In diabetes mellitus the limited joint mobility (as a consequence of the glycation of collagen) often previously more commonly referred to as ‘cheiroarthropathy’ leads to a flexion contraction of the fingers so that they can not fully oppose the palms of the hand. It has been reported to affect up to 50% or more of those with diabetes mellitus. It is typically not painful and can affect the carrying out of daily activities that require fine movement of the hands and fingers (eg shirt buttons; shoelaces; foot self-care). The distal and proximal interphalangeal joints in the fifth finger are typically affected first. This is called the prayer sign:
|Negative Prayer Sign||Positive Prayer Sign|
The term, ‘cheiroarthropathy’ means: cheiro- is a variant of the prefix, chiro-, meaning ‘hand’. This stiffness and flexion contraction of the fingers that is seen in the prayer sign is also referred to as diabetic stiff hand syndrome. As all joints in the body can be affected by the glycation of the collagen, ‘limited joint mobility’ is the preferred term over the use of ‘diabetic cheiroarthropathy’ or ‘diabetic stiff hand syndrome’.
Differential diagnosis: Dupuytren contracture (this is more common in those with diabetes mellitus).
Treatment for the ‘Prayer sign’:
Improved glycaemic control to stop or slow progression.
Physical therapy and exercises to improve mobility of the affected joints.
Occupational therapy and the use of aids to assist with activities of daily living that have become difficult.
- It is thought that this is less common now due to better glycaemic control and the use of exercise therapy to keep the hand more mobile.
- ‘Limited joint mobility’ is the preferred term over diabetic cheiroarthropathy’ , ‘diabetic stiff hand syndrome’ or ‘the prayer sign’.
Limited joint mobility
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