Diabetic Hand Syndrome

I am looking for insight on Diabetic Hand Syndrome. I have had T1D for 35 years, and about 8 years ago, I had surgery for carpal tunnel on both hands, and 1 trigger finger. That finger never really healed well, and the doctor doesn’t really know why (he is considered one of the top hand surgeons in my area). Over the past few years, I have been having more and more issues in my hands. I returned to the surgeon, and was told I would need trigger finger surgery on multiple fingers. After much thought, I decided not to go that route, as it didn’t help much. I have started wearing a flat splint overnight, that keeps my fingers straight. There is some relief with that.
Here’s my questions: Anyone else struggling with trigger fingers/painful hands? What have you done for them? Are there connective tissue specialists or surgeons that specialize in this topic?
Thanks for your input!!
Karen

Have you talked with your endo about diabetic neuropathy? They or a neurologist may be able to help you manage it without surgery. Just a thought.

I have not thought about it from a neuropathy path - but worth a conversation. I will be seeing my endo if a few weeks, so thank you for that thought.

Sure thing. No offense to surgeons but I imagine since that’s what they do that’s their natural recommendation. I hope you’re able to eliminate other possibilities before having any more surgical procedures. Glad you are seeing your endo so soon so you can get started!

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@T1Dx2, Karen, I had carpal tunnel & trigger finger repairs. The key to my recovery was rehab each time by Certified Hand Therapists (CHT). CHTs are special occupational therapists who are separately credentialed.

Each time I spent 12 weeks in therapy. It started with 3x per week & went down to twice per week at the end.

CHT is the key after hand surgery.

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Thank you for that input. I actually did extensive therapy, because the finger locked at 90 deg the day after the surgery. That finger continues to click, and the surgeon thinks I have crossed tendons? I’m just so leery of doing any other cutting, since it didn’t help.
How long did you suffer with trigger finger before having surgery and how many fingers have been operated on?

Karen,

A dehabilitating condition some Type 1 Diabetics get is called Frozen Shoulder. I believe mobility is lost around the shoulder region and is hard to regain for 1-2 years. I had it in my 30s and never want to go through it again. Ask your Diabetologist about it. It may or may not have a relation with your hands. I have two experts I always recommend from NYU Medical Center - Dr. Iven Young and Dr. Anastasios Menassis.

Geoff Z.

Hello Karen,

I’m sorry to hear about your hand issues.

I too have been having some hand problems lately. I have had T1D for 43 years. Years ago I had several hand attacks where my middle finger primarily would swell and get stiff and be very sore. I went to a doctor and she diagnosed me with pseudo gout. I haven’t have an attack on this in several years (knock knock).

Now I am experiencing something similar but believe it to be trigger finger thing. My middle finger again on my left hand has gotten stiff and if I clench my hand together, it hurts and a knuckle pops.

I believe I have gotten some relief by icing it down for 25 minutes every night. I put the ice pack in my palm right below the finger. Definitely not as stiff but still get the knuckle pop. Some days it’s better than others.

I play drums and have had to modify my grip so as not to hurt.

I have not seen a doctor yet.

DDrumminman

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My husband is from West Africa and prefers natural treatments whenever possible (he is not Type 1). He frequently recommends I try natural shea butter for, shall we say, generalized aches and pains. My allergies had me sneezing like crazy just yesterday - I put some on my chest and under my nose and a few minutes later it stopped! He’s been having some joint problems and says it’s helping.
I’m not a doctor and I’m not saying this is a cure, but it is a natural product you can try by rubbing it in the affected area if you want - it might give you some relief.We use the “raw” kind that comes in a tub, not a lotion that contains it.

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Hi. I have been T1 for close to 44 years. I had 3 trigger fingers about a year apart on my right hand 10-15 years ago (I am left handed). Each time I had a cortisone shot before surgery that did not help. After surgery I went for hand rehab for 8 weeks +/- they all healed fairly well, not perfect. I am now experiencing early signs of trigger finger on left ring finger. The surgeons I went to see and my endo all said that it is a side effect of T1 and there is no way to avoid it. I tried ice, heat and massage, but the result was the same. I hate to go for surgery but without it I was in a great deal of pain and the hand was becoming less and less useful.

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Karen.

T1D for 12 years. Now Both hands trigger thumbs. Started as inflammation from extensive yardwork and weeding due to Covid and job loss. No arthritis, recommendations is physical therapy.
Last week I began reading Dr. Bernstein‘s Diabetes’s Solution, on page 68 he gives an answer.
It reads.
“Prolonged high blood sugars can cause glycation of tendons. Glycation is the permanent fusing of glucose to proteins, and the simplest analogy is bread crust. Think of the soft inside of the bread as your tendons as they should be, and the crust as what happens when they’re exposed to elevated blood sugars over a long period of time. Glycation of tendons occurs in such common diabetic complication. Frozen shoulders, trigger fingers, carpal tunnel syndrome, and iliotibial band tensor/fascia syndrome of the hips and upper legs. All of these conditions are easily treated if caught early and blood sugars are controlled.”

I’m hoping that I caught it early enough that I won’t have permanent damage. My blood sugar has been high for two years, high being 7.5-8.2. I’m now desperately trying to bring it down into range. I’m hoping it will help and my thumbs may get a little better.

