Abstract
Five patients with diabetes mellitus who had stiffness of hands were reported.
The patients, 3 males and 2 females, ranged in age from 47 to 60 years. Duration of diabetes mellitus was from 7 to 22 years. Their diabetic conditions were poorly controlled although four of them received 28 to 40 units of insulin daily and one oral medication.
Four patients had interphalangeal joint pain. Symptoms, including pain, swelling and motor disturbance were observed predominantly in the proximal interphalangeal joints. Two patients developed transient bilateral “claw hand” appearance with flexion contractures of the proximal interphalangeal joints. There was no accumulation of joint fluid. Hand stiffness, which was the most prominent after rising in the morning and improved gradually in the afternoon. However, sometimes it might persist throughout the day. Grasping power of the hands decreased in the patients with severe hand stiffness. All five patients revealed diabetic neuropathies of a greater or lesser degree. Electromyography of the median nerve of the patients showed reduced motor and sensory nerve conduction velocity. However, hand stiffness was not necessarily correlated with the degree of neuropathy. Latex test and C-reactive protein were always negative in the patients. There were no immunological abnormalities, nor hyperuricemia. Roentgenological findings of the finger bones showed slight osteoporosis, small cystic changes of bones or periarticular cortical erosions. Stiffness of the hands improved concomitantly with improvement of the diabetic condition.
This diabetic hand stiffness seems to be caused by diabetic neuropathy as well as osteoarthritis of the interphalangeal joints or other neuroskeletal abnormalities of the upper extremities.
