diabetic hand syndrome

Photoessay: The Skin and Diabetes Mellitus

by A Huntley

Dermatology Online Journal, December 1995
Volume 1, Number 2

Diabetic Hand Syndrome

First described for insulin dependent diabetic children, skin thickening and joint limitations involving the hands are also demonstrable in adult onset diabetics (with or without insulin dependence). While severe joint limitation coupled with scleroderma-like skin thickening is fortunately an uncommon event, a lesser degree of hand involvement seems to occur in slightly less than half the patients examined. These findings are largely passed over by the patient and physician. Diabetic hand syndrome consists of joint limitations (inability to fully extend a finger) and thickened skin of the hand, especially involving the dorsum of the fingers

palpably thickened skin

Some patients with diabetes mellitus develop thickening of the skin on the fingers which is termed "scleroderma-like". This terminology does not imply that existence of vasculitis, or Raynaud's phenomenon, only that the skin is thicker.

Fig 15. The patient's finger on the right is pushing against the examiner's fingers on the left. This patient has diabetic hand syndrome. The finger skin is taught and when the patient pushed, his finger blanched except for a periungual blush.

Fig 16.The examiner is attempting to tent the dorsal finger skin which is distal to the proximal interphalangeal joint of this patient with diabetic hand syndrome.. With non-diabetic subjects, it is fairly easy to pick up a fold of skin on the dorsum of the fingers. This is often not the case in persons with diabetes. This test is often used by rheumatologists to assess skin thickness in scleroderma.

Fig 17. The examiner is attempting to tent the dorsal finger skin which is proximal to the proximal interphalangeal joint of another patient with diabetic hand syndrome. With more extensive involvement, the difficulty tenting the skin extends more proximal as is the case here. These findings are often not noted by the patients prior to the examination.

joint limitation

In addition to thickened skin, diabetic hand syndrome is characterized by joint limitation. Often diabetics develop asymptomatic joint limitations of the fingers. This limitation is usually minor and not incapacitating. Thick skin and joint limitation seem to correlate with retinopathy.

Fig 18. Hand of a patient with diabetes mellitus and diabetic hand syndrome. The fifth finger demonstrates a typical minor joint limitation. The fifth finger cannot fully extend. The patient is aware of the limitation but not concerned.

Figs 19,20. The hands of two patients with diabetes mellitus and the diabetic hand syndrome. The patients are attempting to fully appose the palms and fingers. The patient on the left illustrates moderate limitation. The patient on the right has significant impairment.