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Diabetic Cheiroarthropathy Symptoms

Musculoskeletal Manifestations Of Diabetes Mellitus

Musculoskeletal Manifestations Of Diabetes Mellitus

Introduction Diabetes mellitus affects nearly 387 million people worldwide. 1 The number of adults with diabetes in Europe is estimated to be over 50 million with a prevalence of 7.9%, and it is estimated that around 17.2 million people remain undiagnosed. Around 90% of patients with diabetes have Type 2 diabetes (T2D), characterized by variable degrees of insulin resistance and deficiency. Type 1 diabetes (T1D) is an autoimmune condition, characterized by the destruction of the insulin-producing beta cells, resulting in lifelong insulin deficiency. In developed countries, T1D is increasing at a rate of around 4% a year. 2 Whilst diabetes is widely recognized as causing significant morbidity and premature mortality due to myocardial infarction, stroke, renal failure, visual impairment and foot ulceration, it is less widely known that diabetes is associated with a number of musculoskeletal conditions. Patients with diabetes may develop several musculoskeletal syndromes or symptoms, many of which are associated with the severity and duration of the disease. These conditions may affect joints, soft tissues, nerves, muscles or tendons. Some conditions are unique to people with diabetes, while others are seen in the general population but have a higher prevalence in the diabetic population. While some of these conditions stem from other complications of diabetes, such as peripheral neuropathy, others seem to be directly caused by the metabolic abnormality, with direct glycosylation damaging tissues. Though musculoskeletal complications of diabetes are rarely life threatening, they usually occur in patients who have other complications, such as cardiovascular, neuropathic, nephropathic or retinal conditions, and can cause significant disability. This article aims to review so Continue reading >>

Diabetic Cheiroarthropathy: The Musculoskeletal Complication Clinicians May Be Overlooking

Diabetic Cheiroarthropathy: The Musculoskeletal Complication Clinicians May Be Overlooking

With more intensive insulin therapy regimens, people with diabetes are living longer and have better control of the disease and its complications. Although severe complications such as blindness and kidney disease receive most of the attention, individuals with longstanding diabetes (approximately 30 years) may also need treatment for complications that are not life threatening but are still debilitating. One of these complications, cheiroarthropathy, is a common syndrome involving the tendons and joints. Consultant360 spoke with David M. Nathan, MD, Director of the Clinical Research Center and the Diabetes Center at Massachusetts General Hospital, to learn more about this little known and underappreciated syndrome that comprises conditions such as carpal tunnel syndrome, adhesive capsulitis, flexor tenosynovitis (commonly referred to as trigger finger), and Dupuytren contracture. Dr. Nathan is also a Professor of Medicine at Harvard Medical School, and he has been involved with the Diabetes Control and Complications Trial (DCCT)1 and the long-term follow up of that study2 during his 40-year career as a researcher of diabetic complications, glycemic control, and the hemoglobin A1c (HbA1c) assay. Could you tell me more about cheiroarthropathy and why so few clinicians seem to be aware of it? Cheiroarthropathy is an old Greek term that loosely translated means musculoskeletal disorders and, specifically, limited joint mobility. Cheiroarthropathy was identified and characterized in people with type 1 diabetes more than 40 years ago.3 However, it has been a generally underappreciated complication because other complications are more dramatic and have a major impact on people’s lives and lifespans. In recent years, a better understanding of the intimate relationship betwee Continue reading >>

