Diabetic cheiroarthropathy

Diabetic cheiroarthropathy or 'stiff joint syndrome' is Of particular importance to an anesthetist, as is may be an indication that the patient is difficult to intubate with an endotracheal tube. The condition is thought to be present in up to 30% Of patients with type I diabetes and is marked by the presence Of a 'positive prayer sign'. With this, patients are unable to achieve contact between their palms and phalangeal joints when the hands are placed together as in prayer.

LIMITED JOINT MOBILITY (CHEIROARTHROPATHY) Limited joint mobility, or what is now termed cheiroarthropathy, was formerly one of the earliest and most common clinical complications seen in type 1 diabetes. Since the Diabetes Control and Complications Trial, it was believed that there was a marked decrease in prevalence of cheiroarthropathy in both children and adults. Unfortunately, this long-term complication of diabetes has received little attention, has not been well studied in clinical research studies, and likely is not well recognized in clinical care. However, if cheiroarthropathy is present, it is a potentially important clinical marker for diabetes complications such as retinopathy, diabetic kidney disease, neuropathy, and abnormalities in growth stature. Risk Factors Cheiroarthropathy is strongly associated with duration of diabetes, particularly individuals with a year history of type 1 diabetes or longer. Accumulation of advanced glycation end products associated with chronic hyperglycemia may be responsible for cheiroarthropathy. Other risk factors include advanced age and the presence of microvascular complications. Definition Diabetic cheiroarthropathy is characterized by thickened skin and limited mobility of joints in the hands and fingers leading to flexion In a recent analysis by the DCCT/EDIC investigators, it was defined as the presence of any one of the following findings: adhesive capsulitis, carpal tunnel syndrome, flexor tenosynovitis, Dupuytren's contracture, or positive prayer sign.