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  Zanko J Med Sci:  Aug. 2017; 21 (2): 1772-1780

Hand abnormalities in diabetics: Prevalence and predictors in Erbil city

Wallada Khalid Mohammed*, Niaz J. Al-Barzinji**


* Erbil Directorate of Health, Erbil, Iraq.

** Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.


Background and objective: The characteristics of diabetic foot disease are well documented in Erbil city; henceforth it would be appropriate to evaluate the problem of diabetic hand syndrome in this environment and to assess the frequency and the most important clinical and biochemical risk factors for the development of these complications.

Methods: This is an observational case-control study done over a period of one year. A total of 100 consecutive patients with type 2 diabetes mellitus were enrolled and described as cases. One hundred age- and sex-matched nondiabetic individuals were taken in the control group; all were examined and then underwent the appropriate investigations.

Results: Of the total 100 diabetic patients, 63% had macrovascular complications and 60% had one or more hand disorders. Limited joint mobility (47% vs. 18%, respectively; P = 0.0001) and Dupuytren’s contracture (16% vs. 2%, respectively; P = 0.001) were significantly higher in type 2 diabetes mellitus patients than in the controls, but not trigger finger. These hand soft-tissue changes correlated significantly with poor glycemic control.

Conclusion: This study shows a high prevalence of hand disorders in diabetic patients with the limited joint mobility being the most common hand disorder. The hand soft tissue changes are under recognized in diabetic patients, occurring in 60% of the cases. We recommend that physicians should consider examining the periarticular region of the joints in the hands in each diabetic patient.

Keywords: Diabetes mellitus; Dupuytren’s contracture; Trigger finger; Limited joint mobility; Hand soft tissues changes.


1. Egede LE. Diabetes, major depression, and functional disability among U.S. adults. Diabetes Care. 2004; 27: 421-8.

2. Ikem RT, Kolawole BA, Olasode O. A descriptive study of foot complications in diabetic patients with symptomatic peripheral neuropathy. Afr J Neurol Sci 2005; 24:7–12.

3. Lekholm C, Sundkvist G, Lundborg G, Dahlin L. The diabetic hand complication of diabetes. Ann Rheum Dis. 2001; 98:306–12.

4. Fam AG. Regional pain problems. In: Klippel JH, Dieppe PA, eds. Practical Rheumatology. London, England: Mosby; 1997.

5. Blyth MJ, Ross DJ. Diabetes and trigger finger. J Hand Surg 1996; 21B:244–5.

6. Trojian TH, Chu SM. Dupuytren's disease: diagnosis and treatment. Am Fam Physician 2007;76(1):86-9.

7. Black EM, Blazar PE. Dupuytren disease: an evolving understanding of an age-old disease. J Am Acad Orthop Surg 2011;19(12):746-57.

8. Kiani J, Goharifar H, Moghimbeigi A, Azizkhani H. Prevalence and Risk Factors of Five Most Common Upper Extremity Disorders in Diabetics. J Res Health Sci 2014;14(1):93-6.

9. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2003; 26(Suppl 1): S33-50.

10. Lekholm C, Sundkvist G, Lundborg G, Dahlin L. The diabetic hand-complication of diabetes. Ann Rheum Dis 2001;98:306–12.

11. Starkman H, Brink S. Limited joint mobility(LJM) of the hand in patient with diabetes mellitus. Diabetes Care 1982;5:534-6.

12. Suzan M. Musculoskeletal manifestations in diabetic patients at a tertiary center. Libyan J Med 2012; 7(1):19162.

13. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 2002; 287 : 2570-81.

14. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327-34.

15. Mota M, Panus C, Mota E, Sfredel V, Patrascu A, Vanghelie L, et al. Hand abnormalities of the patients with diabetes mellitus. Rom J Intern Med 2001; 38-39:89–95.

16. Pandey A, Usman K, Reddy H, Gutch M,  Jain N, Qidwai SA. Prevalence of Hand Disorders in Type 2 Diabetes Mellitus and its Correlation with Microvascular Complications. Ann Med Health Sci Res 2013; 3(3):349–54.

17. Loos B, Puschkin V, Horch RE. 50 years experience with Dupuytren's contracture in the Erlangen University hospital: A retrospective analysis of 2919 operated hands from 1956 to 2006. BMC Musculoskelet Disord 2007;8: 60.

18. Ramchurn N, Mashamba C, Leitch E, Arutchelvam V, Narayanan K, Weaver J, et al. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med 2009; 20: 718.

19. Savas S, Koroglu BK, Koyuncuoglu HR, Uzar E, Celik H, Tamer NM. The effects of the diabetes related soft tissue hand lesions and the reduced hand strength on functional disability of hand in type 2 diabetic patients. Diabetes Res Clin Pract 2007; 77:77-83.

20. Ardic F, Soyupek F, Kahraman Y, Yorgancioglu R. The musculoskeletal involvement seen in type 2 diabetes. Clin Rheumatol 2003; 22:229-33.