by Nicole Evans M.D.

Created on: October 19, 2009

Individuals with poorly controlled or long-standing diabetes may develop limited mobility of their hands. Their finger joints may be stiff and straightening their fingers completely may be difficult or impossible.

There are two main causes of hand tightness and stiffness in diabetic individuals. These include a condition called Dupuytren's contractures and a condition known as diabetic limited joint mobility of the hand. The latter condition may also be called cheiroarthropathy.

Dupuytren's Contracture:

This condition results from a thickening and fibrosis of the palmar fascia. Dupuytren's contracture causes the fingers to bend toward the palm and the metacarpalphalangeal joint (first knuckle joint). Often, the fourth and fifth fingers are most affected in individuals with Dupuytren's contractures.

This diagnosis is suggested by examining the palm of the hand for characteristic taut fibrous bands and, occasionally, nodules. Treatment is limited and may involve surgery.

Limited Joint Mobility:

The diabetic complication termed limited joint mobility refers to a painless stiffening of the hands. This condition is thought to occur because of deposition abnormal collagen in connective tissue around joints. All four fingers are usually affected.

Often, sclerodactyly is present in patients with limited joint mobility of the hand. Diabetic sclerodactyly is a waxy thickening of the skin on the hands. This usually occurs on the skin on the backside of the hand.

Treatment for limited joint mobility of the hand is limited to passive stretching of the palm, often done by pressing the fingertips on the edge of a table or desk and applying gentle downward pressure. Occupational therapy may be beneficial in some individuals.

Other Diagnoses:

Carpal tunnel syndrome also occurs with increased incidence in those with diabetes. Severe carpal tunnel syndrome may cause decreased mobility of the fingers but it is distinguished from diabetic limited joint mobility of the hand by the presence of dysfunctional nerve symptoms in a specific area of the hand.

It may be particularly difficult to distinguish limited joint mobility of the hand from severe carpal tunnel syndrome when the picture is confused by the presence of the classic glove and stocking peripheral neuropathy of diabetes.

Individuals with carpal tunnel syndrome tend to have pain, numbness or pins and needles sensations of the hand in very specific areas which are supplied by the median nerve. The fact that the pain or numbness is limited to the median nerve distribution is important in distinguishing carpal tunnel syndrome in diabetics from the classic glove and stocking peripheral neuropathy of diabetes.

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