Frequency and associated factors of upper limb musculoskeletal disorder among Bangladeshi diabetic population: A facility-based multicentered cross-sectional study
Background: Musculoskeletal complications are now being acknowledged as significant but overlooked complications of diabetes mellitus, leading to disability and poor quality of life. Yet, there is a scarcity of research on upper limb musculoskeletal disorders (ULMSDs) in diabetic patients in Bangladesh. Aim: Our study aims to assess the prevalence and risk factors of ULMSDs among Bangladeshi adults with diabetes. Methods: A multicenter, cross-sectional study was conducted among 363 adult diabetic patients from multiple health care facilities in Bangladesh. Information on socio-demographic and lifestyle-related factors, clinical profile, comorbidities, and common ULMSDs was gathered through face-to-face interviews and physical examination. Prevalence was calculated using descriptive statistics, and binary logistic regression analysis was conducted to examine the factors associated with ULMSDs. Odds ratios (ORs) and 95% confidence intervals were adjusted for. Results: The prevalence of ULMSDs was 57.6%. The most prevalent ULMSDs were diabetic hand syndrome (44.9%), adhesive capsulitis (38.8%), rotator cuff tendinitis (38.0%), and carpal tunnel syndrome (37.2%) respectively. Severe physical inactivity was significantly associated with ULMSDs (p = 0.03). Longer duration of diabetes (more than 10 years) was associated with an increased risk of ULMSDs (p = 0.01). Diabetic neuropathy (OR = 2.06, p = 0.031), diabetes control by lifestyle modification only (OR = 3.93, p = 0.03), and dyslipidemia (p < 0.05) were also significant predictors in our study. Conclusion: ULMSDs are common in Bangladeshi adults with diabetes. Periodic screening and holistic clinical and epidemiological approaches are needed to enhance the quality of life. Relevance for patients: Integrating upper limb musculoskeletal screening into diabetes care may improve function, reduce disability, and enhance quality of life.
- Bekele A, Abebe G, Hailu T, et al. Prevalence and associated factors of carpal tunnel syndrome among diabetic patients in Arba Minch General Hospital, South West Ethiopia, 2021. Diabetes Metab Syndr Obes. 2022;15:983-993. doi: 10.2147/DMSO.S356484
- Mustafa KN, Khader YS, Bsoul AK, Ajlouni K. Musculoskeletal disorders of the hand in type 2 diabetes mellitus: prevalence and its associated factors. Int J Rheum Dis. 2016;19(7):730-735. doi: 10.1111/1756-185X.12617
- Becker J, Nora DB, Gomes I, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol. 2002;113(9):1429-1434. doi: 10.1016/S1388-2457(02)00201-8
- Kaka B, Maharaj SS, Fatoye F. Prevalence of musculoskeletal disorders in patients with diabetes mellitus: a systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2019;32(2):223-235. doi: 10.3233/BMR-171086
- Merashli M, Chowdhury TA, Jawad ASM. Musculoskeletal manifestations of diabetes mellitus. QJM. 2015;108(11):853-857. doi: 10.1093/qjmed/hcv106
- Picard S, Vasilevski D, Fagherazzi G. Distribution of highly prevalent musculoskeletal disorders and their association with diabetes complications in a population of 140 individuals with type 1 diabetes: a retrospective study in a French diabetes center. Clin Diabetes. 2020;38(2):181-187. doi: 10.2337/cd19-0062
- Alenazi AM, Alothman S, Alshehri MM, et al. The prevalence of type 2 diabetes and associated risk factors with generalized osteoarthritis: a retrospective study using ICD codes for clinical data repository system. Clin Rheumatol. 2019;38(12):3539-3547. doi: 10.1007/s10067-019-04712-0
- Alenazi AM, Obaidat SM, Alshehri MM, et al. Type 2 diabetes affects joint pain severity in people with localized osteoarthritis: a retrospective study. Pain Med. 2020;21(5):1025-1031. doi: 10.1093/pm/pnz299
- Ceruso M, Lauri G, Bufalini C, et al. Diabetic hand syndrome. J Hand Surg Am. 1988;13(5):765-770. doi: 10.1016/S0363-5023(88)80145-X
- Rosenbloom AL. Limitation of finger joint mobility in diabetes mellitus. J Diabet Complications. 1989;3(2):77-87. doi: 10.1016/0891-6632(89)90016-0
- Lekholm C, Sundkvist G, Lundborg G, Dahlin L. [The diabetic hand--complications of diabetes]. Lakartidningen. 2001;98(4):306-312. [In Swedish].