Diabetic Cheiroarthropathy: A Case Report And Review Of The Literature

Diabetic Cheiroarthropathy: A Case Report And Review Of The Literature

Go to: 2. Case Presentation A 28-year-old female with a 12-year history of type 1 diabetes mellitus reported pain and stiffness in both hands of one-year duration. The pain was described as dull and aching lasting throughout the day and worsening at night. She reported morning stiffness in her hands lasting for 5 minutes. She admitted limited movements of all joints in her hands with associated tightening of the skin. She denied any changes in the color of her skin in her fingers with cold weather. There waere no dysphagia, no dry eyes, and no dry mouth. Of note, her glycemic control was poor with glycosylated hemoglobin (HbA1c) ranging between 8.5 and 10%. She was on an insulin pump. She was found to have nonproliferative diabetic retinopathy and microalbuminuria. She did not have any neuropathy. There was no family history of rheumatologic disease. Diabetic cheiroarthropathy was diagnosed clinically after eliciting the “prayer” and “table top” signs. The prayer sign is said to occur whenever there is incomplete approximation of one or more of the digits when the patient attempts to approximate the palmar surfaces of the proximal and distal interphalangeal joints with palms pressed together and the fingers abducted (Figure 1). She was not able to completely lay her palms flat on a horizontal surface which denotes a positive tabletop sign. There was no evidence of Duputren's contracture. Carpal tunnel syndrome was ruled out with negative Tinel's and Phalen's tests. There was no flexor tenosynovitis as evidenced by the absence of palpable crepitus. Laboratory investigations such as erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and other collagen vascular workup were normal. Radiographs of both hands showed mild prominence of proximal to m Continue reading >>

Mri Of Diabetic Cheiroarthropathy

Mri Of Diabetic Cheiroarthropathy

Carver College of Medicine University of Iowa Iowa City, IA 52242 Citation: American Journal of Roentgenology. 2007;188: W94-W95. 10.2214/AJR.06.0672 Diabetic cheiroarthropathy, or stiff-hand syndrome, is characterized by painless limitation of mobility of the small joints of the hands. Although a well-described entity in the endocrine and rheumatology literature, the imaging findings of diabetic cheiroarthropathy have been described in only one article, to our knowledge, and that article focused on the sonography findings [ 1 ]. A 14-year-old girl was referred to the pediatric rheumatology service at our hospital with a 1-year history of inability to straighten her fingers. She had been diagnosed with juvenile arthritis at an outside facility and was started on antiinflammatory drugs without symptomatic relief. Her history was remarkable for a 3-year history of poorly controlled type 1 diabetes. Fig. 1A 14-year-old girl with type 1 diabetes and stiff hands. Coronal T2-weighted images with fat saturation of left (A) and right (B) hands show thickening and edema of synovial sheath along flexor tendons of all five digits, extending from wrist to phalanges. Flexion deformity of hands prevented inclusion of digits on same coronal plane. Fig. 1B 14-year-old girl with type 1 diabetes and stiff hands. Coronal T2-weighted images with fat saturation of left (A) and right (B) hands show thickening and edema of synovial sheath along flexor tendons of all five digits, extending from wrist to phalanges. Flexion deformity of hands prevented inclusion of digits on same coronal plane. Fig. 1C 14-year-old girl with type 1 diabetes and stiff hands. Axial T1 fat-saturation gadolinium-enhanced images of left (C) and right (D) hands show thickening of flexor digitorum superficialis (white Continue reading >>

Cheiroarthropathy In Type 1 Diabetes Common, Underappreciated

Cheiroarthropathy In Type 1 Diabetes Common, Underappreciated

Cheiroarthropathy in Type 1 Diabetes Common, Underappreciated CHICAGO A group of musculoskeletal conditions including frozen shoulder and carpal-tunnel syndrome, collectively known as "cheiroarthropathy," is extremely common in people with longstanding type 1 diabetes and is an important source of functional disability in this population, new data from the Diabetes Control and Complications Trial (DCCT) indicate. The findings were presented here at the American Diabetes Association (ADA) 2013 Scientific Sessions , in a special symposium commemorating the 30th anniversary of the launch of the landmark DCCT and its long-term follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC). The major results from this were previously reported . The full extent to which cheiroarthropathy affects those with type 1 diabetes had not been fully appreciated, said Mary E. Larkin, RN, MSN, CDE, assistant director of the Diabetes Research Center and EDIC study coordinator at Massachusetts General Hospital, Boston, who presented the new findings. These conditions are believed to be related to an accumulation of advanced glycosylation end products, she said Detailed assessment of cheiroarthropathy was not part of the original EDIC plan, but investigators created an ancillary study for it in 2011 year 18 of EDIC after several study coordinators observed how often study subjects complained about the conditions, which also include flexor tenosynovitis ("trigger finger"), and a thickening of the hand tissues that causes joint flexion and results in the positive "prayer sign," in which patients are unable to place the palms of their hands flatly against one another. "It's an underrecognized complication of type 1 diabetes," Ms. Larkin told Medscape Medical News, addin Continue reading >>

