiple digit involvement in trigger finger and a greater need for surgical release compared to non-insulin-dependent patients [2]. Furthermore, the presence of diabetes mellitus is the most important factor for developing trigger digit after carpal tunnel release, with severity being less important than the mere presence of the disease [14]. Frozen shoulder is also more prevalent in diabetic patients, although recent data suggest this prevalence is less than previously reported [23].

The clinical course of diabetic upper-limb disease is characterized by progressive deterioration and complex surgical challenges. Limited joint mobility shows continuing gradual deterioration with increasing disease duration, while finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [8]. Hand manifestations often present with multiple visits for hand conditions over time [18]. Diabetes exacerbates the burden of surgical upper-extremity infections, which are characterized by more proximal locations, deeper involved anatomy, and broader pathogenic microbiology [9]. These infections carry an increased need for repeat drainage and a higher risk for amputation [9]. Patients with insulin-dependent diabetes mellitus face a greater risk of complications following hand and upper extremity surgery, specifically an increased risk of surgical site infections [11]. While hand infection requiring hospitalization is an infrequent complication in diabetics [32], musculoskeletal hand disorders remain prevalent in type 2 diabetes mellitus patients [74].

Background & Causes

Diabetes mellitus is a significant risk factor for multiple upper-limb pathologies, including Dupuytren's disease [38], tendinopathy [39], and frozen shoulder [54]. The systemic nature of these musculoskeletal impairments has traditionally been underappreciated but is gaining recent attention [12]. Upper extremity impairments are prevalent and significant in patients with diabetes mellitus [7], with shoulder pain and disability being common and persistent in adults with the condition [6]. In adults with hand syndromes associated with diabetes, disability is related to impaired muscle function and carpal tunnel syndrome [15].

Frozen Shoulder Etiology People with diabetes are more likely to develop frozen shoulder [54]. Diabetes is a likely causal risk factor for this condition, likely through a pathway involving long-term high blood glucose levels [55]. While type 2 diabetes may be a cause of frozen shoulder, it does not support the hypothesis that the effect is mediated by metabolic health [43]. Although frozen shoulder might be associated with the duration of diabetes, the association between metabolic control and frozen shoulder has yet to be clearly shown [27]. Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic adhesive capsulitis with idiopathic adhesive capsulitis, suggesting that these conditions are distinct clinical entities [72]. Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles [24].

Stenosing Flexor Tenosynovitis and Joint Mobility The presence of limited joint mobility was positively associated with the prevalence of multiple digit involvement by stenosing flexor tenosynovitis in diabetic patients [33]. There is continuing gradual deterioration of limited joint mobility with increasing duration of disease [8]. The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit after carpal tunnel release [14].

Carpal Tunnel Syndrome Diabetic patients without peripheral neuropathy have an association with higher incidence of carpal tunnel syndrome, suggesting that there are disparate mechanisms causing diabetic peripheral neuropathy and carpal tunnel syndrome [66]. However, type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome [69]. Molecular and pathological studies provide a potential basis for the predisposition of diabetic patients to the development of carpal tunnel syndrome [71]. Among patients with diabetes who had carpal tunnel syndrome, higher RAGE expression was observed in those with more severe disease, suggesting that RAGE-mediated pathways may play a role in the pathophysiology of carpal tunnel syndrome in patients with diabetes [70].

Infection and Wound Healing Diabetes exacerbates the burden of surgical upper-extremity infections, characterized by more proximal locations, deeper involved anatomy, broader pathogenic microbiology, increased need for repeat drainage, and higher risk for amputation [9]. Diabetes mellitus is associated with a significantly increased risk of wound healing problems after soft tissue surgery of the hand (carpal tunnel release and trigger finger release) [73]. In a study of pyogenic human hand infections, three patients had overt diabetes and four had latent diabetes, representing a disproportionately high incidence of metabolic disorders [13].

Neuropathy and Other Associations In Charcot foot of diabetic origin, a severe loss of sympathetic nerve fibers was observed [56]. The frequencies of hand region abnormalities were significantly higher in diabetic subjects as compared to the controls (p-value <0.001) [34].

