Joints, Muscles, Tendons, and Bones

The term “musculoskeletal system” refers to your joints, muscles, tendons, ligaments, and bones.

Diabetes can cause a number of changes in the musculoskeletal system, which is usually a surprise to people with diabetes as well as their caregivers. These changes can result in a variety of symptoms and conditions that you should be aware of.

Some musculoskeletal conditions are unique to diabetes, whereas others are the same as those seen in nondiabetics. However, they may occur at a higher frequency among people with diabetes. It is important to understand that many of these conditions are treatable, but you must first recognize and identify them. This is often the biggest challenge.

Treatments for Three Common Hand Problems

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is seen in up to 20 percent of people with diabetes.

The syndrome is due to compression of the median nerve as it passes through the wrist into the hand. The compression can occur as a result of repetitive movements of the muscles and other structures of the wrist, which can cause inflammation around the involved nerve. Or, in people with diabetes, the compression could be due to structural changes in the tissues of the wrist even without the typical inciting trauma of repetitive motion.

Affected people often notice a burning pins-and-needles sensation or a loss of sensation in the thumb, index and middle fingers as well as half of the ring finger. They might also have pain in the same areas, which may be experienced in the forearm or the upper arm as well. The pain might be worse at night and can waken sufferers from sleep. It is usually made worse by activities using the wrist, such as holding a newspaper or book, driving, typing and using a knife and fork.

Treatments for Carpal Tunnel Syndrome

Initial treatment includes wrist splints, worn at night, with or without anti-inflammatory medications (ibuprofen, Advil) or acetaminophen (Tylenol). Local steroid injections of the carpal tunnel may be given as well. For severe cases or when other therapy fails, referral to a hand surgeon for surgical release of the compression is appropriate and effective.

Trigger Finger

Flexor tenosynovitis, known as trigger finger, is another frequent diabetic complication affecting the hands.

People with diabetes with this problem complain of a catching sensation or locking of the finger or fingers, which may be associated with pain. The finger can become “frozen” in position when one attempts to bend it, sometimes requiring use of the other hand to straighten the stuck finger. There is often a nodule that can be felt, typically on the palm, at the base of the affected finger. This condition is more common with longstanding diabetes.

Treatments for Trigger Finger

Trigger finger can usually be treated with a steroid injection into the affected area. In most cases, a minor outpatient surgical procedure to “release” the trigger finger is necessary.

Dupuytren’s Contracture

Dupuytren’s contracture results from a thickening, shortening and fibrosis of the structures just under the skin of the palm. As a result, the fingers are pulled downward, particularly the ring finger, but the other fingers can also be affected. The affected fingers can become fixed in a partially bent position, but they are not stuck as is seen with trigger finger. Bumps or nodules might also be felt on the palm.

Treatments for Dupuytren’s Contracture

Physical therapy may be helpful for early or mild cases. No specific treatment is known at this time; however, if the condition is severe, hand surgery can help.

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