Bone And Joint Problems Associated With Diabetes

Bone And Joint Problems Associated With Diabetes

If you have diabetes, you're at increased risk of various bone and joint disorders. Certain factors, such as nerve damage (diabetic neuropathy), arterial disease and obesity, may contribute to these problems — but often the cause isn't clear. Learn more about various bone and joint disorders, including symptoms and treatment options. Charcot joint What is it? Charcot (shahr-KOH) joint, also called neuropathic arthropathy, occurs when a joint deteriorates because of nerve damage — a common complication of diabetes. Charcot joint primarily affects the feet. What are the symptoms? You might have numbness and tingling or loss of sensation in the affected joints. They may become warm, red and swollen and become unstable or deformed. The involved joint may not be very painful despite its appearance. How is it treated? If detected early, progression of the disease can be slowed. Limiting weight-bearing activities and use of orthotic supports to the affected joint and surrounding structures can help. Diabetic hand syndrome What is it? Diabetic hand syndrome, also called diabetic cheiroarthropathy, is a disorder in which the skin on the hands becomes waxy and thickened. Eventually finger movement is limited. What causes diabetic hand syndrome isn't known. It's most common in people who've had diabetes for a long time. What are the symptoms? You may be unable to fully extend your fingers or press your palms together flat. How is it treated? Better management of blood glucose levels and physical therapy can slow the progress of this condition, but the limited mobility may not be reversible. Osteoporosis What is it? Osteoporosis is a disorder that causes bones to become weak and prone to fracture. People who have type 1 diabetes have an increased risk of osteoporosis. What are Continue reading >>

Cheiroarthropathy: A Diabetes Complication

Cheiroarthropathy: A Diabetes Complication

HEALTH FEATURE ARCHIVE Cheiroarthropathy - A Diabetes Complication Diabetes mellitus, commonly referred to as "diabetes," is a chronic medical condition associated with abnormally high levels of sugar (glucose) in the blood. Diabetes can lead to eye, kidney, nerve, and heart damage. It can also be complicated by a syndrome that affects the function of the hands, cheiroarthropathy. Cheiroarthropathy is syndrome of limited joint mobility that occurs in patients with diabetes. Cheiroarthropathy is characterized by thickening of the skin resulting in contracture of the fingers. Cheiroarthropathy causes such limited motion of the fingers that the affected individual is unable to extend the fingers to fully flatten the hand. Typically both hands are affected by cheiroarthropathy. Rarely, larger joints are affected (generally in more advanced, longstanding diabetes). Cheiroarthropathy has been reported in over half of patients with insulin-dependent diabetes and approximately three quarters of those with noninsulin-dependent diabetes. Cheiroarthropathy occurs more frequently in those with a longer history of diabetes. Treatment of cheiroarthropathy includes pain reliever and/or antiinflammation medicines, stretching exercises, and tight control of the blood sugar level. Amputations. INVOKANA® may increase your risk of lower-limb amputations. Amputations mainly involve removal of the toe or part of the foot; however, amputations involving the leg, below and above the knee, have also occurred. Some people had more than one amputation, some on both sides of the body. Youmay be at a higher risk of lower-limb amputation if you: have a history of amputation, have heart disease or are at risk for heart disease, have had blocked or narrowed blood vessels (usually in leg), have damage Continue reading >>

