Discussion
Several musculoskeletal disorders have been associated with diabetes.
The prevalence of musculoskeletal disorders in patients with diabetes
has increased compared to the healthy population.2,5-7 Musculoskeletal system disorders were detected
in 322 (45.9%) of the 702 diabetic patients evaluated in our study. The
frequency of musculoskeletal system disorders ranged from 36% to 75%
in other researches.2,8-10 The variability may be
caused by the inclusion of different patient populations in those
studies in terms of the distribution of diabetes duration and types.
Carpal tunnel syndrome (CTS) is a trap neuropathy that develops as a
result of compression of the median nerve under the transverse carpal
ligament at the wrist. Nerve compression can also stem from the
thickening and abnormal growth of the connective tissue. In studies
conducted in the literature, the frequency of carpal tunnel syndrome was
found to vary between 5.3% and 41.7%.2,7,9,11,12 In
a study of 432 patients with diabetes by Kiani et al.12, the prevalence of CTS was found to be 8%, and it
was shown that there was a significant relationship between female
gender and duration of diabetes. In the study of Khader et al.9 , it was emphasized that obesity is related to CTS.
In our research, the most common musculoskeletal finding was carpal
tunnel syndrome (17.7%), and there was a statistically significant
correlation between HbA1c level and carpal tunnel syndrome (p =
0.045). In some studies, the relationship between CTS and microvascular
complications has been investigated, and an association has been shown
between CTS and retinopathy. 9,13 In our study, there
was no difference in the frequency of CTS with the presence of
retinopathy and nephropathy, while it was observed that it was
significantly more common in those with neuropathy (Table 3).
Dupuytren’s contracture is a fibroproliferative disease of palmar and
digital fascia, characterized by abnormal scar tissue formation in the
palmar region of the hand. Its frequency was reported to be between 13%
and 39% in patients with diabetes. 5,14 In our study,
the frequency of Dupuytren’s contracture was found to be 14.4%.
Rajendran et al. 7 reported a higher Dupuytren’s
contracture prevalence (42%) in their study composed of 206 patients
with type 2 diabetes. Similar to our results, the frequency of
Dupuytren’s contracture was found to be 13% in a study by Ramchurm et
al.2 In the study of Pandey et al.13, Dupuytren’s contracture was found to be 19%, and
the relationship with the HbA1c level was shown in patients. In
our study, Dupuytren’s contracture was found to be associated with the
HbA1c level, as shown in Table 3. In studies conducted,
Dupuytren’s contracture was found to be related to the presence of
neuropathy and retinopathy, which are microvascular complications.9,13 In our study, Dupuytren’s contracture was found
to be significantly associated with all microvascular complications.
Adhesive capsulitis is characterized by painful, gradual loss of active
and passive shoulder motion resulting from fibrosis and contracture of
the joint capsule. The prevalence of adhesive capsulitis differs in the
research depending on the criteria used for diagnosis and the population
investigated. This difference is thought to occur due to the fact that
calcific tendinitis of the shoulder is not included in some studies
since imaging technologies are not used. In a meta-analysis evaluating
18 studies by Zreik et al. 15, the prevalence of
adhesive capsulitis in diabetes was found to be five times higher than
in the normal population. Its frequency varied between 19% and 29% in
patients with diabetes. 14,16 The frequency of
adhesive capsulitis was found to be 13.8% in our study, and its
prevalence was similar to the studies in the literature. Ardic et al.6 found the frequency of adhesive capsulitis as 12.8%
in their research. In another study, the frequency of adhesive
capsulitis was found to be 29%, and the relationship with age and
duration of diabetes was shown. At the same time, adhesive capsulitis
was compared with other complications of diabetes and was associated
with the presence of retinopathy. 16,17 In our study,
a significant relationship was found between adhesive capsulitis and
neuropathy, and retinopathy (Table 3).
The limited joint mobility syndrome is characterized by flexion
contractures, especially in small joints, and thickening and hardening
of the skin on the back of the hand and fingers. Its prevalence varies
between 8% and 60% in patients with diabetes.2,7-9,11,13 Mathew et al. 10 found
the frequency of LJMS as 8.06% in their study. Similarly, LJMS
prevalence was found to be 10.2% in our study. In a study in which
Frost et al. 18 evaluated 335 patients with type 1
diabetes, the relationship between the presence of LJMS and nephropathy
and retinopathy, especially in men, was demonstrated. When we evaluated
our study in terms of microvascular complications, there was a
significant relationship between LJMS and the presence of nephropathy