I hope this helps you.

I feel your pain. I’ve been T1D for over 55 years and have had dupuytren’s contracture on both hands for the past 30 years. I’ve had two surgeries with no positive results and 6 out of my 8 fingers are significantly, permanently bent. The second surgeon, highly respected in his field, explained that he could “fix” the mistakes from my first surgery. The result was a disaster and I had to have a graft to “fix” his mistake. I now have numbness in addition to the constant bent fingers, but at least I can use my hands. I know my situation (dupuytren’s vs trigger finger) is different than yours, but like I said, I feel your pain.

Thank you for your input. I have heard that frozen shoulder is terrible - has it resolved? Does it go away on it’s own, or surgery?

Thank you for sharing - my sugars have been 7.5-8 for many years - and, although that’s not really bad, it may be enough to contribute to these complications. Wearing a flat splint at night, to keep the fingers stretched and straight, seems to be helping some. But yes, repetitive activities, like weeding, painting, sewing, can be very painful and irritating.

Your story of surgery outcomes, is why I posted this. The carpal tunnel surgeries did great, but my trigger finger is only slightly better, and with numerous other fingers starting to need fixed, I am not so excited about getting cut on again. Have you seen the medication on TV for Dupuytrens? I noticed it the other day and read a little on it…unfortunately not for trigger finger.

Karen,

I looked this up since I assume we all react differently to similar medical conditions: Hope this helps…

Geoff

https://www.diabetesnet.com/about-diabetes/diabetes-complications/frozen-shoulder-in-diabetes/

Frozen Shoulder In Diabetes

By Paul Schickling, RPh, CDE, and John Walsh, PA, CDE

Long term complications of diabetes may include changes in connective tissue that occur as a result of high glucose levels. Adhesive capsulitis, often referred to as frozen shoulder refers to a pathological condition of the shoulder joint which causes a gradual loss of motion usually in just one shoulder.

Adhesive capsulitis (AC) has a prevalence of 2% in the general population but is reported to occur in 10 to 29% of those with diabetes. Studies have shown it is caused by glycosylation of the collagen within the shoulder joint triggered by the presence of high blood sugars. Dupuytren’s Contracture of the palms and fingers of the hand is another example of contracture syndrome related to diabetes. It is sometimes referred to as stiff-man syndrome although it occurs in both sexes.

Stages of Adhesive Capsulitis

Stage 1: The Initialization Stage has a duration of 0 to 3 months is associated with pain and reduced range of motion (ROM). It may be noticed when the person can no longer do things like comb their hair or reach a shelf above their shoulder.

Pain is described as achy at rest and at night. Arthroscopy and biopsy reveal joint changes and an influx of inflammatory cells. Evaluation is important to establish reference points for later assessment of the progression of the disease. Treatment goals are to lessen pain and inflammation by the use of nonsteroidal anti-inflammatory drugs (NSAID) like aspirin and ROM exercises.

Stage 2: The Freezing Stage, which lasts from 3 to 9 months, presents itself with chronic pain and further reduced ROM. This stage moves from the inflammatory stage to the fibrotic process. X-rays reveal a decreased joint space. Treatments may consist of NSAIDs and corticosteroid injections.

Stage 3: The Frozen Stage has a duration from 9 to 14 months with minimal pain, but a significantly limited range of motion in the shoulder. In stage 3, a person shows a marked stiffening of the shoulder and substantial loss of ROM. In general, an extremely painful phase may resolve itself spontaneously, but with continued stiffness and loss of ROM. Treatment may be possible with surgical intervention, manipulation, aggressive stretching, and a home exercise program.

Stage 4: The Thawing Stage is from 15 to 24 months and shows minimal pain and progressive improvement in ROM. At this stage, the pain and active fibroplasia in the shoulder has completely subsided. An individual has to recover ROM by strength and conditioning exercises.

Early detection, proper staging, and appropriate treatment can allow the patient with diabetes to avoid the painful and disabling consequences of Adhesive Capsulitis.

Reference: For additional information, read “Clinical Appearance and Treatment of Adhesive Capsulitis in Diabetes” by J. MacGillvray, MD., and M. Drakos, BA in Practical Diabetology, June 2001.

Paul Schickling, RPh, CDE, can be reached at:

Diabetes Wisdom, Inc.
1107 E. Chapman, Ste. 206,
Orange, CA 9286

Hi Karen,
I’ve been a T1 for 44 years and have had 3 triggers fingers and a frozen shoulder. My hand surgeon treated the fingers with cortisone injections, which really hurt but worked for me. But he did say that I was one of his few T1 patients for whom the injections worked! The frozen shoulder was treated with months of intense physical therapy, where the therapist moved the shoulder joint a little bit at each session to break up the stiff tissues. Also painful, but better than surgery and it worked. I will say that both of these conditions were a good 15 years ago, when my diabetes was not so well controlled, and have not returned.

However I do have “ropey” tendons in my palms and some fingers are stiff in the morning. A little hand stretching and daily finger flexing/bending helps. My vote would be for surgery only as a last result. If he’s still there, my hand specialist was Steven Stuchin at NYU. Good luck!