(Overview of Diabetes-Related Hand Disorders)
Author: Lori B. Siegel and Stephen R. Huang
Source: Diabetes Forecast, 4/1/2003
When you hear about the complications of diabetes, you usually hear about your heart, eyes, kidneys, nerves, and feet. But diabetes can affect the muscles and joints of your hands, too. Diabetes-related hand conditions are usually not life-threatening, but they can have a great impact on the quality of your life.
Poor blood sugar control is thought to play a major role in diabetes-related musculoskeletal disorders of the hands. The theory is that high blood sugars change the amount and character of the protein and collagen in your tissues, leading to damage of small blood vessels.
Three musculoskeletal conditions associated with diabetes can affect your hands: stiff-hand syndrome, Dupuytren’s contracture, and carpal tunnel syndrome.
Stiff-hand syndrome is a painless disorder caused by an increase in collagen in and just below the skin. The stiffness begins in the little finger and spreads to the thumb. Eventually, the stiffness can make it difficult for you to fully extend your fingers. Thick, tight, and waxy skin may also develop on the back of your hand.
To see if you might have stiff-hand syndrome, hold your palms together like you are praying. Can you make all of the skin and joints of your palms and fingers touch? If not, you may have stiff hand syndrome.
Hand stretches and muscle strengthening exercises may correct stiff-hand syndrome. First, warm up your hands with warm water (use your elbow to check the water’s temperature), then remove them from the water, dry them, and gently stretch your hands. With your right hand, manually move the fingers of your left hand through their full range of motion, up and down, bending each joint. Then use your left hand to manipulate the fingers of your right hand. Practice making and releasing a fist with each hand. Try to touch your right thumb to each finger on your right hand. Then repeat the exercise with your left hand. Never force a stretch, however, and if it hurts, stop.
If these exercises hurt, or if they do not help alleviate your symptoms, physical therapy may help. Paraffin wax treatments, carefully administered by a therapist in a medical setting, may also help.
The best treatment for stiff-hand syndrome is prevention. In addition to keeping your blood sugars in control, practice playing with a ball or clay to keep your hands strong and flexible.
Like stiff-hand syndrome, Dupuytren’s contracture can be attributed to increased collagen in the tissues that connect and separate the skin, muscles, and tendons of the hand. As a result, the tendons of the fingers become shortened and unable to glide over one another properly. The fingers are pulled into the hand, making it hard or impossible for you to open your hand fully.
One early symptom of this condition, called “trigger finger,” is characterized by a “locking-up” sensation in one or more fingers. (The index and middle fingers are most often involved.)
As with stiff-hand syndrome, the best treatment is prevention, based on good blood sugar control and regular range-of-motion and strengthening exercises for the hands. Heat also seems to help, but remember to check the temperature of warm water with your elbows.first. Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen and naproxen may help. If you have kidney disease, however, you should talk to your doctor before taking NSAIDs. (People who have kidney disease should only use NSAIDs under a doctor’s supervision.)
If your fingers begin to lock or get stuck, a local corticosteroid injection by a hand surgeon, orthopedic surgeon, or rheumatologist may allow for more mobility. These injections should be used with caution because they may temporarily raise your blood sugars. If you get such a shot, monitor your blood sugars very carefully for 24 hours afterward.
Splints to hold the fingers in an extended position may be helpful if your fingers seem to be locking up very quickly. Surgery is also possible, but it’s a last resort.
Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS), which is most commonly associated with repetitive stress and use of the hands, occurs more frequently in people with diabetes than in the general public. Among people with diabetes, CTS is more common in those who have neuropathy.
The carpal tunnel is a small area of the wrist through which many structures pass, including a major nerve called the median nerve. A band of ligaments surrounds the carpal tunnel. Any prolonged stress on this area or thickening of the band will increase the pressure in the carpal tunnel and possibly compress the median nerve. If you have diabetes, high blood sugars may alter collagen in your wrist and increase pressure on the carpal tunnel.
Symptoms of CTS include numbness and tingling in the thumb and index, middle, and ring fingers of the hand. It may occasionally involve the pinkie as well. Your hands may feel like they are asleep. The changes in collagen and nerves often occur at night, so the symptoms may wake you up. You may also have symptoms during the day when you flex your wrists. The discomfort, although most common. in the hand, may extend back to the elbow.
Your doctor can diagnose CTS by tapping the affected ligament or holding your hands together in an, inverted prayer position, the backs of the hands together, fingers pointed down. If other nerve problems are a concern, your doctor may also test your nerve conduction by placing electrodes on your skin in various places, then stimulating the nerves with mild electrical impulses. Your doctor should test for muscle strength in your hands because prolonged, untreated CTS may result in irreversible weakness.
There are several ways to treat CTS. The first step involves reducing any activity that may place additional stress on the median nerve. You may have to wear a splint to hold your hands and wrists in a neutral position. It is important to wear the splints as much as possible during the day. You should also wear them at night because you may change your position in your sleep and aggravate the condition.
Along with splinting, an occasional corticosteroid injection into the carpal tunnel may help reduce any inflammation. This should be done by the appropriate specialist and you should monitor your blood sugars carefully for 24 hours afterward.
If these treatments are ineffective, the pain is disabling, or there are signs of muscle weakness or atrophy, it might be tirne to consider surgery.
When it comes to your hands, good blood sugar control and exercise can go a long way. Keeping your hands limber will not only lessen your risk of future hand problems; it will also greatly contribute to your independence and enjoyment of life.
Lori B. Siegel, MD, FACP, is a professor of medicine and chief of the Division of Rheumatology in the Department of Medicine at Finch University of Health Sciences at the Chicago Medical School in North Chicago, Ill. Steven R. Huang, MD, is a family-practice resident at Maine Medical Center in Portland, Maine.