Clinical Diabetes 19:132-135, 2001
© American Diabetes Association ®, Inc., 2001
Musculoskeletal Complications of Diabetes Mellitus
Rachel Peterson Kim, MD,
Steven V. Edelman, MD and
Dennis D. Kim, MD
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Introduction
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Diabetes may affect the musculoskeletal system in a variety of ways. The metabolic perturbations in diabetes (including glycosylation of proteins; microvascular abnormalities with damage to blood vessels and nerves; and collagen accumulation in skin and periarticular structures) result in changes in the connective tissue.
Musculoskeletal complications are most commonly seen in patients with a longstanding history of type 1 diabetes, but they are also seen in patients with type 2 diabetes. Some of the complications have a known direct association with diabetes, whereas others have a suggested but unproven association. This article will review the musculoskeletal and rheumatological manifestations commonly seen in patients with diabetes (Table 1).
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Table 1. Musculoskeletal and Rheumatological Complications of Diabetes
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Hands
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Hands are a target for several diabetes-related complications. Diabetic cheiroarthropathy, also known as diabetic stiff hand syndrome or limited joint mobility syndrome, is found in 8–50% of all patients with type 1 diabetes and is also seen in type 2 diabetic patients. The prevalence increases with duration of diabetes. This condition is associated with and predictive of other diabetic complications.
This syndrome is characterized by thick, tight, waxy skin reminiscent of scleroderma. Limited joint range of motion (inability to fully flex or extend the fingers) and sclerosis of tendon sheaths are also seen. The underlying cause is thought to be multifactorial. Increased glycosylation of collagen in the skin and periarticular tissue, decreased collagen degradation, diabetic microangiopathy, and possibly diabetic neuropathy are thought to be some of the contributing factors. Flexion contractures of the fingers may develop at advanced stages. One indication of the presence of this condition is known as the "prayer sign" (Fig. 1). This is patients’ inability to press their palms together completely without a gap remaining between opposed palms and fingers.
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Figure 1. The "prayer sign" indicates the presence of diabetic cheiroarthropathy. . . . [Full Text of this Article] |
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Shoulders
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Feet
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Muscles
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Skeleton
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Osteoarthritis
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Conclusion
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Footnotes
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Copyright © 2001 by the American Diabetes Association.
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