Cheiroarthropathy|causes|symptoms|treatment

Cheiroarthropathy|causes|symptoms|treatment

Cheiroarthropathy: Causes, Symptoms, Treatment Cheiroarthropathy is a disorder in which there is a limited finger movement as the hands become waxy and thickened. This is a diabetes complication and is also known as Diabetic cheiroarthropathy or Diabetic stiff hand syndrome. People with both the types of diabetes, i.e. diabetes type 1 and diabetes type 2 can be affected by Cheiroarthropathy. However, optimizing glycemic control and physical therapy can slow down the development of this diabetes complication. Let us know about the condition in a more precise way. An Introduction On "Cheiroarthropathy: A Diabetes Complication": Diabetes mellitus or diabetes , is a chronic medical condition that is associated with abnormally high levels of glucose or sugar in the blood. This condition can lead to eye, kidney, nerve as well as heart damage. Diabetes can also be complicated by a syndrome that affects the function of your hands, and is known as Cheiroarthropathy, where there is a limited joint mobility in the fingers and the hands. Here the patients are unable to extend the fingers to fully flatten the hand. In Cheiroarthropathy, typically both the hands are affected. Rarely, the larger joints are affected in Cheiroarthropathy. This diabetes complication has been reported in more than half of patients with insulin-dependent diabetes and approximately three quarters of those people with noninsulin-dependent diabetes. Cheiroarthropathy occurs more frequently in individuals with a long history of diabetes Cheiroarthropathy is characterized by the inability to strengthen joints in the hands and thus the function of the hands can be severely limited. The sufferers find stiffness begins in their little finger and the spreads to the thumbs. Eventually, this stiffness can prevent th Continue reading >>

Diabetic Cheiroarthropathy

Diabetic Cheiroarthropathy

Diabetes may affect the muscle and joint systems in a variety of ways. Diabetic cheiroarthropathy, also known as diabetic stiff hand syndrome, is commonly found in patients with type 1 diabetes and to a lesser extent, type 2 diabetes . Diabetic cheiroarthropathy is found in 8% to 50% of all patients with type 1 diabetes, and a similar proportion of patients with type 2 diabetes. The longer someone has diabetes, the more likely it is that they will develop stiff hand syndrome. Risk Factors for Diabetic cheiroarthropathy The longer someone has diabetes, the more likely it is that they will develop diabetic cheiroarthropathy. How is Diabetic cheiroarthropathy Treated? There is currently no known way to reverse the effects of diabetic cheiroarthropathy. Control of blood sugar levels is one of the most important aspects, both to help prevent the development of diabetic cheiroarthropathy and other complications. Physiotherapy and occupational therapy are important to maintain hand mobility and prevent further loss of movement. [1] Aljahlan, Lee, Toth. Limited joint mobility in diabetes. (1999) Vol 105; No. 2 Postgraduate Medicine. [available online @ [2] Fisher L, Kurtz A, Shipley M. Association between cheiroarthropathy and frozen shoulder in patients with insulin-dependent diabetes mellitus. Br J Rheumatol 1986;25(2):141-6 [3] Ismail, Dasgupta, Tanqueray, et al. Ultrasonographic features of diabetic cheiroarthropathy. The British Journal of Rheumatology, Vol 35, 676-679. [4] Kim, Edelman, Kim. Musculoskeletal Complications of Diabetes Mellitus. [available online @ Continue reading >>

