Introduction

People with diabetes can develop many different bone and joint disorders. Sometimes the cause isn't clear. However, contributing factors may include nerve damage (neuropathy), circulation problems, muscle shrinking (atrophy) and obesity.

Charcot's joint

What is it?
Charcot's joint is a destructive bone disorder that primarily affects the feet. It occurs when a joint deteriorates because of nerve damage (neuropathy), a complication of diabetes. Eventually, the bone structure of the foot collapses, resulting in deformities.

Also called
Diabetic osteoarthropathy, neuropathic arthropathy, neuropathic joint disease

How does it affect people with diabetes?
About 15 percent of people with diabetes may have Charcot's joint. It typically affects people with severe type 1 diabetes complicated with nerve damage.

Signs and symptoms

• Numbness and tingling
• Open sores (ulcers)
• Loose or swollen joints
• Foot and ankle deformities

Treatment

• Immobilization of the affected joint or use of crutches to reduce weight bearing on the joint
• Braces or other support

Diabetic hand syndrome

What is it?
Diabetic hand syndrome is a disorder in which the skin on the hands becomes waxy and thickened. As the skin thickens and tightens, it limits joint movement (mobility) in the fingers. People with diabetic hand syndrome may be unable to fully extend their fingers or to press their palms together flat. This disorder can resemble scleroderma.

Also called
Diabetic cheiroarthropathy, stiff-hand syndrome

How does it affect people with diabetes?
This disorder typically occurs in people with type 1 diabetes but may also occur in people with type 2 diabetes. The cause isn't known.

Treatment

• Tight control of blood sugar levels
• Hand therapy to stabilize or improve joint mobility and function

Osteoporosis

What is it?
Osteoporosis is a disorder that causes bones to become weak and brittle — so brittle that even mild stresses such as bending over or coughing can cause a fracture.

How does it affect people with diabetes?
People with type 1 diabetes are at increased risk of osteoporosis. Strong evidence indicates that people with type 1 diabetes have lower than normal bone mineral density.

Signs and symptoms

• Back pain
• Loss of height over time, with an accompanying stooped posture
• Fracture of the vertebrae, wrists, hips or other bones

Treatment

• Medications to help slow bone loss

Osteoarthritis

What is it?
Osteoarthritis is a joint disorder characterized by the breakdown of joint cartilage. It may affect any joint in your body, including those in your fingers, hips, knees, lower back and feet.

Also called
Degenerative joint disease

How does it affect people with diabetes?
People with type 2 diabetes are at greater risk of osteoarthritis than are people who don't have diabetes. This is likely due to obesity, a risk factor for type 2 diabetes, rather than to the diabetes itself. Extra weight puts added stress on your joints and can speed deterioration of joint cartilage.

Signs and symptoms

• Pain in joint during or after use, or after a period of inactivity
• Discomfort in a joint before or during a change in the weather
• Swelling and stiffness in a joint, particularly after use
• Bone enlargement on the middle or end joints of your fingers or the base of your thumb
• Loss of joint flexibility

Treatment

• Medications to treat joint pain and inflammation
• Lifestyle changes to maintain joint and overall movement (mobility)
• Physical therapy
• Surgery

Diffuse idiopathic skeletal hyperostosis (DISH)

What is it?
A musculoskeletal disorder characterized by bony overgrowth (hyperostosis) where tendons and ligaments attach to bone.

Also called
Forestier disease

How does it affect people with diabetes?
DISH may be associated with type 2 diabetes. The cause isn't clear but it may be due to insulin or insulin-like growth factors that promote new bone growth.

Signs and symptoms
DISH typically causes no symptoms. But when it affects your spine, it may cause increased stiffness in your back or neck.

Treatment

• Losing weight, if you're overweight
• Physical therapy to help slow stiffening of the spine

Dupuytren's contracture

What is it?
Dupuytren's contracture is a hand deformity in which one or more fingers are bent (contracted) toward the palm and can't be fully straightened. It results from thickening and scarring of connective tissue under the skin (fascia) in the palm of the hand and in the fingers. It's typically painless.

How does it affect people with diabetes?
Dupuytren's contracture occurs more often in people with diabetes than in those without diabetes. It has been suggested that as many as two-thirds of people with long-standing diabetes have some degree of Dupuytren's contracture. This may be due to metabolic changes related to the diabetes.

Treatment
If the disorder is mild, it may require no treatment. In more severe cases, surgery may be needed.

Frozen shoulder

What is it?
Frozen shoulder is a condition characterized by stiffness and pain in your shoulder joint. It typically affects only one shoulder.

Also called
Adhesive capsulitis

How does it affect people with diabetes?
Frozen shoulder affects about 20 percent of people with diabetes, compared with 5 percent of people without diabetes.

Signs and symptoms
Frozen shoulder typically develops slowly, and in three stages:

• Painful stage. During this stage, which lasts several months, pain occurs with any movement of your shoulder.
• Frozen stage. Pain may diminish. But your shoulder becomes stiffer and your range of motion is decreased. This stage lasts several months to one year.
• Thawing stage. During this stage, which can last up to one year, the condition may begin to improve.

Treatment
It usually improves on its own without treatment.