Symptoms & Presentation

General Musculoskeletal Manifestations

Upper limb musculoskeletal abnormalities in diabetes are associated with poor metabolic control [1]. The systemic nature of these impairments has traditionally been underappreciated but is recently gaining attention [12]. Diabetes mellitus is associated with a variety of hand manifestations, including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility [18]. These conditions often present with multiple visits for hand issues over time [18]. The frequencies of hand region abnormalities are significantly higher in diabetic subjects compared to controls [34].

Trigger Finger (Stenosing Tenosynovitis)

Insulin-dependent diabetic patients have a higher rate of requiring surgical release for relief of symptoms (56% of digits) compared to non-insulin-dependent diabetic patients (28% of digits) [2]. In diabetic patients, flexor tenosynovitis typically affected more than one digit in the same hand [59]. The presence of limited joint mobility is positively associated with the prevalence of multiple digit involvement by stenosing flexor tenosynovitis in diabetics [33].

Limited Joint Mobility

No specific evidence bullets were provided for this subsection in the source document.

Shoulder Conditions

In 36 patients (4.5 per cent.), both shoulders were involved in periarthritis, with a high incidence in insulin-dependent diabetics [3]. The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients [23]. Although frozen shoulder might be associated with the duration of diabetes, the association between metabolic control and shoulder disorders has yet to be clearly shown [27]. A patient who presents with a painful shoulder of insidious onset with restricted motion for which an intrinsic cause can be ruled out radiographically has a 38.6% chance of being diabetic [35]. A patient who presents with a painful shoulder of insidious onset with restricted motion for which an intrinsic cause can be ruled out radiographically has a 32.95% chance of being prediabetic [35]. Patients with and without diabetes experienced similar pain except during exertion [29]. Diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases following arthroscopic capsular release for adhesive capsulitis [64].

Infections

More than one third of patients in a clinical series of hand infections were diabetic [17]. There was an increased severity of hand infections in diabetic patients treated during the pandemic, linked to poor glycaemic control [28]. Outcome in insulin dependent patients with poor glycemic control, deep hand infection and presence of associated ESRD, is the worst [36].

Management

Assessment and Monitoring

Limited joint mobility deteriorates gradually as disease duration increases, although finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more [8]. Surgeons must account for the fact that limitation of joint mobility is not uncommon in the nondiabetic ageing population [65].

Trigger Finger

Insulin-dependent diabetic patients exhibit a higher incidence of multiple digit involvement (59% of patients) and a greater need for surgical release (56% of digits) compared to non-insulin-dependent diabetic patients (28% of patients with multiple digit involvement; 28% of digits requiring surgery) [2]. Percutaneous release with or without simultaneous corticosteroid injection is equally effective and safe in diabetics and nondiabetics [46]. Excision of the ulnar slip of the flexor digitorum superficialis, with or without A1 pulley release, is a safe and effective treatment for stenosing flexor tenosynovitis in the diabetic patient [49].

Carpal Tunnel Syndrome

Patients with diabetes achieve the same beneficial outcome after carpal tunnel release as nondiabetic patients [31], with long-term improvement remaining to the same extent as in patients without diabetes [37]. The duration of diabetes and its treatment can be related to the severity of disease symptoms after carpal tunnel releasing surgeries [57]. Preoperative semaglutide use was not associated with a reduction in 90-day complications or 2-year reoperation-free survival in patients with type II diabetes mellitus undergoing carpal tunnel release [68].

Frozen Shoulder and Adhesive Capsulitis

In 36 patients (4.5 per cent.), both shoulders were involved, with a high incidence in insulin-dependent diabetics [3]. Results in diabetics were significantly worse than those in non-diabetics six months post-operatively, with a tendency towards persistent limitation of movement two years after operation for arthroscopic release of frozen shoulder [30]. When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM [58]. Platelet-rich plasma injection is a safe and well-tolerated method for adhesive capsulitis management for diabetic patients [48].

Infections

Three patients were found to have overt diabetes and four had latent diabetes, representing a disproportionately high incidence of metabolic disorders in pyogenic human hand infections [13]. While fewer patients attended the service during the pandemic, there was an increased severity of hand infections in those treated, linked to poor glycaemic control [28].

Pharmacologic Considerations

A digital injection of the corticosteroid methylprednisolone acetate in diabetic patients with trigger finger causes a hyperglycemic effect that lasts for at least 5 days but can help prevent the need for surgery more than half the time [22]. Patients with HbA1c levels of 7% or greater experience higher and longer-lasting blood glucose elevations after corticosteroid injections compared to those with lower levels, suggesting HbA1c can predict the degree of glucose elevation [67]. Loxoprofen seems to be a first line treatment of acute pain in diabetics [51].

