Ijaz Ahmad, Dilawaiz Nadeem, Amer Aziz.
Musculoskeletal disorders in long-standing diabetes mellitus cases.
J Pak Orthop Assoc Jan ;20(1):38-48.

Objective: To assess the frequency of different musculoskeletal disorders in patients suffering from DM for more than 10 years and also to measure changes in BMI, waist and hip circumference, quadriceps muscle power, power of ankle dorsiflexors and plantarflexors due to long-standing DM. Design: Cross-sectional (Descriptive). Place and Duration of Study: “Diabetic clinic” of Lahore Medical and Dental College/Ghurki Trust Teaching Hospital, Lahore, during year 2006. Patients and Methods: Three-hundred previously diagnosed diabetic patients fulfilling the inclusion criteria were studied. Each patient was examined for the presence or otherwise of some selected musculoskeletal disorders. Moreover their BMI, waist and hip circumference, quadriceps muscle power and power of ankle dorsiflexors as well as plantarflexors were recorded on a specialized proforma and compared against a cut off value of respective variables. Results: There were 56% females and 44% males in the study. More than 90% were type II diabetics. Their age was more than 40 years and the duration of diabetes more than 10 years. They were not known cases of IHD, renal failure, CVA, myopathies, cushing disease or any physical or mental disability; 62.66% patients were found to be suffering from burning feet, 58.33% from numbness of feet; 25.66% from delayed wound healing; 13.66% from callus formation; 9% from hammer toes; 7.3% from foot ulceration; 4% from interdigital ulceration and only one case (0.33%) of Charcot’s joint was noted. Mean BMI of these patients was noted as 27.38kg/m2 as against the cut off value of 22. Mean waist circumference was noted as 93.73 cm as against the cut off value of 75. Mean hip circumference was noted as 95.67cm as against the cut off value of 90. Mean quadriceps muscle power grade was noted as 4.62 as against the cut off value of 5 (In other words, 187 patients had muscle power, of Grade 5, while 113 had Grade 4, according to MRC Scale). Similarly, the mean power grade of ankle plantarflexors was 4.86 (273 patients had grade 5 power, 23 had grade 4 while 4 had grade zero) and that of dorsiflexors was noted as 4.96 (287 patients had grade 5 power and remaining 13 patients had grade 4 ) as against the cut off value of 5. Conclusion: Different musculoskeletal disorders are frequently observed in patients suffering from long-standing DM. It also causes increase in BMI, hip and waist circumference, but, on the other hand, it decreases the muscle power of the otherwise healthy looking (obese) diabetic patients.

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