Diabetic hand syndromes as a clinical and diagnostic tool for diabetes mellitus patients

Abstract

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia with various complications including diabetic hand syndrome (DHS); a condition characterized by association of distinct entities; limited joint mobility (LJM), Dupuytren's disease (DD), flexor tenosynovitis (FTS) and carpal tunnel syndrome (CTS) resulting in significant morbidity and mortality. The aim of this study was to evaluate the prevalence of these changes and their association to diabetes duration. We studied 142 type 2 and 45 type 1 DM patients and investigated the presence of these hand changes and peripheral neuropathy (PNP).

The prevalence of LJM was 29.4%, DD was 17.6%, FTS was 10.7% and CTS 41.7% in all diabetics. The prevalence of CTS was more in type 2 DM (83.3%) as compared to type 1 DM (24.4%). Age and duration of diabetes were clearly related to these changes. A clear association between these changes and PNP was observed. The prevalence of CTS and hand changes was higher in type 2 diabetics. The association of DD and PNP suggests that common factors could contribute to their pathogenesis. Consequently, clinical examination for diabetic hand should not ignore it.

Introduction

Diabetic hand syndrome (DHS) is a common clinical problem for diabetic patients and almost invariably involves the long standing diabetes, suboptimal glycemic control and microvascular complications [1], [2], [3], [4], [5]. The hand may reveal some vital pathological signs for diabetic patients and clinical examiners should not ignore these signals during diagnosis [5]. The questions rises, does DHS is another significant sign for all diabetic patients? Although there is some previous accumulating evidence suggesting that [6], yet this is not proven scientifically.

DHS is characterized by three conditions: first, the limited joint mobility (LJM) or diabetic cheiroarthropathy [4], [6], [7], [8] which is quite frequent in diabetes with a prevalence ranging from 20 to 54% [7], [9]. Second, trigger finger or flexor tenosynovitis (FTS) [3], [10], [11] with a prevalence of 13–20% [7], [10], [12]. Third, Dupuytern's disease (DD) [10], [13], [14] with an incidence of 14–26% [7], [13], [14]; some of which are often combined and can be potentially disabling.

Compression neuropathies i.e., the carpal tunnel syndrome (CTS) is more common in diabetic than in non-diabetic patients [7], [10], [15], [16] with a prevalence of 14–60% [7], [10], [17].

Although several such studies have been conducted in the western population, very limited data (if any) are available from our country. Moreover, since these hand disorders are also observed in non-diabetic patients, the prevalence is thought to be much higher in diabetic patients [18]. To confirm this dogma, in this study we evaluate the prevalence of these changes and their association to diabetes duration and its complication in DHS using clinico-electrophysiological measurements.