Diabetic Cheiroarthropathy

Diabetic cheiroarthropathy (limited joint mobility) is stiffness of hand joints with thick waxy skin from collagen glycation.

• Affects 8 to 50% of type 1 diabetics, linked to duration and poor control, and associated with microvascular disease.
• Related: Dupuytren contracture, trigger finger, carpal tunnel syndrome, adhesive capsulitis.

• Painless limited extension of the fingers (MCP, PIP), starting at the fifth finger.
• Waxy, thickened tight skin on the dorsal hands.
• Prayer sign: inability to appose palmar surfaces; table top sign: inability to flatten the palm.
• Reduced grip, impaired fine function.

• Clinical (prayer and tabletop signs).
• Exclude scleroderma (Raynaud, nailfold changes, antibodies), hypothyroidism, rheumatoid arthritis.
• Screen for retinopathy and nephropathy, which correlate with severity.

• Intensive glycaemic control may prevent or slow progression, rarely reverses established changes.
• Hand physiotherapy, daily stretching, occupational therapy.
• Steroid injection (triamcinolone 10 mg) for trigger finger; carpal tunnel release when indicated.
• Dupuytren or severe contracture: surgery.
• Screen for other microvascular complications.