- Bilolikar VK, Seigerman DA, Ilyas AM. Diagnosis and management of common hand infections. JBJS Rev. 2020;8(4):e0188. doi: 10.2106/JBJS.RVW.19.00188
- Jung Y, Hohmann TC, Gerneth JA, et al. Diabetic hand syndrome. Metabolism. 1971;20(11):1008-1015. doi: 10.1016/0026-0495(71)90023-0
- Papanas N, Maltezos E. The diabetic hand: a forgotten complication? J Diabetes Complications. 2010;24(3):154-162. doi: 10.1016/j.jdiacomp.2008.12.009
- Gamstedt A, Holm-Glad J, Ohlson CG, Sundström M. Hand abnormalities are strongly associated with the duration of diabetes mellitus. J Intern Med. 1993;234(2):189-193. doi: 10.1111/j.1365-2796.1993.tb00729.x
- Lu YC, Wang PW, Liu RT, et al. Limited joint mobility of the hand: prevalence and relation to chronic complications in non-insulin-dependent diabetes mellitus patients. J Formos Med Assoc. 1993;92(2):139-143.
- Chammas M, Bousquet P, Renard E, Poirier JL, Jaffiol C, Allieu Y. Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am. 1995;20(1):109-114. doi: 10.1016/S0363-5023(05)80068-1
- Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. J Diabetes Complications. 1997;11(5):287-290. doi: 10.1016/S1056-8727(96)00076-1
- Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-2128. doi: 10.1016/S0140-6736(12)61728-0
- Arkkila PE, Kantola IM, Viikari JS. Dupuytren's disease: association with chronic diabetic complications. J Rheumatol. 1997;24(1):153-159. PMID:9002027
- Rydberg M, Zimmerman M, Gottsäter A, Nilsson PM, Melander O, Dahlin LB. Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden. BMJ Open Diabetes Res Care. 2020;8(1):e001298. doi: 10.1136/bmjdrc-2020-001298
- Tony AA, Tony EAE, Selim YARM, Saad E. Carpal tunnel syndrome in patients with and without diabetes mellitus in Upper Egypt: the impact of electrophysiological and ultrasonographical studies. Alexandria J Med. 2018;54(4):437-443. doi: 10.1016/j.ajme.2017.11.003
- Aroori S, Spence RAJ. Carpal tunnel syndrome. Ulster Med J. 2008;77(1):6-17.
- Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-158. doi: 10.1001/jama.282.2.153
- Wamisho BL, Fantaye Y. Epidemiology and clinical profile of common musculoskeletal diseases in patients with diabetes mellitus at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. East Cent Afr J Surg. 2018;22(2):49-62. doi: 10.4314/ecajs.v22i2.6
- Dieck GS, Kelsey JL. An epidemiologic study of the carpal tunnel syndrome in an adult female population. Prev Med. 1985;14(1):63-69. doi: 10.1016/0091-7435(85)90021-0
- Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg Br. 2004;29(4):315-320. doi: 10.1016/j.jhsb.2004.02.009
- Tseng CH, Liao CC, Kuo CM, Sung FC, Hsieh DPH, Tsai CH. Medical and non-medical correlates of carpal tunnel syndrome in a Taiwan cohort of one million. Eur J Neurol. 2012;19(1):91-97. doi: 10.1111/j.1468-1331.2011.03440.x
- Singh R, Gamble G, Cundy T. Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes. Diabet Med. 2005;22(5):625-630. doi: 10.1111/j.1464-5491.2005.01487.x
- Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565-569. doi: 10.2337/diacare.25.3.565
- Ramchurn N, Mashamba C, Leitch E, et al. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med. 2009;20(7):718-721. doi: 10.1016/j.ejim.2009.08.001
- Islam MR, Rahman T, Islam RN, et al. Frequency of carpal tunnel syndrome in patients having diabetes mellitus with neuropathy in a tertiary care hospital of Bangladesh. Birdem Med J. 2018;8(3):240-245. doi: 10.3329/birdem.v8i3.38131
- Al Mahmud FR, Mandal MA, Rahman AM, Khatun MS, Rahman MA. Pattern of musculoskeletal disorders among diabetic patients attending the Department of Physical Medicine and Rehabilitation in a tertiary care hospital. KYAMC J. 2021;12(1):41-43. doi: 10.3329/kyamcj.v12i1.53367
- Raosoft. Sample size calculator. Raosoft.com. Accessed September 2, 2026. http://www.raosoft.com/samplesize.html.
