Diabetic Shoulder Mobility

Not Applicable

Completed

Interventions: Other: Optimized Shoulder Movement Program
Other: ADA Guideline Instructed

Brief Summary: The primary goal of this project is to determine how advanced glycation end-product (AGEs) accumulation and shoulder movement (humeral thoracic range of motion and "activity count") interact to contribute to shoulder limited joint mobility (LJM), pain and disability, and if an intervention consisting of a tailored dose of stretching and active shoulder movement can reduce these problems in people with diabetes mellitus (DM). The investigators will focus on the following measures that span health domains; Skin intrinsic fluorescence to measure AGEs; Ultrasound to measure supraspinatus tendon thickness; 3 dimensional joint range of motion and "activity counts" to measure shoulder movements; and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire to measure patient reported pain and disability. The investigators will test the innovative hypothesis that metabolic and movement factors interact to cause severe shoulder problems in people with DM and that an optimized shoulder movement intervention can have an important impact on reducing the development of limited joint mobility, pain and disability in this population.

Recruitment & Eligibility

Inclusion Criteria

individuals with type 2 DM and duration of diagnosed diabetes more than 10 years OR type 2 DM and presence of a 'positive prayer sign' OR shoulder flexion < 150 degrees; disability of arm, shoulder and hand (DASH) scores in the range of <70%; between the age of 40-70 will be recruited.

Exclusion Criteria

currently diagnosed adhesive capsulitis
diagnosed rotator cuff tear
recent (6 months) upper extremity injury and/or fractures
surgery in the upper extremity or thorax
cervical radiculopathy
thoracic outlet syndrome
stroke with residual upper extremity involvement
severe skin allergies in area to be tested
rheumatic conditions
known connective tissue diseases
carpal tunnel syndrome
use of a cane
individuals who engage in heavy upper extremity/ overhead use (ie, painters, tennis players) because they likely have a different mechanism of injury than those with low shoulder activity.

Arm && Interventions

Group	Intervention	Description
Optimized Shoulder Movement Program	Optimized Shoulder Movement Program	The experimental intervention is the Optimized Shoulder Movement Program. Participants will be trained in a progressive home exercise program that includes passive stretching of end range shoulder flexion and external rotation, and active shoulder motion based on the participant's baseline "activity count" .
ADA guideline Instructed	ADA Guideline Instructed	The control intervention will be instruction in basic wellness activities according to the American Diabetes Association guidelines

Primary Outcome Measures

Name	Time	Method
Arm elevation.	One year	Arm elevation is a composite of shoulder (glenohumeral) and scapular motion and will be measured using goniometry and computer assisted kinematics. Glenohumeral elevation and external rotation motions are the main focus.

Secondary Outcome Measures

Name	Time	Method
Disability of the Arm, Shoulder, and Hand (DASH) questionnaire	One year	The DASH is an established, standardized measure used to characterize pain and disability in the upper extremity.

Locations (1): Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States

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