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Common Hand Issues Found in People with Diabetes Mellitus

People who have diabetes run the risk of developing several long-term complications resulting from the disease. Among those are conditions of the hands that are often seen among this population.

As early as 1957, it was noticed that many people with diabetes complained of stiffness in the hands or stiff joints. This was eventually called limited joint mobility (LJM). It was found most often in people with what was called then, juvenile diabetes, just called Type 1 diabetes now. On examination, the hands of people with this complaint couldn't stretch out as much as they should. For example, if placing the hands palms down on a table top, normally the fingers spread out. In patients with this stiffness, the fingers and palm of the hand will not lie flat. The authors of this article caution, however, that this sign could also be of another disorder called Dupuytren's contracture or from a previous injury, so this shouldn't be relied on alone for final diagnosis.

When doing research on the causes of LJM, researchers have tried to find the connection between LJM and diabetes. What most have found is that it is most common in older patients who have had diabetes for a long time. Studies showed that anywhere from 7 percent to 76 percent of older patients with diabetes have LJM, but the most common figure is 30 percent. In one study, researchers looked at patients who had type 2 diabetes (what used to be called adult onset) for 10 years or less and none of the patients showed signs of LJM.

Similar to LJM is another disease called Dupuytren's disease and it, too, is more common among those of have diabetes than those who do not. Researchers have a better understanding of DD than LJM though. People with DD have nodules and cords on their fingers and palms of the hands, and the problem seems to occur most often in the ring fingers and middle fingers rather than all of them as in LJM. How old a patient is and how long he or she has had diabetes also is a factor in if they develop DD.

Carpal tunnel syndrome is one that many people are familiar with, however it is worse in people with diabetes than those without. As well, if people with diabetes have the surgery to release the carpal tunnel, they have worse outcomes than those without.

Studies have estimated that between 11 percent and 21 percent of patients with diabetes also have CTS. One theory is that the connective tissue is more vulnerable to injury in those with diabetes.

Trigger finger, or stenosing tensynovitis is not as well known in the diabetic population but it is more common than in the non-diabetic population. The signs of trigger finger are stiffness of the finger and locking in position. This seems to happen more among females, in both hands, and not often in the index fingers or smaller fingers. Studies estimate that about 20 percent of the diabetic population may experience trigger finger, compared wit 2 percent in the general population.

Infections can happen to anyone, with diabetes or without, but the low blood sugar (hypoglycemia) makes is easier for infection to settle in. Therefore, infections of the hand are more common among those with diabetes. As well, weakness in the hand seems to be more common among those with diabetes.

Another issue noticed by the authors of this study are lesions on the hands and fingers, as well as other parts of the body. Diabetic blisters, called bullosis diabeticorum can occur in patients with severe diabetes. They usually appear and last for anywhere between two to four weeks. Small papules called granuloma annulare seem to occur more often in those with diabetes as well. These do not go away on their own but often are left untreated.

A third type of skin problem is called Huntley's papules, which look like little skin pebbles. They are often found on the top of the hands or in the joints. Finally, painless, scaly papules, called necrobiosis lipoidica diabeticorum, can appear on the hands, although they are more likely to form on the legs. The complication that occurs with this problem is that they can ulcerate, or split open, causing an open wound.


Peter G. Fitzgibbons, MD and Arnold-Peter C. Weiss, MD. Hand Manifestations of Diabetes Mellitus. In Journal of Hand Surgery. June 2008. Vol. 33. No. 5. Pp. 771-775.

07/30/2008

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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