Stiff hands in a man with type 1 diabetes

DIABETIC CHEIROARTHROPATHY

Diabetic cheiroarthropathy is a recognized complication of type 1 and type 2 diabetes. It is known to occur in 18.3% to 28.5% of patients with diabetes^1,2 and is more common in those with type 1 diabetes.³ Increased blood glucose leads to glycosylation and cross-linking of collagen, hindering its degradation and resulting in tight, waxy skin over the hands. An association between the severity of joint mobility restriction and the presence of diabetes-related microvascular complications has been reported.¹ Our patient also had associated diabetic retinopathy but no nephropathy.

DIFFERENTIAL DIAGNOSIS OF STIFF HANDS

Dupytren contracture mimics diabetic cheiroarthropathy and has been reported in 16% to 42% of patients with diabetes.^4,5 It involves thickening of the palmar aponeurosis, leading to the formation of nodules and flexion contractures, commonly affecting the fourth finger. However, in our patient, limited joint mobility was observed in all four fingers, without the presence of taut fibrotic bands.

Flexor tenosynovitis is another condition that mimics diabetes-related cheiroarthropathy,⁶ but it differs in that the contracture is not fixed and can be released, which produces a distinct snap.²

Magnetic resonance imaging has revealed thickening of the flexor tendon sheaths,⁷ but this finding is nonspecific and should be interpreted within the appropriate clinical context.

TREATMENT RECOMMENDATIONS

The primary focus of treatment lies in improving glycemic control and implementing physical therapy. There have been reports suggesting symptom relief, improved joint mobility, and overall improvement with these interventions.⁸ Unfortunately, in our patient, significant improvement was not observed. Symptom-targeted therapies like anti-inflammatory drugs, analgesics, and intralesional corticosteroids have also been used, but their effectiveness is limited. Improving glycemic control remains the cornerstone of management to prevent further progression and irreversible disability.⁹

Limited joint mobility, or diabetic cheiroarthropathy,⁶ is a commonly occurring but often overlooked complication in patients with diabetes. This is important to recognize not only because of its potential to cause severe disability, but also because it is often associated with diabetes-related microvascular complications.

DISCLOSURES

The authors report no relevant financial relationships which, in the context of their contributions, could be perceived as a potential conflict of interest.