How common are flexor tenosynovitis DeQuervains tenosynovitis Dupuytrens contractures in Diabetes?
Flexor tenosynovitis occurs in 5% to 33% of patients with diabetes. Women with long-standing diabetes are more commonly affected than men. Patients complain of aching and stiffness in the palmar aspect of the hand. Symptoms are worse in the morning. A “trigger” finger may occur as a result of an inflammatory nodule getting caught in the proximal pulley at the base of the finger. The thumb of the dominant hand is most commonly involved (75%), although multiple fingers on both hands can be affected. Laboratory findings and radiographs are unremarkable. Treatment includes NSAIDs, local steroid injections, and surgery.
DeQuervain’s tenosynovitis occurs in 20% of patients with diabetes. Similar to flexor tenosynovitis, increased prevalence of this condition is thought secondary to a combination of microvascular disease affecting local nerves and blood vessels, glycosylation of proteins, and deposition of extracellular matrix proteins in the skin and periarticular structures.
Dupuytren’s contractures occur in 30% to 60% of patients with type 1 diabetes. Patients present with nodular thickening of the palmar fascia, leading to flexion contractures usually of the fourth and fifth digits. Patients usually have long-standing diabetes, although there is no association with control of the diabetes. The pathogenesis is thought to be due to contractile myofibroblasts producing increased collagen secondary to microvascular ischemia. Treatment includes NSAIDs, physical therapy, local steroid or collagenase injections, and rarely, surgical release.