Diabetes And Your Hands

Diabetes And Your Hands

Did you know that diabetes can hurt, stiffen, and even disable your shoulders, wrists, fingers, and other joints? None of these conditions is well understood. So how can you prevent them and deal with them? Of course, people without diabetes can have joint issues, but having diabetes raises your risk. All of these conditions seem to be related to thickening or stiffening of connective tissues — the ligaments and tendons that hold our bodies together. These tissues are mostly made of collagen, a protein that should have some give and flow to it, like a soft rubber ball. When collagen stiffens, joints start to hurt and don’t work as well. Here are four of the more well known diabetes-related joint conditions: Frozen shoulder, also known as adhesive capsulitis, is a condition in which the range of motion of the shoulder joint is severely restricted. According to the American Diabetes Association, it affects 20% of people with diabetes and 5% of the general population. It usually starts with shoulder pain and inflammation and can progress to stiffness and near-complete immobility. Then it starts to resolve, and is usually gone within two years, especially with treatment. Diabetic stiff hand syndrome is a painless disorder caused by an increase in collagen in and just below the skin. It can sharply limit hand function. Carpal tunnel syndrome (CTS) is a painful condition caused by pressure on the median nerve, which passes into the hand through a narrow “tunnel.” If this tunnel is squeezed by thickening of ligaments or other structures, severe pain can result. CTS is often associated with typing or other repetitive work that keep wrists in unnatural positions. Trigger finger is a condition where one or more fingers curl up and are difficult to straighten. The tendons Continue reading >>

Cheiroarthropathy - Iddt

Cheiroarthropathy - Iddt

This is often called limited joint mobility and in people with diabetes it generally involves the small joints of the hands, although it can affect larger joints such as wrist, shoulder, knees, hips. It is usually painless but numbness and pain may be present if there is also neuropathy or angiopathy of the hand. Most people do not report the problem until there is some deformity or loss of movement of the fingers. The affected fingers are swollen with a thick, tight and waxy skin and there is an inability to press both hands together hence the term, diabetic prayer. Other disorders of the hand, such as carpel tunnel syndrome and Dupuytrens contracture, have different and distinct clinical features. Cheiroarthropathy is linked with more serious microvascular complications of diabetes eg retinopathy, nephropathy and neuropathy, so diagnosis is important. The causes of cheiroarthropathy are not really understood. Treatment because of the relationship with the microvascular complications of diabetes, improved diabetic control is advised but there is no well established treatment. Physiotherapy is important to maintain movement and prevent further deterioration. Surgery and corticosteriod injections may help in severe cases. Studies show a wide variation which could be due to genetic or racial factors or incorrect diagnosis. However, it does increase with the duration of diabetes Continue reading >>

Limited Joint Mobility In Diabetes Mellitus: The Clinical Implications

Limited Joint Mobility In Diabetes Mellitus: The Clinical Implications

ABSTRACT: Limited joint mobility (LJM) is a common complication of diabetes mellitus (DM). LJM often is characterized by hand stiffness, but other joints may be involved. The prayer and tabletop signs may be used to detect limitation of joint mobility in the hands. Range of motion should be checked in the large joints as well as in the hand and finger joints. LJM should be distinguished from other musculoskeletal conditions that also are seen frequently in the hands of patients with DM. LJM may be associated with the duration of DM. Treatment is controversial. Strict control of blood glucose usually is advocated. Physical therapy may improve function. No medications have been approved for clinical use. (J Musculoskel Med. 2011;28:118-124) Limited joint mobility (LJM), or diabetic cheiroarthropathy, is a condition characterized by hand stiffness resulting from flexion contractures of the fingers and by thickened, tight, waxy skin.1 “LJM” is the newer, preferred term used in describing the condition because joints other than those in the hands (eg, in the wrists and elbows, feet, and spine) also may be involved.2 Lundbaek3 first reported LJM in 5 patients with diabetes mellitus (DM) in 1957, but the syndrome did not receive more attention until 1974, when Rosenbloom and Frias4 described it again in children with DM. The existence of this clinical entity was confirmed by larger studies of children with insulin-dependent (type 1) DM5-7 and, subsequently, was demonstrated in adult and geriatric patients with non–insulin-dependent (type 2) DM.8-12 LJM is a common complication of DM, occurring in 8% to 58% of patients; most studies suggest that the prevalence is about 30% to 40%.1,7,13,14 Although early investigators did not find sex differences, one study reported that Continue reading >>

