Understanding the Symptoms of Tendon Damage in Diabetes Patients
Among its numerous harmful consequences on the body, diabetes can injure tendons. Tendons are tough structures that link muscles to bones so that they can move. When diabetes is poorly managed or has been present for a long time, it can result in a variety of problems, some of which may damage tendons.
Here are a few tendon degeneration symptoms that might manifest in diabetics:
Sensitivity and Pain: Tendon damage may cause localised pain and soreness at the affected site. The discomfort could get greater if you move or conduct physical activity that involves the torn tendon.
Limited Motion Range: Tendon damage may lead to decreased flexibility and range of motion in the injured joint. You could find it challenging to fully flex or extend the joint where the injured tendon is.
Angiogenesis and Inflammation: Tendon injuries frequently swell, appear red, and become inflamed. The area could feel warm to the touch.
Vulnerability or instability: When a tendon is damaged, the joint it connects to may become unstable or weaker. You could find it difficult to lift things or perform activities that require strength and stability.
Crepitus: Crepitus is a cracking or crackling sound that occurs when moving the injured joint. It might be caused by the irregular mobility of the tendon damage.
Tear in a tendon: A highly injured tendon may finally totally rupture, rupturing or detaching from the bone. This typically results in an abrupt loss of motion and intense pain in the affected joint.
The Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing:
About 300,000 tendon repairs are performed annually in the United States to treat damage to tendons caused by either acute trauma or chronic tendinopathy. People with type II diabetes mellitus (T2DM) have a fourfold higher risk of tendinopathy and a fivefold higher risk of tendon rupture or tear compared to non-diabetics. Given that over 10% of the population in the US has diabetes and that 33% of the population is pre-diabetic, this is a particularly difficult healthcare issue.
Tendon rehabilitation is typically challenging and frequently unsatisfactory because mechanically poor scar-tissue is produced instead of the native tendon structure being rebuilt. In T2DM tendons, there is evidence of an enhanced scar tissue response, which could be connected to a higher risk of rupture or a slower recovery of range of motion.
T2DM's aetiology is complicated. Environmental, lifestyle, and genetic factors have been shown to have a substantial impact on the pathogenesis and progression of T2DM. Increased adiposity, namely abdominal obesity, which contributes to aberrant endocrine function and increased pro-inflammatory cytokine production, is thought to be one of the main underlying causes of T2DM. T2DM is characterised by systemic metabolic dysfunction, including dyslipidemia and elevated plasma glucose levels (hyperglycemia).
By lowering insulin receptor signalling in peripheral and hepatic organs, decreased insulin sensitivity decreases glucose absorption. Organ function is significantly hampered when these alterations in systemic homeostasis occur concurrently. T2DM, for instance, has well-known effects on the cardiovascular system; diabetics have narrower coronary arteries, more atherosclerotic plaques, and greater atheromas than non-diabetics. Heart disease and stroke are the main causes of death and disability in patients with T2DM.
The effects of T2DM on tendon homeostasis in the absence of acute damage have received little attention in basic science and preclinical literature, which may be due to an ignorance of the clinical problem's full nature. Chronic degenerative alterations to tendon structure do, however, pose a considerable clinical and social burden since patients have decreased mobility and quality of life.
Importantly, Zakaria et al. found that T2DM patients had a far higher likelihood of experiencing a tendon rupture that necessitated hospitalisation than non-diabetics. Diabetes tendinopathy, also known as tendon homeostasis abnormalities, is a common occurrence in these people. These problems may include functional alterations like a reduced range of motion, structural abnormalities like loss of collagen organisation, thickening, and calcification, or both, all of which may raise the risk of tendon rupture.
It is challenging to pinpoint the precise incidence of diabetic tendinopathy because significant variations in the relative prevalence are noted between studies, as explained in the sections below that concentrate on the impact on certain tendons. Variations in the research patient groups' sizes, patient demographics, and the specific tendon under study are likely to blame for these discrepancies. However, the overwhelming majority of evidence demonstrates a rise in the incidence of tendinopathy in T2DM patients when compared to non-diabetic patients.
Additionally, there is undeniable evidence that the severity of tendinopathy worsens as T2DM disease progresses. The high prevalence of T2DM patients without a diagnosis and the silent, asymptomatic development of degenerative alterations to tendon structure are likely to blame for the advanced stage of diabetic tendinopathy that shows clinically. T2DM is a complicated condition, making it difficult to determine the proportionate contributions of a single factor to diabetic tendinopathy.
However, increased serum levels of haemoglobin A1C (HbA1c) are strongly associated with the development of tendinopathy. HbA1c > 7% has been identified as an independent risk factor for tendinopathy.
How does diabetes affect your tendons?
Because of the high blood sugar levels associated with diabetes, your tendons may stiffen, making it more difficult for you to sustain heavier loads. Patients with diabetes are consequently more susceptible to tendon-related issues, such as achilles tendon rupture. Rotator cuff tear. People with type II diabetes mellitus (T2DM) have a fourfold higher risk of tendinopathy and a fivefold higher risk of tendon rupture or tear compared to non-diabetics.
A high glucose level can block the pro-resolving pathway and trigger an inflammatory response in healthy tendon cells. Both of these ailments carry the risk of lingering inflammation, which raises the likelihood of tendinopathy.
The tendon is a very under-vascularized tissue that mostly receives nutrition from synovial fluid diffusion. Tendon injury requires blood system cell infiltration to deliver the necessary reparative components for tissue regeneration, much like damage to any other tissue.
Diagnosis of tendonitis:
Tendonitis is typically easy to diagnose. A doctor will probably check the afflicted area and inquire as to how the tendon was injured. Additionally, imaging tests like MRIs and ultrasounds could be required.
Treatment of tendonitis:
Resting frequently helps the problem, but if the pain doesn't go away, medical attention may be required. Which tendon is injured will determine the best course of action. Even though tendonitis might linger longer, it often only lasts a few days. Resting a sore tendon is crucial if you have one. You can use cold packs, take painkillers, and in some circumstances, wearing a brace may be beneficial.
For the first several days, stay away from hot baths, heat packs, alcohol, and massages to reduce swelling. Try to move even when it's not uncomfortable to prevent the tendon from stiffening up. Your doctor or physiotherapist may also recommend rehabilitation activities to help you regain full movement and function.
If the issue does not resolve, you might require therapies like shock wave therapy, a physiotherapy technique, and corticosteroid injections or other anti-inflammatory drugs. A very limited number of times, surgery might be necessary.
Prevention of tendonitis:
If you've already experienced tendonitis, practising the proper techniques for any sports you play and strengthening the muscles around the problematic area will help you avoid further injury. To prevent your joints and tendons from being put under too much pressure, you might also need to perform an ergonomic examination of your workspace and make adjustments to your chair, keyboard, and desktop.
It is critical to keep in mind that these symptoms could be caused by other musculoskeletal issues in addition to tendon damage. If you suspect you may have tendon injury or have any of these symptoms, it is crucial to contact a healthcare specialist for an accurate diagnosis and the best course of treatment. They can do a physical exam, ask for imaging tests like an MRI or ultrasound, and offer suggestions for the best course of action.