Vascular Disease and Amputation

Arterial occlusive disease in the distal upper extremity is primarily related to the combination of diabetes, renal disease, and often organ transplantation [45]. Many patients with critical ischemia due to complications of diabetes and renal disease will have multiple levels of partial occlusion that can be seen in the forearm vessels on arteriography, and these types of lesion do not lend themselves to a local approach [44]. In patients with factors or injury characteristics that contraindicate single-digit replantation (eg, advanced age, diabetes mellitus, smoking), revision amputation is indicated [42].

General Management and Research Gaps

The best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications [20]. Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed [10]. Exercise and diet are the first means of management for persons diagnosed with adult-onset type 2 diabetes (or noninsulin-dependent diabetes mellitus, NIDDM) [41]. Patients with coronary artery disease, peripheral vascular disease, and diabetes mellitus must be considered individually when prescribing exercise, because their clinical status can vary greatly [61]. In this retrospective analysis of 194,205 older patients with T2DM and a history of metformin use, GLP 1RA users experienced a similar risk of upper extremity fragility fractures compared to matched controls without GLP1-RA use [62].

Key Considerations

Prevalence and Assessment

Diabetes significantly alters the clinical presentation and epidemiology of upper-limb conditions. Insulin-dependent diabetic patients demonstrate a higher incidence of multiple digit involvement in trigger finger (59% of patients) compared to non-insulin-dependent diabetic patients (28% of patients) [2]. Furthermore, these insulin-dependent patients require surgical release for trigger finger symptoms at a higher rate (56% of digits) than their non-insulin-dependent counterparts (28% of digits) [2]. In periarthritis of the shoulder, bilateral involvement occurs in 36 patients (4.5 per cent.), with a high incidence observed in insulin-dependent diabetics [3].

Diagnostic evaluation must account for metabolic status. A patient presenting with a painful shoulder of insidious onset and restricted motion, where an intrinsic cause is ruled out radiographically, has a 38.6% chance of being diabetic and a 32.95% chance of being prediabetic [35]. Conversely, patients diagnosed with idiopathic frozen shoulder who are 60 years or younger and not known diabetics have a similar probability of having diabetes or prediabetes to an age-matched population [80]. Metabolic disorders are also disproportionately prevalent in infectious presentations; in a series of pyogenic human hand infections, three patients had overt diabetes and four had latent diabetes [13]. Analysis of a clinical series of diabetic hand infections demonstrates that more than one third of the patients are diabetic [17].

Specific Conditions and Risk Factors

Surgical outcomes and complication rates vary by condition and metabolic control. Patients with insulin-dependent diabetes mellitus (IDDM) face a greater risk of complications following hand and upper extremity surgery, specifically surgical site infections [11]. While the best current evidence supports the efficacy of surgical interventions for upper limb conditions in diabetic individuals, additional research is required to determine whether treatment outcomes are equivalent to those of nondiabetic patients and whether diabetes is associated with an increased risk of complications [20].

For carpal tunnel syndrome, patients with diabetes experience more symptoms both before and after open carpal tunnel release, but can expect the same relative improvement from surgery as patients without diabetes [76]. In a study of carpal tunnel release in diabetic patients, outcome was considered excellent if there was complete resolution of symptoms, which occurred in 35% of the treated hands [77]. For frozen shoulder, results of arthroscopic release in diabetics were significantly worse than those in non-diabetics six months post-operatively, with a tendency towards persistent limitation of movement two years after operation [30]. However, there were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus [79]. An initial failure rate of approximately one-third for manipulation under general anesthesia for frozen shoulder in diabetic patients may be considered unacceptably high in other general orthopedic procedures, but with appropriate counseling and consent and combined with a repeat MUA for recurrence, this protocol may represent a satisfactory treatment strategy [78]. Additionally, the preoperative status of the ulnar nerve, based on electrophysiology, among individuals with diabetes may be clinically relevant for surgery for cubital tunnel syndrome [53].