Stiff Hand Syndrome

Stiff Hand Syndrome

Tweet Diabetic stiff hand syndrome, also known as diabetic cheiroarthropathy, is a disorder in which finger movement becomes limited as the hands become waxy and thickened. Both people with type 1 diabetes and type 2 diabetes can be affected by diabetic stiff hand syndrome, but optimising glycemic control and physical therapy can slow down the development of the condition. Who is affected? Rachel Peterson Kim, MD et al report that diabetic stiff hand syndrome is found in eight to 50 per cent of patients with type 1 diabetes, but that type 2s can also develop the disorder. Prevalence is reportedly increased as patients have diabetes for longer, while it can also be more common in patients with diabetic neuropathy. Diabetic stiff hand syndrome is associated with being a predictor for other diabetes-related complications. Symptoms of diabetic stiff hand syndrome Diabetic stiff hand syndrome is characterised by the inability to strengthen joints in the hand. As a result, hand function can be severely limited. Affected patients find stiffness begins in the little finger and spreads to the thumb. Eventually, this stiffness can prevent people bringing all of the fingers together completely upon holding their palms together. Thick, tight, and waxy skin may also develop on the back of your hand as diabetic stiff hand syndrome develops. What causes diabetic stiff hand syndrome? Multiple factors are thought to be related to the underlying cause of diabetic stiff hand syndrome. Peterson et al report factors that can enhance development include when glycosylation - the process of sugar molecules attaching to protein molecules - is increased and causes additional collagen in the skin. Harry Belcher MS, FRCS also writes that changes to the composition of collagen which lead to abnorma Continue reading >>

Diabetic Cheiroarthropathy

Diabetic Cheiroarthropathy

Diabetic cheiroarthropathy is a cutaneous condition characterized by thickened skin and limited joint mobility of the hands and fingers, leading to flexion contractures, a condition associated with diabetes mellitus[1]:681 and it is observed in roughly 30% of diabetic patients with longstanding disease.[2]:540 [3] Limited Joint Mobility, or LJM, is a complication of Type 1 Diabetes. It was one of the earliest known complications, first documented in 1974.[4] See also[edit] Diabetic dermadromes Necrobiosis lipoidica List of cutaneous conditions [edit] Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5] Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fa Continue reading >>

Resolution Of Diabetic Cheiroarthropathy After Pancreatic Transplantation

Resolution Of Diabetic Cheiroarthropathy After Pancreatic Transplantation

Resolution of Diabetic Cheiroarthropathy After Pancreatic Transplantation 1Arc Epidemiology Unit, University of Manchester, Manchester, U.K 2University of Manchester Rheumatism Research Centre, Central Manchester and Manchester Childrens University Hospitals National Health Service Trust, Manchester, U.K 3Manchester Institute of Nephrology and Transplantation, Central Manchester and Manchester Childrens University Hospitals National Health Service Trust, Manchester, U.K Address correspondence to S.L. Hider, Arc Epidemiology Unit, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, U.K. E-mail: sam.hider{at}man.ac.uk Diabetes Care 2004 Sep; 27(9): 2279-2280. A 51-year-old man was referred to our unit with a 12-month history of progressive impairment of hand function. He was unable to make a fist and had difficulty picking up small objects. He did not describe any joint pain, swelling, or morning stiffness, and there were no features to suggest an inflammatory arthropathy. He had been diagnosed with type 1 diabetes at age 7 years, complicated by diabetic nephropathy requiring a renal transplant 20 years previously (for which he was on long-term ciclosporin) and retinopathy. On examination, his skin appeared slightly thickened. He had contractures evidenced by a positive prayer sign and was unable to flatten his hands completely. The remainder of the physical examination was unremarkable except for a functioning renal transplant; specifically, he had no evidence of synovitis or neuropathy. Laboratory investigations, including erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor, were normal. His HbA1c was 6.0%. Hand radiographs were unremarkable. He was treated with physiotherapy and wax for a presumed diagnosis of diabetic c Continue reading >>

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