Type 1 Diabetes: Complications

Musculoskeletal Issues (continued)

Diabetic Stiff Hands Syndrome

Diabetic stiff hands syndrome, also known as diabetic cheiroarthropathy or limited joint mobility, affects some people with type 1 diabetes and is also seen in those with type 2 diabetes. It is, however, more prevalent in patients with diabetic neuropathy than in those without.

Diabetic stiff hands syndrome is characterized by thick, tight, waxy skin. People with limited joint mobility are unable to completely bring all of their fingers completely together when they holds their palms together.

There is currently no specific treatment for this complication except with tight glucose control and therapy to help maintain as much pain-free motion as possible.

Frozen Shoulder

Frozen shoulder is a painful restriction of shoulder movement. It affects 11 to 30% of people with diabetes, as opposed to 2 to 10% of people who don’t have diabetes. Frozen shoulder is also known as adhesive capsulitis, shoulder periarthritis, or obliterative bursitis. The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, the shoulder bones are unable to freely move within the joint.

The main symptom of frozen shoulder is pain and, as result, stiffness sets in. Over time and/or with treatment, mobility can slowly return. Treatment often includes non-steroidal anti-inflammatory medications (NSAIDs), steroid injections, and physical therapy. People with diabetes who are treated with steroid injections may experience increased blood sugar levels over 24 to 48 hours after receiving the injection.

In people without diabetes, frozen shoulder can present itself about the age of 50. For people with diabetes, this condition can occur in those as young as 40, sometimes younger. While frozen shoulder is usually less painful for those who are afflicted at a younger age, treatment may not be as effective and the condition may last a longer time. Tight control over blood sugar levels helps in the prevention of frozen shoulder.

Trigger Finger

Trigger finger is associated with how long a person has had diabetes, not with age – e.g. a 30-year-old who has had diabetes for 20 years has a higher risk of developing trigger finger than a 40-year-old who has had diabetes for 10 years.

Trigger finger, also known as flexor tenosynovitis, is an irritation of the sheath that surrounds the flexor tendons, sometimes causing the tendon to catch and release like a trigger. The flexor tendons are muscles, which move your fingers but are located in the forearm, not the fingers.

Trigger finger may start as stiffness or there may be a clicking sound when you move the finger. There may also be a bump or tenderness at the base of the affected finger in your palm, which is where the tendon is likely catching. As trigger finger progresses, the finger may catch in a bent position and then suddenly pop straight. Eventually, the finger may not fully straighten.

Treatment of trigger finger includes injecting corticosteroids into the tendon sheath. If this is not successful, a visit with orthopedic hand surgeon may be required.

Tight blood sugar control and regular visits with your doctor are key factors in preventing musculoskeletal disorders but it is also important to seek medical help the moment you notice any problems developing.


Sources:
1 – British Journal of Sports Medicine. “Musculoskeletal Manifestations of Diabetes Mellitus.” PDF article downloaded from www.bjsm.bmj.com, accessed 7/26/07.

2 – The Journal of the Canadian Chiropractic Association. “The Musculoskeletal Effects of Diabetes Mellitus.” PDF article downloaded from www.pubmedcentral.nih.gov, accessed 7/24/07.

3 – Clinical Diabetes. “Musculoskeletal Complications of Diabetes Mellitus.” PDF
article downloaded from http://clinical.diabetesjounals.org, accessed 7/26/07.

4 – MedlinePlus. Nlm.nih.gov

5 – FootPhysicians.com. “Charcot Foot.” http://www.footphysicians.com/footankleinfo/charcot-foot.htm#1. Accessed 11/9/07

6 – National Institute of Neurological Disorders and Strokes. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Accessed 12/28/07.


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Reviewed by Francine Kaufman, M.D., 07/08