Rarer Manifestations Of Diabetes Mellitus

Diabetic cheiroarthropathy

This rheumatic complication of diabetes manifests itself as limited joint mobility associated with thickening and tightening of the skin especially noticed on the dorsal surfaces of the hands. Resultant contraction prevents the affected patient from placing their hand flat on to a surface and from approximating the palmar surfaces of the hand - the 'prayer' hand sign (Figure 150). Although seen in both adult-onset type 1 and type 2 diabetes, it is most commonly encountered in children and young adults with type 1 DM often related to poor glycemic control and associated with other more specific diabetic complications such as retinopathy.

Dupuytren's contracture

Dupuytren's contracture (Figure 151) has a quoted prevalence varying between 20 and 63% in DM. Furthermore, in patients presenting with Dupuytren's contracture, a high prevalence of diabetes is found. It is more commonly found in elderly patients with a long duration of diabetes and may have an association with carpal tunnel syndrome.

Adhesive capsulitis of the shoulder

There are numerous reports of an association between periarthritis of the shoulder - 'frozen shoulder' - and DM and such patients are encountered frequently in routine diabetic follow-up clinics. This condition is characterized by pain and limitation of movement of the shoulder joint, both active and passive. Referral to a rheumatologist is appropriate.

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