A 48-year-old Caucasian woman diagnosed with type 1 diabetes at the age of 10 complains of stiffness in her wrists, elbows, knees, and ankles. She also has frozen shoulders. Surgical history includes hip osteotomy and bilateral acromioplasties for impingement as well as bilateral carpal tunnel and trigger-finger (two on each hand) release. Despite these orthopedic problems, she continues to work full-time but with significant joint pain. X-rays show no arthritis. All blood work has come back negative (even the stiff-man antibody). She is currently being treated for joint limitation resulting from long-term diabetes. Her hemoglobin A1c runs <7.0%. What might explain such extensive stiffness in a type 1 diabetic?
—MARY LESKO, CNP, Seven Hills, Ohio

The musculoskeletal effects of diabetes are often forgotten and sometimes overlooked. Some common orthopedic complaints in diabetics are Dupuytren contracture, carpal tunnel syndrome, adhesive capsulitis, stiff-hand syndrome, tenosynovitis, neuropathic joints, and peripheral neuropathy. These patients also have a higher incidence of calcific tendinitis, limited joint mobility without overt signs of arthritis, diffuse idiopathic skeletal hyperostosis, and complex regional pain syndrome. Unfortunately, it sounds like your patient is experiencing some of the orthopedic manifestations of diabetes. She should continue with orthopedic follow-up as needed and surgical intervention as warranted. Good glucose control and a daily exercise and stretching regimen are imperative for any diabetic.
—Michael E. Zychowicz, DNP, NP-C (124-13)