Thursday, June 23, 2011

With Diabetes, the Hands Aren’t Free

You’ve got to hand it to diabetes for leaving few parts of the body unscathed, including the hands. While far less common than foot problems, hand complications that are more common in people with diabetes – including tenosynovitis (aka “trigger finger”), Carpal tunnel syndrome, Dupuytren’s contracture, De Quervain syndrome, and limited joint mobility – can be equally crippling.
“Hand problems, although not usually life-threatening, can certainly be livelihood threatening,” according to Dr. Leo Rozmaryn, an orthopedic hand surgeon in Rockville, Md.

Photo credit: Miriam E. Tucker
This is my hand following my most recent surgery for tenosynovitis.

Although vascular complications can occur in the hands, diabetes-related hand problems more often involve the tendons, nerves, and/or joints. The exact mechanisms aren’t well understood, and the complications can occur even in diabetes patients who are well-controlled, particularly in those with type 1 diabetes.
The most common is “trigger finger,” which occurs when the sheath surrounding the flexor tendon in the finger becomes inflamed and thickened, causing stiffness and pain and impairing movement. Instead of gliding smoothly when the fingers bends, the tendon gets caught and “snaps” back.
Dr. Rozmaryn says that he sees about 7-8 patients a day with trigger fingers, and of those about a quarter to a third have diabetes. But diabetics make up about 70% of patients who present with multiple trigger fingers, as I did. I’ve had trigger “release” operations – in which the tendon is cut in order to widen the space within the sheath – on 8 fingers, including a thumb.
Cortisone shots are a temporary fix for some cases of trigger finger. But Dr. Rozmaryn says that he doesn’t like to give those to patients with diabetes, because the steroid can drastically raise blood sugar levels. “I’m very hesitant to give diabetics shots of cortisone unless they’re very well controlled and can monitor themselves and adjust their insulin doses.”
Most studies on diabetic hand complications are published in orthopedic and rheumatologic literature, rather than in endocrinology or primary care journals. As a result, diabetic hands aren’t often on the radar screen, Dr. Rozmaryn says.
“With diabetes, you’re worrying about the eyes, kidneys, the heart, and so many other things. But still, if you’re a physician who’s treating diabetics, my advice is don’t ignore the hands.”
—Miriam E. Tucker (@MiriamETucker on Twitter)

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