Diabetic hand syndrome 3/5 (1)

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Diabetic hand syndrome with crooked fingers tested by palm imprint test. Hashim K, Thomas M, Indian Journal of Anesthesia, (2014). CC BY-NC-SA 3.0

Definition

Patients with d type 1 and type 2 have more frequent ailments from the musculoskeletal system than healthy people. The disease can cause typical changes in both hands. The symptoms must be distinguished from rheumatic inflammation as in systemic connective tissue disease, especially scleroderma / systemic sclerosis.

Occurrence

Insulin-dependent diabetes mellitus is a risk factor, but the condition also occurs among otherwise healthy. In diabetes, diabetic hand syndrome is seen in 8-50%, especially after severely manageable disease over several years.

Disease Cause

Most people have had insulin-requiring diabetes mellitus for several years. Increased incidence among those with difficult-to-control diabetes. The disease process leads to increased connective tissue (collagen) which is not degraded. In addition, changes in small blood vessels (microangiopathy) which affects blood circulation skin and subcutaneous tissue.

Symptoms of diabetic hand

"Diabetic hand" is characterized by increasing stiffness and reduced mobility. Thus, there is reduced grip strength. Reduced finger movement (diabetic kyaroarthropathy / chiroarthropathy). In particular, it is difficult to extend the fingers completely. Eventually crooked fingers are seen. The condition is not particularly painful.

Dupuytren's contracture has increased incidence of diabetes. It begins with painless thickening over later in the palm, most often within the finger 3-5.

Trigger finger (stenosing tendovaginitis / tenosynovitis): The finger «locks».

Carpal tunnel syndrome / canalis carpi syndrome: Varying numbness and sticking out in finger 2-4.

Charcot neuro-arthropathy (less frequently): Misalignments / skew in joints.

Algodystrophy / Reflective dystrophy (less frequently): Pain, skin and muscle changes.

Infections of the hands are less common.

Examinations

An early examination finding in "diabetic hand" is that the fingers can not be extended when the palm is placed against a table surface. Similarly, the fingers remain bent when the palms are placed against each other ("Prayers sign").

Dupuyten's contracture is often easily recognizable in the palm of your hand. Both hands need not be attacked. Blood tests, inclusive Antinuclear Factors (ANA) with subgroups (Scl70, CENP) expected to be normal.

Similar diseases / differential diagnoses in diabetic hand

Diabetic hand syndrome can be mistaken for scleroderma / systemic sclerosis. However, in diabetic hand syndrome is not expected Raynaud's phenomenon, telangiectasia, calcinosis (lime under the skin) or other facial and skin changes. Capillaroscopy is usually normal, without megapapillaries and bleeding, such as in systemic sclerosis.

Treatment

The best regulation of blood sugar is preventive and can better the changes at an early stage. Stretches to stretch your fingers can have an effect. In some cases, hand surgery is necessary, but one must be aware that the complication risk of diabetes is greater than that of otherwise healthy ones that are treated for Dupuytren's contracture or trigger finger.

Literature

Goyal A, Cureus, 2018

Singla R, Gupta Y, Kalra SJ Pak Med Assoc. 2015 

Todd & Rosenthal. Curr Opin Rheumatol 2009


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