Perioperative Management and Research Gaps

Perioperative management requires a tailored approach to metabolic evaluation. Data did not support the guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery overall [50]. In contrast, a collaborative and comprehensive approach to the pre-operative medical evaluation of patients with diabetes is critical for shoulder arthroplasty outcomes [52]. Future prospective research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes [47].

Key Evidence

• [L3] Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications. [1] (10.1016/j.ejim.2009.08.001)
• [L4] Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) and of requiring surgical release for relief of symptoms (56% of digits) when compared to non-insulin-dependent diabetic patients (28% of patients with multiple digit involvement; 28% of digits requiring surgery). [2] (10.1016/s0363-5023(05)80432-0)
• [L4] In 36 patients (4.5 per cent.), both shoulders were involved and there was a high incidence in insulin-dependent diabetics. [3] (10.1136/ard.31.1.69)
• [L3] Examination of the hands and shoulders should be included in the evaluation of patients with diabetes. [4] (10.1016/s0002-9343(02)01045-8)
• [L3] The prevalence of musculoskeletal disorders in people with type 2 Diabetes mellitus remains high despite advances in medical management over the last two decades. [5] (10.1016/j.jht.2021.04.013)
• [L4] Shoulder pain and disability are common, and persistent in adults with diabetes. [6] (10.1093/rheumatology/ken333)
• [L3] These findings suggest that upper extremity impairments are prevalent and significant in this population. [7] (10.1016/j.physio.2014.07.003)
• [L3] There is continuing gradual deterioration with increasing duration of disease, though finger joint contractures are prevalent only in longstanding diabetics with a disease duration of nine years or more. [8] (10.1136/ard.44.2.93)
• [L2] Diabetes exacerbates the burden of surgical upper-extremity infections, characterized by more proximal locations, deeper involved anatomy, broader pathogenic microbiology, increased need for repeat drainage, and higher risk for amputation. [9] (10.1016/j.jhsa.2017.11.003)
• [L3] Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed. [10] (10.1007/s10067-003-0704-7)
• [L2] Our data demonstrate a greater risk of complications following hand and upper extremity surgery for patients with IDDM, specifically surgical site infections. [11] (10.1016/j.jhsa.2018.06.006)
• [L4] The systemic nature of musculoskeletal impairments in people with DM traditionally has been underappreciated but recently is gaining attention. [12] (10.1016/j.foot.2020.101680)
• [L4] Three patients were found to have overt diabetes and four had latent diabetes, representing a disproportionately high incidence of metabolic disorders. [13] (10.1016/s0363-5023(78)80140-3)
• [L4] The presence of diabetes mellitus rather than its severity was the most important factor for developing trigger digit. [14] (10.1016/j.jhsa.2013.10.023)
• [L4] In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome. [15] (10.3899/jrheum.090239)
• [L4] Analysis of the authors' clinical series demonstrates that more than one third of the patients are diabetic. [17] (10.1016/s0749-0712(21)00424-8)
• [L4] Diabetes mellitus is associated with a variety of hand manifestations including stenosing tenosynovitis, Dupuytren's contracture, carpal tunnel syndrome, and limited joint mobility, which often present with multiple visits for hand conditions over time. [18] (10.1016/j.jhsa.2008.01.038)
• [L3] Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. [19] (10.1016/j.jhsa.2014.01.014)
• [L4] The best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications. [20] (10.1016/j.jhsa.2011.10.002)
• [L4] A digital injection of the corticosteroid methylprednisolone acetate in diabetic patients with trigger finger causes a hyperglycemic effect that lasts for at least 5 days but can help prevent the need for surgery more than half the time. [22] (10.1016/j.jhsa.2006.03.022)
• [L3] The prevalence of frozen shoulder is less than previously reported but still greater in diabetic patients. [23] (10.1016/j.jse.2007.02.133)
• [L3] Patients with painful shoulders, irrespective of having type 2 diabetes mellitus, seem to have abnormal shoulder muscles. [24] (10.1186/s12891-022-05627-9)
• [L2] Local corticosteroid injection to the shoulder can create a significant, short-term increase in systemic glucose levels in patients with type 2 diabetes not treated with insulin. [26] (10.1016/j.jseint.2022.05.016)
