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Introduction: Increased prevalence of shoulder dysfunction among people with diabetes is a recognised source of disability resulting in functional impairments. Metabolic perturbations in diabetes result in glycosylation and microvascular abnormalities in shoulder muscles altering muscle mechanics and activation pattern. Aim: The present study was aimed to evaluate surface electromyographic activity of shoulder muscles among people with diabetes with and without shoulder dysfunction with an objective of suggesting clinical recommendations to maximise shoulder function. Materials and Methods: The present observational, casecontrol study was conducted over two years from March 2015 to May 2017 at Physiotherapy Department, Sancheti Hospital, Pune, Maharashtra, India. Following Institutional Ethical Committee Approval, surface-Electromyography (EMG) was recorded in 45 patients with diabetes and shoulder dysfunction, 45 patients with diabetes without shoulder dysfunction; within the age group of 40-60 years and 45 healthy aged matched controls. Muscle activity was recorded from pectoralis major, supraspinatus, infraspinatus, upper trapezius, biceps and middle deltoid muscles during Maximal Voluntary Isometric Contraction (MVIC) and various functional tasks after normalisation. Shoulder Pain and Disability Index (SPADI) was used to assess shoulder function and compared among the groups using post-hoc tests. Results: Significant linear decline in muscle activity of pectoralis major (p0.001), upper trapezius (p>0.001), biceps (p0.05). Posthoc comparison revealed higher score of SPADI in people with shoulder dysfunction compared to healthy controls (p

Title: Prevalence of shoulder dysfunction among people with type II diabetes Background: Despite high prevalence of musculoskeletal disorders among people with diabetes mellitus (type II), limited information is available on associated musculoskeletal complications in Indian population. Therefore present study aimed to investigate prevalence of shoulder dysfunction among people with type II diabetes prospectively and retrospectively. Methods: Ethical Approval was sought from Institutional Ethical Review Committee. Data were collected prospectively and retrospectively for comprehensive analysis. Seven hundred and thirty seven participants were included following signed informed consent. Prospective method involved screening of 102 patients with type II diabetes based on clinical evaluation for prevalence of shoulder dysfunction. Shoulder dysfunction was defined as clinical manifestation of pain in and around shoulder region in addition to functional limitation. Disability associated with shoulder dysfunction was evaluated using Disability of Arm, Shoulder and hand (DASH) questionnaire. Retrospective data from 635 patients with shoulder dysfunction were retrieved from medical records retained by Physiotherapy outpatient department of MGM Hospital, Aurangabad to study prevalence of type II diabetes among people with shoulder dysfunction. Results: Prospective data analysis revealed 52.9% prevalence of shoulder dysfunction among people with diabetes and retrospective data analysis revealed 50.5% prevalence of type II diabetes among patients with shoulder dysfunction. Conclusions: Awareness of these findings will alert practitioners to the high prevalence of shoulder dysfunction among patients with type II diabetes resulting in early detection and management for better functional outcome. Key Words: diabetes, shoulder dysfunction, India

We would like to provide updated information on the prevalence of shoulder dysfunction in Indian people with diabetes in view of benefit to wider Asian population and clinical practitioners. International Diabetes Federation reported 61.3 million people in India with diabetes in 2011. The figure is projected to rise to 101.2 million by 2030, i.e., approximately 58 % increase in two decades [1]. Impact of type II diabetes mellitus is considerable as it increases morbidity affecting the HRQOL [2]. An increased prevalence of musculoskeletal problems affecting hand and shoulder is recognized in type II diabetes which is likely to cause major limitations in activities of daily living casting a negative influence on H-RQOL. Despite high prevalence of musculoskeletal disorders among people with diabetes mellitus (type II), limited information is available on associated musculoskeletal complications in Indian population. To acquire accurate information and comprehensive analysis, data were collected prospectively (102 patients) and retrospectively (635 patients). High prevalence of 52.94 % of shoulder dysfunction in Indian patients with type II diabetes and the total prevalence of type II diabetes in patients with shoulder dysfunction was 50.55 %. Current findings provide recent quantification of growing health burden associated with shoulder dysfunction due to diabetes in India. In summary, approximately 50 % of people suffering from shoulder pain and stiffness have diabetes and vice versa which will alert practitioners to adopt measures for early detection and management of shoulder dysfunction in diabetes in India. This crude prevalence rate of shoulder dysfunction could be an underestimation of actual prevalence, due to inability to include entire diabetic population in the North central zone of Maharashtra State. Until extensive and nationally representative studies are available, present findings provide valuable guide to shoulder dysfunction in Indian population with diabetes. Current findings report that patients presenting with shoulder dysfunction has an approximately 50 % chance of being diabetic. By understanding the knowledge of high prevalence of shoulder dysfunction among people with diabetes will urge clinical practitioner to screen patients with shoulder pain for diabetes. Early diagnosis and prompt management of diabetes is known to reduce the risk of musculoskeletal complications. Monitoring for signs of musculoskeletal complications can be an invaluable component of comprehensive diabetes care. Alarming high prevalence of shoulder dysfunction and vice versa will alert the clinical practitioners for early detection and management to achieve better shoulder function. Diabetic care programs must include screening, prevention, and rehabilitation strategies for shoulder dysfunction.