Upper Limb Complications in Diabetes: A Narrative Review

Upper limb complications (ULCs) in diabetes, affecting joints, tendons, muscles, connective tissue, nerves, and skin, are underrecognized but prevalent conditions in type 1 and type 2 diabetes. Advances in diabetes care have extended life expectancy, leading to an aging diabetic population with increased susceptibility to long-term complications beyond traditional vascular issues. Despite some data on ULC epidemiology, understanding of their pathogenesis, prevention, and impact on quality of life remains limited, and treatments are often based on clinical experience rather than robust evidence. ULCs, including frozen shoulder, trigger finger, carpal tunnel syndrome, ulnar nerve entrapment, Dupuytren´s disease with contracture, and limited joint mobility, occur 2-3 times more frequently in diabetes, with higher rates in individuals over the age of 50 years and those with longer diabetes duration. Chronic hyperglycemia, glycation of collagen, and low-grade inflammation are hypothesized contributors. Modifiable risk factors include poor glycemic control, smoking, and obesity. Individuals with diabetes face slower symptom resolution, higher recurrence rates, and a greater likelihood of bilateral or multiple conditions. Awareness among clinicians and patients is critical, emphasizing routine screening and proactive management. Early diagnosis, patient education, and targeted interventions can mitigate long-term complications and improve quality of life. Future guidelines should integrate ULC monitoring into routine diabetes care and prioritize clinical trials to establish evidence-based management strategies. Addressing ULCs comprehensively will enhance outcomes for individuals with diabetes, ensuring better functional health and reduced societal burden.