Symptoms of diabetic stiff hand syndrome
How does the diabetic stiff hand syndrome present?
This syndrome, also known as diabetic cheiroarthropathy, presents with the insidious development of flexion contractures involving the small joints of the hands, starting with the distal and proximal interphalangeal joints and moving proximally over time. This condition occurs in patients with type 1 or type 2 diabetes (estimated prevalence 10%–20%) and correlates with disease duration, glucose control, and renal/retinal microvascular disease.
The “prayer sign” observed on physical examination reflects the inability to fully extend the joints of the fingers. These finger contractures are attributed to excessive glycosylation of dermal and periarticular collagen, decreased collagen degradation, and increased dermal hydration resulting in indurated and thickened skin around the joints. This condition can be confused with scleroderma. Laboratory serologies and hand radiographs are unremarkable. Treatment is physical therapy and control of the underlying diabetes. Contractures usually progress slowly but rarely limit function significantly.
