الفهرس 
introduction and aim of the workOnly 14 pages are availabe for public view
 |  | from | 143 |  |  |
| | | from | 143 | | |
Abstract
Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia due to defects in insulin secretion by pancreatic β-cells, insulin action on target tissues, or both. Based on its etiology, DM has been classified into four main groups; (1) Type 1 DM (T1DM) that results from lack of insulin production due to selective autoimmune destruction of pancreatic β-cells; (2) Type 2 DM (T2DM) caused by a combination of insulin resistance in the main target tissues (liver, muscle, and fat) and inadequate compensatory insulin secretion response by β-cells; (3) other specific type of diabetes which includes the genetic defects of the β-cell; (4) gestational diabetes mellitus (GDM), characterized by glucose intolerance with onset or first recognition during pregnancy (Mellado-Gil et al., 2012).
Diabetes mellitus accounts for a number of vascular complications, which impair patients’ survival. Musculoskeletal complications are also found, and, although less valued than the vascular ones, they significantly compromise the patients’ quality of life (Savas et al., 2007).
Musculoskeletal complications in type 2 diabetes are known to predominantly affect the upper limbs especially the hand and shoulder (Ramchurn et al., 2009). Musculoskeletal disorders of the hand and shoulder occur four times more frequently in diabetic than non diabetic patients. It has been found that diabetic shoulder and hand syndromes are associated with retinopathy, nephropathy and neuropathy (Enrico et al., 2002).
The incidence of DM and the life expectancy of diabetic patients have both increased, resulting in an elevation in the prevalence and clinical importance of those musculoskeletal changes. The following have been described in diabetic patients: stiff hand syndrome; Dupuytren’s contracture; trigger finger; shoulder capsulitis; calcific periarthritis of the shoulder; carpal tunnel syndrome; muscular infarction; diffuse idiopathic skeletal hyperostosis (DISH); and charcot’s arthropathy (Lebiedz-Odrobina and Kay, 2010).
Diabetic microvascular (involving small vessels, such as capillaries) and macrovascular (involving large vessels, such as arteries and veins) complications have similar etiologic characteristics. chronic hyperglycemia plays a major role in the initiation of diabetic vascular complications through many metabolic and structural derangements, including the production of advanced glycation end products (AGE), abnormal activation of signaling cascades (such as protein kinase C [PKC]), elevated production of reactive oxygen species (ROS, oxygen-containing molecules that can interact with other biomolecules and result in damage), and abnormal stimulation of hemodynamic regulation systems (such as the renin-angiotensin system [RAS]) (W Todd Cade , 2008).
Examination of the shoulder with ultrasound has become a widely accepted method for evaluating a number of musculoskeletal disorders (O’Regan et al., 2005). High resolution ultrasound has been shown to be an efficient imaging modality for the assessment of a wide spectrum of rotator cuff & non-rotator cuff disorders (Anthanasios et al., 2006).
Shoulder capsulitis (SC) exists more frequently in diabetics than in control populations, with a prevalence of 36% in type 2 diabetic subjects (Cagliero et al., 2002).
This study aims at studying thoroughly the prevalence of the different patterns of upper limb involvement in patients with type II diabetes mellitus & to find a correlation between upper limb affection and chronic microvascular diabetic complications namely retinopathy & nephropathy. As well as to correlate shoulder joint affection with other disease variables.
Sixty consecutive patients with type 2 diabetes mellitus were included in this study. Patients comprised 11 males (18.3%) and (81.6%) 49 females with a mean age of 55.4+6.6 years ranging from 43 to 77 years. The duration of DM more than 8 years .
Twenty healthy volunteers were enrolled in this study as the control group. They were 4 males (20%) and16 females (80%). Their age ranged from 42 to 63 years with a mean age of 52.7 ± 6.45 years.
Patients & control subjects included in this study underwent full clinical evaluation, detailed MSK examination of upper limb , laboratory investigations as well as imaging of both shoulder joints using: ultrasonography&EMG/NCS.
This study showed that:
• The prevalence of periarticular soft tissue involvement as assessed qualitatively by US :
-Tenosynovitis at Rt upper limb was detected in 8 patients (13.3%).
-Tendopathy at Rt upper limb was detected in 9 pateints(15%) .
-Abnormalities Rt MN at radiuoulnar joint was detected in 23 patients (38.3%) .
-Abnormalities Rt MN at bisiform was detected in 36 patients (60%).
-Tenosynovitis at Lt upper limb was detected in 13 patients (21.7%).
-Tendopathy at Lt upper limb was detected in 11 pateints(18.6%) .
-Abnormalities Lt MN at radiuoulnar joint was detected in 14patients (23.3%) .
-Abnormalities Lt MN at bisiform was detected in 33 patients (55%).
• Diabetes specific microvascular complications were detected in patients ,Retinopathy was detected in 33 patients (55%), nephropathy in 43 patients (74.1%) .
• Shoulder joint involvement as detected by U/S showed a significant correlation with diabetic neuropathy (r = 0.42, p = 0.016).
• Lt upper limb abnormalities as detected by U/S showed a negative correlation with nephropathy (r = -0.51).
• Lt upper limb abnormalities as detected by U/S showed a non-significant correlation with retinopathy (p = 0.335).
• Rt upper limb abnormalities as detected by U/S showed a non significant correlation with nephropathy (p = 0.975).
• Rt upper limb abnormalities as detected by U/S showed a non-significant correlation with retinopathy (p = 0.375).
• HBA1c showed a significant correlation with diabetic musculoskeletal affection in upper limb ( p = 0.044).
from our results we can conclude that:
1. There is an increased prevalence of upper limb affection in patients with type 2 diabetes mellitus especially when evaluated using ultrasonography.
2. There is a possible correlation between glycemic control (HBA1c levels) and the development of diabetes specific microvascular complications.