Diabettes Mellitus ve Kas-İskelet Sistemi Sorunları
Özet
Diabetes mellitus (DM), kas-iskelet sisteminde yaşam kalitesini önemli ölçüde düşüren çeşitli komplikasyonlara yol açmaktadır. Bu sorunların arkasındaki temel patogenetik mekanizmanın, ileri glikasyon son ürünlerinin (AGEs) birikmesi ve kollajen çapraz bağlantılarının oluşması olduğu düşünülmektedir. DM hastalarında karpal tünel sendromu, kısıtlı eklem mobilitesi (diyabetik keiroartropati), tetik parmak ve dupuytren kontraktürü gibi el problemleri sıkça görülmektedir. Ayrıca omuz bölgesinde adeziv kapsülit (donuk omuz) ve rotator kaf tendinopatisi gibi ciddi hareket kısıtlılıkları gelişebilmektedir. Nörolojik tutulumun eşlik ettiği kronik ve yıkıcı bir durum olan Charcot nöroartropatisi (Charcot eklemi) ise özellikle ayak yapısında geri dönüşümsüz deformitelere yol açmaktadır. Diyabet, kemik mikro-mimarisini ve kalitesini bozarak kemik frajilitesini ve kırık riskini de artırmaktadır. Nadir görülen diyabetik amiyotrofi ve kas enfarktı gibi durumlar ise şiddetli ağrı ve kas atrofisi ile seyretmektedir. Bu komplikasyonların yönetiminde multidis disipliner bir yaklaşım benimsenmekte olup, tüm tablolarda glisemik kontrolün sağlanması, fizik tedavi uygulamaları ve hasta özelinde planlanan medikal veya cerrahi müdahaleler öncelikli tedavi stratejilerini oluşturmaktadır.
Diabetes mellitus (DM) leads to various musculoskeletal complications that significantly reduce the quality of life. The primary underlying pathogenetic mechanism is thought to be the accumulation of advanced glycation end-products (AGEs) and the formation of collagen cross-links. Hand problems, such as carpal tunnel syndrome, limited joint mobility (diabetic cheiroarthropathy), trigger finger, and Dupuytren's contracture, are frequently observed in diabetic patients. Furthermore, severe motion restrictions like adhesive capsulitis (frozen shoulder) and rotator cuff tendinopathy can develop in the shoulder region. Charcot neuroarthropathy (Charcot joint), a chronic and destructive condition associated with neuropathy, causes irreversible deformities particularly in the foot structure. Diabetes also impairs bone microarchitecture and quality, thereby increasing bone fragility and fracture risks. Rare conditions such as diabetic amyotrophy and spontaneous muscle infarction present with severe pain and muscle atrophy. A multidisciplinary approach is adopted for managing these complications; achieving optimal glycemic control, implementing physical therapy, and utilizing patient-specific medical or surgical interventions constitute the primary treatment strategies across all manifestations.
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