• [L2] Although frozen shoulder might be associated with the duration of diabetes, the association between metabolic control and the two aforementioned shoulder disorders has yet to be clearly shown. [27] (10.1111/jdi.12491)
• [L4] While fewer patients attended the service during the pandemic, there was an increased severity of hand infections in those treated, linked to poor glycaemic control. [28] (10.1177/17531934231196026)
• [L3] Patients with and without diabetes experienced similar pain except during exertion. [29] (10.1177/0300060516675112)
• [L3] The results in diabetics were significantly worse than those in non-diabetics six months post-operatively with a tendency towards persistent limitation of movement two years after operation. [30] (10.1302/0301-620x.96b10.34476)
• [L2] Patients with diabetes have the same beneficial outcome after carpal tunnel release as nondiabetic patients. [31] (10.1016/j.jhsa.2009.04.006)
• [L4] Hand infection requiring hospitalization is an infrequent complication in diabetics. [32] (10.1016/s0266-7681(97)80041-1)
• [L2] Multiple regression analysis in diabetic patients revealed that the presence of limited joint mobility was positively associated with the prevalence of multiple digit involvement. [33] (10.3899/jrheum.081024)
• [L3] The study found that the frequencies of hand region abnormalities were significantly higher in diabetic subjects as compared to the controls (p-value <0.001). [34] (10.1186/1756-0500-6-16)
• [L4] The study shows with statistical significance that a patient who presents with a painful shoulder of insidious onset with restricted motion for which an intrinsic cause can be ruled out radiographically has a 38.6% chance of being diabetic and a 32.95% chance of being prediabetic. [35] (10.1097/smj.0b013e3181705d39)
• [L4] Outcome in insulin dependent patients with poor glycemic control, deep hand infection and presence of associated ESRD, is the worst. [36] (10.1142/s2424835519500401)
• [L2] Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. [37] (10.1016/j.jhsa.2014.01.012)
• [L3] Diabetes is a significant risk factor for Dupuytren's Disease. [38] (10.1016/s0363-5023(03)80324-6)
• [L1] These findings provide strong evidence that diabetes is associated with higher risk of tendinopathy. [39] (10.1136/bjsports-2015-094735)
• [L5] Exercise and diet are the first means of management for persons diagnosed with adult-onset type 2 diabetes (or noninsulin-dependent diabetes mellitus, NIDDM). [41] (10.1016/s0278-5919(05)70170-8)
• [L2] This study suggests that type 2 diabetes may be a cause of frozen shoulder but does not support the hypothesis that the effect is mediated by metabolic health. [43] (10.1186/s12891-025-08672-2)
• [L4] Percutaneous release with or without simultaneous corticosteroid injection has shown promising results and is equally effective and safe in diabetics and nondiabetics. [46] (10.1016/j.jhsa.2018.03.045)
• [L2] Future prospective research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes. [47] (10.1016/j.jse.2014.01.046)
• [L3] Additionally, it is a safe and well-tolerated method for AC management for diabetic patients. [48] (10.5397/cise.2021.00381)
• [L4] This procedure is a safe and effective treatment for the often-difficult problem of stenosing flexor tenosynovitis in the diabetic patient. [49] (10.1007/s11552-007-9065-z)
• [L3] The data did not support the guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery overall. [50] (10.1177/1558944720937363)
• [L4] Loxoprofen seems to be a first line treatment of acute pain in diabetics. [51] (10.1016/j.injury.2026.113298)
• [L4] A collaborative and comprehensive approach to the pre-operative medical evaluation of patients with DM is critical, as is future investigation into alternative methods associated with outcomes after shoulder arthroplasty in patients with DM. [52] (10.1007/s00264-018-3874-2)
• [L5] They note that the preoperative status of the ulnar nerve, based on electrophysiology, among individuals with diabetes may also be clinically relevant. [53] (10.1177/17531934231172595)
• [L1] People with diabetes are more likely to develop frozen shoulder. [54] (10.1136/bmjopen-2022-062377)
• [L1] Diabetes is a likely causal risk factor for frozen shoulder, likely through a pathway involving long-term high blood glucose levels. [55] (10.1371/journal.pgen.1009577)
• [L4] In Charcot foot of diabetic origin a severe loss of sympathetic nerve fibers was observed. [56] (10.1002/jor.20807)
• [Paper] However, the duration of diabetes and its treatment can be related to the severity of the disease symptoms after the carpal tunnel releasing surgeries. [57] (10.1055/s-0039-1697059)
