Is There Any Relationship between Frequency of Shoulder Impingement Steroid Injection and Diabetes Mellitus

Abstract

Objective: Determine the relationship between frequency of steroid injections, duration between injections and diabetic status among shoulder impingement patients. Design: Retrospective. Setting: Outpatient. Participants: Charts of 412 patients presented with unilateral or bilateral shoulder pain diagnosed shoulder impingement syndrome and treated with steroid injections over a period of 01/2019-12/2020. Exclusion criteria: Those having manifestations suggesting of cervical radiculopathy, neuromuscular diseases, or shoulder trauma history. Interventions: Reviewing and collecting patient charts data; demographic data including occupation, body mass index, detailed medical history including DM history. Shoulder exam including impingement provocative tests; Hawkins test, Neer’s sign. Neck exam including Spurling test. Full neurological exam. Main outcome measures: Number of steroid injections received and duration between each injection over past 2 years. Laboratory results: Glycosylated hemoglobin (HgA1c), liver and kidney functions. MRI shoulder results if available. Results: Mean age 59.4 ± 11.123. All patients were right-handed, Male 37.1%, female 62.9%, Mean body mass index (BMI) 32.2 ± 8.2. Majority were manual workers (55.1%). significant relationship between shoulder impingement and sex and BMI. HgA1c <5.5 has the fewest patients (7.3%), highest number of patients with HgA1c 5.5-6.0. significant incidence of shoulder impingement with rising category of HgA1c with highest among HgA1c >7 (p=0.0001) with significant bilateral disease. Significant incidence of shoulder impingement (unilateral or bilateral among diabetics (HgA1c>6) compared to non- diabetics (p=0.011). Mean number of injections among diabetics 1.1756 ± 1.17283, non-diabetics 0.6391 ± 0.89051 (p=0.0001). No significant relation between DM and duration between injections (p=0.129). Conclusion: Steroid injection has proven efficacy in diabetic shoulder impingement patients. No studies discussed effect of DM on frequency of steroid injection. This study showed that presence of DM among shoulder impingement patients significantly increases the frequency of steroid injection but not affecting duration between injections.