You may have heard that diabetes can affect just about every organ system in the body; diabetes can also affect a part of the body that you normally don’t think about — and maybe take a little bit for granted: your hands!
We rely on our hands to do so many things: Holding and carrying items, writing, typing and texting, playing games, driving a car, patting our pets, and holding hands are just some of the daily tasks that require our hands to function properly.
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Our hands contain 27 bones; the wrist alone has eight bones. In addition, our hands are made up of muscles, tendons, ligaments, nerves and joint capsules. Numerous problems can occur with the hands, including sprains, fracture, tendonitis, arthritis and dislocation. If you have type 1 or type 2 diabetes, you may also be at risk of developing other disorders, often grouped under the term “diabetic hand syndrome.” Let’s take a look at what comprises this syndrome.
Diabetic stiff hand syndrome, or DSHS, is also known as diabetic cheiroarthropathy. As the name implies, finger movement becomes limited due to an increasing stiffness of the hands. Hand stiffness can make even the simplest tasks become more and more difficult. DSHS is one of the most common hand disorders in people with diabetes. It tends to occur first in the pinky finger and over time, spreads to the thumb.
If you have DSHS, you may be unable to fully straighten your fingers; if you hold the palms of your hands together and all parts of your hand don’t touch, this could be DSHS. Another symptom of this condition is waxy-looking skin that is tight and thick on the backs of your hands.
DSHS is more likely to occur in people who have had diabetes for a long time. Why does this occur? It’s possible that constant high blood sugars cause glycosylation, the process by which glucose molecules attach to protein (in this case, collagen), causing stiffness. Besides glycosylation, diabetic neuropathy (nerve damage) and diabetic microangiopathy (a blood vessel disorder) can also contribute to DSHS.
Now for the treatment. There isn’t a way to reverse DSHS, but treatment involves both physical and occupational therapy. Keeping your hands strong is also important with hand exercises. And, tight blood glucose control can both prevent and slow the development of DSHS.
Dupuytren’s contracture, sometimes called Dupuytren’s disease, is a condition where the connective tissue in the palm of the hand thickens and contracts. Knots of tissue can form under the skin and can eventually create a thick cord that pulls one or more fingers into a bent position, according to the Mayo Clinic. Dupuytren’s makes it difficult to extend the fingers; it can occur in thumbs as well as fingers and can occur in both hands at the same time.
Dupuytren’s can occur in people with either type 1 or type 2 diabetes, but some research indicates that it’s more likely to occur at a younger age in those with type 1 diabetes, as well as women with diabetes.
Besides diabetes, other risk factors for this condition include:
· Being of northern European descent
· Family history of Dupuytren’s
· Tobacco and alcohol use
· Use of medications to treat epileptic seizures
How do you know if you have Dupuytren’s contracture? A typical sign is one or more fingers that are bent and that will not extend, or straighten out. If you are unable to flatten your hand if you lay it on a table, you may have this condition. Daily tasks such as carrying things or fitting your hand into narrow spaces can be extremely difficult, if not impossible, to carry out.
Mild cases of Dupuytren’s that don’t progress quickly may not require treatment. But more severe cases can be treated by breaking apart the tough cords that are pulling on the fingers. This may be done with a procedure called needling, in which a needle is inserted through the skin to puncture and break the cord. This does not “cure” the condition, but if it recurs, needling can be repeated. Needling can’t be used in certain places in the finger due to risk of nerve or tendon damage.
Other types of treatment include injecting an enzyme in the cord to soften and weaken it, steroid injections or surgery. Surgery is most often used for advanced cases of Dupuytren’s contracture and involves making a cut in the hand to remove the thickened tissue. However, contractures can occur again, even with surgery.
Trigger finger or thumb occurs when your finger gets stuck in a bent position. The finger may snap when it is bent or straightened. The “fancy” name of trigger finger is stenosing tenosynovitis, and it happens when the sheath surrounding the tendon in the affected finger becomes inflamed. In severe cases, the finger may stay locked in a bent position.
Trigger finger is more common in people with diabetes, possibly due to chronically high blood sugar levels that cause glycosylation of the connective tissue. People who do work that requires repetitive gripping movements, people with gout or arthritis, people between the ages of 40 and 60, and women are at higher risk of developing this condition.
Symptoms of trigger finger include:
· Finger stiffness, especially in the morning
· A snapping or popping sensation when moving the finger
· Soreness, pain and/or stiffness at the base of the finger or thumb when bending or grasping
· Swelling or tenderness in the palm of the hand
· A locking of the finger or thumb in the bent position.
Mild cases of trigger finger can be treated by resting the hand, wearing a splint and doing stretching exercises. Over-the-counter anti-inflammatory medicines, such as ibuprofen or steroid injections, are also used to treat milder cases.
In more advanced cases, a procedure called percutaneous release may be used. This entails inserting a needle into the tissue around the tendon to break up the constriction. Surgery is an option, too, and this involves cutting the constricted section of the tendon sheath.
Carpal tunnel syndrome (CTS) occurs when the median nerve (the nerve that runs from the forearm into the palm of the hand) becomes pressed or squeezed at the wrist. The median nerve resides inside the carpal tunnel, which is a rigid passageway of ligaments and bones at the base of the hand. The median nerve provides sensation to the palm side of the thumb and to the index, middle and part of the ring fingers (but not the little fingers).
CTS can occur when thickening from irritated tendons or other swelling narrows the tunnel and compresses the median nerve.
Causes of and risk factors for CTS include:
· Trauma or injury to the wrist, such as a sprain or fracture
· Rheumatoid arthritis
· Underactive thyroid
· Fluid retention that occurs during pregnancy or menopause
· A cyst or tumor in the carpal tunnel
· Kidney failure
· Repeated use of vibrating tools or work that requires repetitive flexing of the wrist
It’s thought that between 15% and 20% of people with diabetes have CTS. The link between these two conditions isn’t entirely clear, but as with other hand conditions, it’s possible that glycation of the carpal tunnel tendons due to high blood sugars and diabetic neuropathy are culprits.
Symptoms of CTS include:
· Numbness or tingling in the fingers, especially in the thumb, index and middle fingers. The numbness or tingling can run up from your wrist into your arm.
· Weakness in your hand due to numbness, making it difficult to grasp objects or do manual tasks.
· The inability to feel the difference between hot and cold (more likely in advanced CTS).
CTS can be diagnosed with a physical exam of the hands, arms, shoulders and neck; X-ray; special tests to produce symptoms; a nerve conduction study; and/or ultrasound.
Treatment of CTS should address the underlying cause, such as diabetes, but may also involve:
· Use of a splint while sleeping
· Adjusting your chair and keyboard if you work at a desk
· Avoiding or limiting daytime activities that produce symptoms
· Applying ice packs
· Use of anti-inflammatory medicines, such as ibuprofen
· Steroid or lidocaine injections
· Surgery to cut the ligament to free up the median nerve
If you have any of the above symptoms in your hands, don’t delay seeing your healthcare provider. Treatments are available. And talk with your diabetes care team to help you get and keep your blood sugars within your target range to lessen further issues down the road.
Want to learn more about diabetes hand disorders? Read “Diabetes and Your Hands” and “Diabetic Neuropathy.”
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