• [L4] When shoulder mobilization was achievable with gentle manipulation under anesthesia, the outcome was satisfactory in both patients with IDDM and those with NIDDM. [58] (10.1067/mse.2002.127301)
• [L3] In the diabetic patients studied here, flexor tenosynovitis typically affected more than one digit in the same hand. [59] (10.1016/s0363-5023(05)80068-1)
• [L5] Patients with coronary artery disease, peripheral vascular disease, and diabetes mellitus must be considered individually when prescribing exercise, because their clinical status can vary greatly. [61] (10.1016/s0278-5919(02)00035-2)
• [L3] In this retrospective analysis of 194,205 older patients with T2DM and a history of metformin use, GLP 1RA users experienced a similar risk of upper extremity fragility fractures compared to matched controls without GLP1-RA use. [62] (10.1016/j.injury.2026.113456)
• [L4] However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. [64] (10.1016/j.otsr.2019.02.014)
• [L4] Limitation of joint mobility is not uncommon in the nondiabetic ageing population. [65] (10.1093/rheumatology/25.2.147)
• [L4] Diabetic patients without peripheral neuropathy have an association with higher incidence of CTS in this study, suggesting that there are disparate mechanisms causing DPN and CTS. [66] (10.1177/15589447211014607)
• [L2] Patients with HbA1c levels of 7% or greater experience higher and longer-lasting blood glucose elevations after corticosteroid injections compared to those with lower levels, suggesting HbA1c can predict the degree of glucose elevation. [67] (10.1016/j.jhsa.2014.06.035)
• [L3] Preoperative semaglutide use was not associated with a reduction in 90-day complications or 2-year reoperation-free survival in patients with type II diabetes mellitus undergoing carpal tunnel release. [68] (10.1016/j.jhsa.2025.09.003)
• [L3] Type 2 diabetes does not seem to be a risk factor for carpal tunnel syndrome. [69] (10.1186/1471-2474-15-346)
• [L2] Among patients with diabetes who had CTS, higher RAGE expression was observed in those with more severe disease, suggesting that RAGE-mediated pathways may play a role in the pathophysiology of CTS in patients with diabetes. [70] (10.1097/corr.0000000000003800)
• [L4] It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS. [71] (10.1007/s00125-014-3271-3)
• [L5] Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. [72] (10.1016/j.jse.2021.06.016)
• [L3] Diabetes mellitus is associated with a significantly increased risk of wound healing problems after soft tissue surgery of the hand (CTR and TFR). [73] (10.1016/j.jhsa.2021.05.009)
• [L4] In the present study, musculoskeletal hand disorders were prevalent in T2DM patients in Jordan. [74] (10.1111/1756-185x.12617)
• [L3] Patients with diabetes experience more symptoms both before and after open carpal tunnel release, but can expect the same relative improvement from surgery as patients without diabetes. [76] (10.1136/bmjopen-2019-030179)
• [L4] Outcome was considered excellent if there was complete resolution of symptoms and this occurred in 35% of the treated hands. [77] (10.1016/0266-7681(94)90131-7)
• [L3] An initial failure rate of approximately one-third may be considered unacceptably high in other general orthopedic procedures; however, with appropriate counseling and consent and combined with a repeat MUA for recurrence, this protocol may represent a satisfactory treatment strategy in the diabetic population. [78] (10.1016/j.jse.2011.11.006)
• [L3] There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus. [79] (10.1016/j.jseint.2023.06.007)
• [L4] Patients diagnosed with idiopathic frozen shoulder who are 60 years or younger and are not known diabetics have a similar probability of having diabetes or prediabetes to an age-matched population. [80] (10.1177/2325967117716450)

References

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[2] Treatment of trigger finger in patients with diabetes mellitus. The Journal of Hand Surgery. 1995. DOI: 10.1016/s0363-5023(05)80432-0

[3] Periarthritis of the shoulder and diabetes mellitus.. Annals of the Rheumatic Diseases. 1972. DOI: 10.1136/ard.31.1.69

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[17] DIABETIC HAND INFECTIONS. Hand Clinics. 1998. DOI: 10.1016/s0749-0712(21)00424-8

[18] Hand Manifestations of Diabetes Mellitus. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.038

[19] Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections Into the Hand and Wrist. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.01.014

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