Diagnosis: Diabetic hand syndrome
Subtle, early signs of diabetic sclerodactyly and Dupuytren contracture (DC) were observed in the context of an existing diagnosis of T1D, leading to a diagnosis of diabetic hand syndrome.
Sclerodactyly, a thickening and tightening of the skin, is a characteristic component of limited and systemic sclerosis. Sclerodactyly is not commonly observed in association with type 1 and type 2 diabetes; however, when it does occur, it is typically found in patients who have had uncontrolled diabetes for some time.1-3 (In the context of diabetes, this skin manifestation is known as pseudoscleroderma and scleredema diabeticorum.) In 1 study of 238 patients with T1D, the prevalence of this diabetes manifestation was 39%, with a range of 10% to 50% also reported.3
Diabetic hand syndrome is an umbrella term for the constellation of debilitating fibroproliferative sequelae of the hand rendered by diabetes.3 In addition to diabetic sclerodactyly, diabetic hand syndrome includes limited joint mobility (LJM), or diabetic cheiroarthropathy, which typically manifests with either the “prayer sign” (the inability of the palms to obtain full approximation while the wrists are maximally flexed) or the “tabletop sign” (the inability of the palm to flatten completely against the surface of a table) (FIGURE 2).4,5 The prevalence of LJM has been reported to range from 8% to 50% of patients diagnosed with longstanding, uncontrolled diabetes.4
Other musculoskeletal abnormalities seen in this syndrome include: DC, often found clinically as a palpable palmar nodule that ultimately results in a flexion contracture of the affected finger; stenosing tenosynovitis, or trigger finger, in which a reproducible locking phenomenon occurs on flexion of a finger, typically in the first, third, and fourth digits; and carpal tunnel syndrome, a median nerve entrapment neuropathy that results in pain and/or paresthesia over the thumb, index, middle, and lateral half of the ring fingers.3-5
Secondary symptoms can signal long-term degenerative disease
Stocking-and-glove distribution polyneuropathy with deterioration of tactile sensation is a common sequela of diabetes, especially as disease severity progresses.2 Although the exact pathogenesis remains unclear, it has been proposed that both diabetic polyneuropathy and increased skin thickness occur secondary to long-term degenerative microvascular disease.
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