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