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Metabolic disorders
Gout, diabetes mellitus, etc.
This metabolic disorder is characterised by an impairment of protein metabolism that results the accumulation of a breakdown product (uric acid) in the soft tissues around joints. In exceptional cases, flare-ups of gout can also occur in the shoulder or the AC joint. Gout in the shoulder is treated in the same way as gout in other joints (e.g. the metacarpo- and metatarsophalangeal joints) and primarily involves medication.
Diabetes mellitus
Diabetes wreaks havoc throughout the body. For example, circulation is adversely affected both generally and specifically, and nerve conduction can be impaired. However, soft tissues can also react badly to diabetes, e.g. with scar-like contraction of the ligaments of the shoulder capsule. Consequently, frozen shoulder occurs more frequently in diabetics. The microscopic changes in the tissues correspond to the scar-like contractures seen in Dupuytren's disease, which affects the palm of the hand. Although the changes in ligament structure are the same, there is probably no connection between these diseases.
Sudeck's dystrophy
This complex disorder, which occurs mainly after an accident or operation, affects all the tissues in the joint. Sudeck's dystrophy is known to occur especially after hand or foot injuries and causes severe pain after trauma or surgery. Disruption of the metabolism, with demineralisation of the bone and impairment of the circulation, combined with adverse effects on the autonomic nervous system lead to a highly complex and very severe impairment of the affected extremity. The shoulder can be affected in rare cases. In Sudeck's dystrophy, it is essential for the doctor to be aware of the full range of treatments and apply them according to the severity of the condition. Drug treatment, including hormone treatment, and strengthening exercises matched to the stage of the disease are very important.