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Losing your grip: diabetes hand syndrome

Diabetes hand syndrome is an umbrella term for a number of painful complications in diabetes.


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Hands of an man with Dupuytren contracture
The hands of a man who has developed Dupuytren’s contracture.

A common but not often talked about complication of diabetes is Diabetic Hand Syndrome.  This term serves as an umbrella for a number disorders.  When they are detected early, they can often be treated successfully.

Both types of diabetes are associated with these ‘musculoskeletal disorders’ affecting the hand.  Musculoskeletal pain affects our bones, muscles, ligaments, tendons, and nerves.  The pain can be acute (having a rapid onset with severe symptoms) or chronic. There are several manifestations of diabetic hand syndrome including:  limited joint mobility (LJM), Dupuytren’s contracture, stenosing tenosynovitis (trigger finger), carpal tunnel syndrome (CTS), and a variety of other hand disorders or hand infections which people are at risk for with diabetes.  It’s important to note that conditions listed under the category of diabetic hand syndrome occur in the general population as well.

These are often considered the most common or notable.

Limited Joint Mobility

LJM is a frequently overlooked and is considered a long-term complication of diabetes. It can be diagnosed by asking for simple signs such as  a “prayer sign” or “table top sign”.  Under normal conditions, each opposing hand or hand on surface will have full contact. If not, this means there are “flexion” contractures which initially painless, can be extremely painful and debilitating.  Genetic susceptibility in combination with other factors such as longstanding hyperglycemia and a highly oxidative stress environment will add to the development of LJM.

Dupuytren’s contracture

Also known as Dupuytren’s disease is a hand disorder that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that may or may not pull one or more fingers into a bent position. The Dupuytren’s Foundation  and Reseach Group believe there are three types of Dupuytren’s  disease listed here.  Dupuytren is the name of the French surgeon who performed the first surgery in 1831.

Carpal Tunnel Syndrome (CTS)

Diabetes has been proposed as a risk factor for CTS, but not all agree with the connection. CTS is a compression neuropathy that causes “pins and needles”, pain or numbness in the territory of median nerve. Generally, factors or conditions, which press or squeeze the median nerve at the wrist, lead to signs of this syndrome.

Trigger finger

A common cause of pain and disability in the hand. It usually presents with discomfort in the palm during movement of the involved finger, usually the ring finger. Gradually, or in some cases acutely, the flexor tendon causes a painful click as the patient flexes and extends their finger. In some cases, it may even become locked. Trigger finger occurs when the affected finger’s tendon sheath becomes irritated and inflamed. This interferes with the normal gliding motion of the tendon through the sheath.

There are several manifestations of diabetic hand syndrome including: limited joint mobility (LJM), Dupuytren’s contracture, stenosing tenosynovitis (trigger finger), carpal tunnel syndrome (CTS), and a variety of other hand disorders or hand infections which people with diabetes are at risk for.

Dr. Mark E. Pruzansky, Director of HandSport Surgery Institute in New York, New York (USA), is a specialist in hand surgerywrist surgery and microsurgery amount other specialties. He gave us the opportunity to ask a few questions about hand disorders in people with diabetes.

What hand conditions to you observe in people with type 1 diabetes and type 2 diabetes?

Trigger finger and carpal tunnel syndrome, digital flexor tenosynovitis are more common, as are mild flexion contractures of the proximal interphalangeal joints.

Some say that hand problems in diabetes are more prevalent in people with type 1 diabetes.  Do you agree?

Yes.

Why do so many people with type 1 diabetes seem to develop Dupuytren’s contracture?

They commonly develop a mild form related to changes in palmar fascia and other connective tissue, whose cause is unknown. Full blown Dupuytren’s contracture requires the genetic predisposition.

Do all hand problems lead to surgery?  What are the dangers of steroid injections?

Not all problems lead to surgery, but the rate is higher among people with diabetes than those without. Steroid injections ought to be used judiciously, as too many in the same location can cause local tissue damage. They are generally less successful at relieving symptoms in people with diabetes. Steroids briefly raise serum (blood) glucose levels.

If you live with diabetes and suspect you may have diabetic hand syndrome, make an appointment to see your doctor and get help.


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