- Maddison R, Ni Mhurchu C, Jiang Y, et al. International Physical Activity Questionnaire (IPAQ) and New Zealand Physical Activity Questionnaire (NZPAQ): a doubly labelled water validation. Int J Behav Nutr Phys Act. 2007;4(1):62. doi: 10.1186/1479-5868-4-62
- Lam WY, Fresco P. Medication adherence measures: an overview. Biomed Res Int. 2015;2015:217047. doi: 10.1155/2015/217047
- Krapek K, King K, Warren SS, et al. Medication adherence and associated hemoglobin A1c in type 2 diabetes. Ann Pharmacother. 2004;38(9):1357-1362. doi: 10.1345/aph.1D612
- Rosenbloom AL, Silverstein JH, Lezotte DC, Richardson K, McCallum M. Limited joint mobility in childhood diabetes mellitus indicates increased risk for microvascular disease. N Engl J Med. 1981;305(4):191-194. doi: 10.1056/NEJM198107233050403
- Mathew AJ, Nair JB, Pillai SS. Rheumatic-musculoskeletal manifestations in type 2 diabetes mellitus patients in south India. Int J Rheum Dis. 2011;14(1):55-60. doi: 10.1111/j.1756-185X.2010.01587.x
- Lebiedz-Odrobina D, Kay J. Rheumatic manifestations of diabetes mellitus. Rheum Dis Clin North Am. 2010;36(4):681-699. doi: 10.1016/j.rdc.2010.09.008
- Powar R, Mahapure K. Accuracy of Quick-DASH tool versus CTS-6 tool in evaluating the outcome of carpal tunnel release. Eur J Plast Surg. 2022;45(2):315-320. doi: 10.1007/s00238-021-01880-8
- Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin-and non-insulin-dependent diabetes mellitus. Rheumatology. 1986;25(2):147-151. doi: 10.1093/rheumatology/25.2.147
- Muluneh AG, Adem KS, Dawud JS, Kibret AK, Yitayal MM, Eriku GA. Upper-extremity musculoskeletal disorders and their associated factors among diabetes mellitus patients attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: cross-sectional study. Front Endocrinol (Lausanne). 2022;13:856521. doi: 10.3389/fendo.2022.856521
- Bhat TA, Dhar SA, Dar TA, et al. The musculoskeletal manifestations of type 2 diabetes mellitus in a Kashmiri population. Int J Health Sci (Qassim). 2016;10(1):57-68.
- Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM. Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. Am J Med. 2002;112(6):487-490. doi: 10.1016/S0002-9343(02)01045-8
- Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy. 2015;101(2):147-154. doi: 10.1016/j.physio.2014.07.003
- Arkkila PET, Gautier JF. Musculoskeletal disorders in diabetes mellitus: an update. Best Pract Res Clin Rheumatol. 2003;17(6):945-970. doi: 10.1016/j.berh.2003.11.001
- Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14(8):473. doi: 10.1007/s11910-014-0473-5
- Zyluk A, Puchalski P. Hand disorders associated with diabetes: a review. Acta Orthop Belg. 2015;81(2):191-196.
- Hasheminasabgorji E, Jha JC. Dyslipidemia, diabetes and atherosclerosis: role of inflammation and ROS-redox-sensitive factors. Biomedicines. 2021;9(11):1602. doi: 10.3390/biomedicines9111602
- Collins KH, Herzog W, MacDonald GZ, et al. Obesity, metabolic syndrome, and musculoskeletal disease: common inflammatory pathways suggest a central role for loss of muscle integrity. Front Physiol. 2018;9:112. doi: 10.3389/fphys.2018.00112
- Olaosebikan H, Azenabor A, Akintayo R, Adelowo O, Ogbera A, Brodie-Mends A. Spectrum of musculoskeletal disorders in Nigerians with type 2 diabetes mellitus: prevalence and predictors. Reumatismo. 2020;71(4):209-217. doi: 10.4081/reumatismo.2019.1232
- Kidwai SS, Wahid L, Siddiqi SA, Khan RM, Ghauri I, Sheikh I. Upper limb musculoskeletal abnormalities in type 2 diabetic patients in low socioeconomic strata in Pakistan. BMC Res Notes. 2013;6(1):16. doi: 10.1186/1756-0500-6-16
- Kim RP, Edelman SV, Kim DD. Musculoskeletal complications of diabetes mellitus. Clin Diabetes. 2001;19(3):132-135. doi: 10.2337/diaclin.19.3.132
- Rahaman M, Shefa J, Sami C, et al. Musculoskeletal disorders in elderly patients with diabetes mellitus in a rural community of Bangladesh. Cureus. 2025;17(5):e84139. doi: 10.7759/cureus.84139
- Chen Y-H, Yeh C-J, Pan L-F, Jong G-P. Relationships between alcohol use, musculoskeletal pain, and work-related burnout. Medicina. 2022;58(8):1022. doi: 10.3390/medicina58081022
- Ebadi SA, Pajavand HA, Asadi A, Asadollahi P, Fatollahzadeh M. Relationship of musculoskeletal diseases with microvascular and macrovascular complications in patients with diabetes in Iran. Diabetes Metab Syndr Clin Res Rev. 2021;15(6):102272. doi: 10.1016/j.dsx.2021.102272
- Azami M, Moradkhani A, Afraie M, et al. The association between diabetes mellitus and musculoskeletal disorders: a systematic review and meta-analysis. Front Endocrinol. 2024;15:1320468. doi: 10.3389/fendo.2024.1320468
