PEOPLE with diabetes are faced with a near fourfold higher risk of adhesive capsulitis, or ‘frozen shoulder’, a 2026 systematic review and meta-analysis has found.
Several additional risk factors for adhesive capsulitis were found: poor glycaemic control, obesity, hyperlipidaemia, hypertension, thyroid issues, age between 40 and 65, being a woman, smoking, and alcohol use.
3.69 Times Higher Odds of Adhesive Capsulitis
The relationship between diabetes and frozen shoulder has long been established. However, researchers reported that the association remains under debate.
Adhesive capsulitis is marked by shoulder pain and progressive restriction of motion, particularly external rotation, researchers reported.
After analysis of a total of 351,486 participants, the study found that people with diabetes had 3.69 times higher odds of developing adhesive capsulitis.
Underlying Mechanisms
One of the most robust explanations for the association between diabetes and frozen shoulder is reportedly related to chronic hyperglycaemia, which triggers a build-up of advanced glycation end products.
Consequently, the structural properties of collagen are adversely affected and connective tissues in the shoulder become progressively stiffer. Chronic hyperglycaemia can also contribute to excessive collagen deposition, which can ultimately lead to fibrosis.
Authors highlighted another potential mechanism: chronic low-grade inflammation, which is commonly seen in patients with diabetes. This, again, contributes to fibrosis and joint stiffness.
Importantly, it was noted that, whilst diabetes is, in and of itself, a major risk factor for frozen shoulder, there may be several contributing factors that frequently coexist with diabetes. These include, for example, obesity, hyperlipidaemia, and hypertension.
Study Limitations
The analysis included mostly studies with observational designs, limiting the conclusion of a causal relationship. Diagnostic criteria for both diabetes and adhesive capsulitis were variable across studies, alongside differences in populations, healthcare systems, and data sources.
Importantly, authors noted, residual confounding factors including age, BMI, and physical activity levels, could partially explain the link.
Implications for Clinical Care
Researchers reported that “clinicians should maintain a high index of suspicion for frozen shoulder in patients with diabetes who present with shoulder pain or progressive limitation of shoulder motion.”
They emphasised the importance of early recognition and intervention in improving mobility outcomes in patients with frozen shoulder. Screening was also recommended, for patients with long-standing or poorly controlled diabetes.
Reference
Hernigou P, Scarlat MM. The diabetic shoulder: association between diabetes mellitus and adhesive capsulitis – a systematic review and meta-analysis. Int Orthop. 2026;50(4):839-851.
Featured image: ZAY WIN HTAI on Adobe Stock
