Background/Purpose:

Soft tissue disorders affecting the upper limb are not commonly thought of as “classic” complications of type 2 diabetes mellitus. However, the majority of upper limb disorders including adhesive capsulitis, carpal tunnel syndrome, Dupuytren’s disease, flexor tenosynovitis, limited hand mobility and rotator cuff tendinitis are more frequent in patients with type 2 diabetes mellitus compared to the general population. With population aging and increasing obesity, the epidemic of type 2 diabetes mellitus is expected to grow. As such, targeting upper limb soft tissue diseases, which contribute to difficulty performing activities of daily living, increased morbidity, poorer health outcomes and higher health service related costs will be important.

The aim of this systematic review is to determine the type and magnitude of upper limb soft tissue comorbidities in patients with type 2 diabetes mellitus compared to the general population.

Methods:

A systematic literature review of the MEDLINE and EMBASE databases was performed. Any study describing upper limb soft tissue disease in patients with type 2 diabetes mellitus was included. A risk of bias assessment was performed. Where the prevalence of a condition was available, the median and range was presented.

Results:

8035 manuscripts were identified by the search strategy. 31 articles were eligible for inclusion. Most studies were cross sectional in design. The risk of bias assessment was high. We found that upper limb soft tissue disease is common in type 2 diabetes mellitus (median 32.1%, range 19-57.7%).

Based on data from two studies, the prevalence of any hand abnormality was higher in T2DM compared to controls (median prevalence 45% (range 20.5-69.5%) and 4.9% respectively). Limited hand mobility in type 2 diabetes mellitus was common, with a median prevalence of 26.7% (range 0-80%) (data from19 studies). Dupuytren’s disease was more common in type 2 diabetes mellitus, with a median prevalence 18.8%, (range 0-43.4%), compared to 8% (range 0-39%) in controls (data from 18 studies). Carpal tunnel syndrome was also more common in type 2 diabetes mellitus compared to controls, with a median prevalence of 14% (range 0.32-83.3%) and 3.1% (range 0-17.5%) respectively. The median prevalence of flexor tenosynovitis in type 2 diabetes mellitus was 7.2% (range 2-16.7%) compared to 2% (range0-3.6%) in controls (data from 13 studies).

The prevalence of any shoulder abnormality in type 2 diabetes mellitus was 19.5% compared to 4.4% in controls (data from one study). Adhesive capsulitis in type 2 diabetes mellitus was more common (median prevalence was 14.6%, range 7-29%) compared to 2.5% (range 0.5-17%) in controls (data from 8 studies). The median prevalence of rotator cuff tendinitis in type 2 diabetes mellitus was also higher (23.3% (range 9.5-43.3%)) compared to 8.7% (range 0.8-50%) in controls (data from 3 studies).

Conclusion:

This systematic review has demonstrated that upper limb soft tissue disease is more prevalent in patients with type 2 diabetes mellitus compared to the general population. These associations need to be further investigated and targeted in patients with type 2 diabetes mellitus in order to optimize health outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-of-the-upper-limb-soft-tissue-comorbidities-in-patients-with-type-2-diabetes-mellitus/