Frozen shoulder (adhesive capsulitis) and Dupuytren’s contracture share a similar pathology. Inflammation leads to changes in the connective tissue and it ends up severely limiting range of motion. Is there a link between the two? Both have been associated with endocrine disorders such as Hashimoto’s thyroiditis and diabetes (Cakir et al., 2003).

Dupuytren’s contracture affects the palms of the hand. Nodules develop and a cord-like structure becomes prominent causing the ring finger and sometimes the pinky finger to curl. Often this ends up in a surgery to release the tissue. Researchers have found that the nodules are comprised mostly of immune cells and it is now being suggested that Dupuytren’s contracture is caused by a T-cell mediated autoimmune response (Walthall et al., 2021).

Frozen shoulder is a painful condition that affects the capsule of the shoulder. The tissue becomes stiff and movement is limited. When you search for the cause, you will consistently find that diabetes and thyroid disease are associated with it. Perhaps there is an underlying culprit that causes all of these problems. 

Thyroid disease is triggered by autoimmune disease. Type 1 diabetes is an autoimmune condition, and there is an established connection between type 2 diabetes and autoimmune disease. Patients with diabetes have altered function of immune cells and have reactive autoantibodies. There is a hypothesis that the inflammation of diabetics is attributable to autoimmune disease (de Candia et al. 2019).

It looks like autoimmune disease may be the common root cause. If that was so, you’d find an increase in the incidence of Dupuytren’s contractures with people that have frozen shoulder. That’s exactly what the evidence found. A study in 2001 (Smith et al.) found that in a sample of 58 patients with frozen shoulder, 30 also had evidence of Dupuytren’s contracture. That’s over 50%. This was compared to another study that found that Dupuytren’s contracture was over 8 times more likely in those with frozen shoulder.

Autoimmune disease is complicated but there is strong evidence that it comes from vitamin D deficiency and something called molecular mimicry. If you want to read more on this, read this blog here. Diabetic patients show an altered number and function of immune cells, of both innate and acquired immunity. Reactive autoantibodies against islet antigens can be detected in a subpopulation of patients, while emerging data are also suggesting an altered function of specific T lymphocyte populations, including T regulatory (Treg) cells. These observations led to the hypothesis that part of the inflammatory response mounting in T2D is attributable to an autoimmune phenomenon.

Proper nutrition and diet has way more implications than just weight loss. Processes like autoimmune disease and its sequelae are something that can happen over decades of poor food choices. This may be why it’s difficult to detect that certain foods may not be right for you. They can be like a slow poison. Getting clear on what diet works best for you may have consequences that are far reaching.

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References:

de Candia P, Prattichizzo F, Garavelli S, et al. Type 2 Diabetes: How Much of an Autoimmune Disease?. Front Endocrinol (Lausanne). 2019;10:451. Published 2019 Jul 4. doi:10.3389/fendo.2019.00451

Cakir M, Samanci N, Balci N, Balci MK. Musculoskeletal manifestations in patients with thyroid disease. Clin Endocrinol (Oxf). 2003 Aug;59(2):162-7. doi: 10.1046/j.1365-2265.2003.01786.x. PMID: 12864792. 

Smith SP, Devaraj VS, Bunker TD. The association between frozen shoulder and Dupuytren's disease. J Shoulder Elbow Surg. 2001 Mar-Apr;10(2):149-51. doi: 10.1067/mse.2001.112883. PMID: 11307078.

Walthall J, Anand P, Rehman UH. Dupuytren Contracture. [Updated 2021 Nov 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526074/