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Khan AZ, Vaughan A, Mandava NK, Wickes C, Ramsey ML, Namdari S. Elevated HbA 1c is not associated with reoperation following arthroscopic rotator cuff repair in patients with diabetes mellitus. J Shoulder Elbow Surg 2024; 33:247-254. [PMID: 37499783 DOI: 10.1016/j.jse.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Hyperglycemia is a known risk factor for tendon degeneration due to oxidative stresses from production of advanced glycosylation end products. In patients with diabetes mellitus (DM), analysis of glycated hemoglobin (HbA1c) provides a 3-month window into a patient's glucose control. No guidelines exist for ideal preoperative HbA1c and glucose control prior to arthroscopic rotator cuff repair. This study evaluated if a critical HbA1c level is associated with reoperation following arthroscopic rotator cuff repair. METHODS We retrospectively evaluated patients with DM who underwent primary arthroscopic rotator cuff repair from January 2014 to December 2018 at a single institution. Patients required a preoperative HbA1c within 3 months of surgery. Medical records were queried to evaluate for reoperation and identify the subsequent procedures performed. Univariate statistical analysis was performed to assess factors associated with reoperation (P < .05 considered significant). Threshold, area under the curve (AUC), analysis was performed to assess if a critical HbA1c value was associated with reoperation. RESULTS A total of 402 patients met inclusion criteria. Patients had an average age of 65.5 years (range 40-89) at time of surgery; 244 (60.6%) patients were male; and average body mass index was 32.96 ± 5.81. Mean HbA1c was 7.36 (range 5.2-12). Thirty-three patients (8.2%) underwent subsequent reoperation. Six patients (1.5%) underwent capsular release and lysis of adhesions, 20 patients (5.0%) underwent a revision rotator cuff surgery, combination revision rotator cuff repair and lysis of adhesions, graft-augmented revision repair, or superior capsular reconstruction, and 7 patients (1.7%) underwent revision to reverse shoulder arthroplasty (1.7%). There were no cases of reoperation for infection. On AUC analysis, no critical HbA1c value was identified to predispose to reoperation. Interestingly, elevated preoperative American Society of Anesthesiologists (ASA) physical status classification score (2.8 vs. 2.28, P = .001) was associated with a higher reoperation rate. DISCUSSION In patients with DM, preoperative HbA1c is not a predictive factor for surgical failure requiring reoperation. Stable glycemic control is important to a patient's overall health and may play a role in minimizing postoperative medical complications, but an elevated preoperative HbA1c should not be a strict surgical contraindication for arthroscopic rotator cuff repair. In patients with DM, an elevated ASA score is associated with an increased rate of subsequent reoperation; diabetic patients should be counseled accordingly.
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Affiliation(s)
- Adam Z Khan
- Department of Orthopaedic Surgery, Northwest Permanente PC, Portland, OR, USA.
| | - Alayna Vaughan
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, USA
| | - Nikhil K Mandava
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, USA
| | - Catherine Wickes
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, USA
| | - Matthew L Ramsey
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, USA
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Paul A, Gnanamoorthy K. The Association of Diabetic Cheiroarthropathy With Microvascular Complications of Type 2 Diabetes Mellitus: A Cross-Sectional Study. Cureus 2023; 15:e36701. [PMID: 37113343 PMCID: PMC10129041 DOI: 10.7759/cureus.36701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Diabetic cheiroarthropathy (DCA), also known as the syndrome of limited joint mobility (LJM), is among the most underdiagnosed complications of diabetes mellitus (DM). Although not severe, it can hamper the day-to-day activities of the patient and significantly reduce the quality of life. It is hypothesized to be due to increased glycation of collagen around joints. The objective of our study was to examine the association of diabetic cheiroarthropathy with microvascular complications of type 2 diabetes mellitus. Methods The study was conducted on 251 previously diagnosed cases of type 2 DM. Patients with previous contractures due to any other cause, who are diagnosed cases of rheumatoid arthritis and scleroderma, and other risk factors such as cardiac or renal disease were excluded from the study. All subjects were subjected to a detailed clinical history including a past history, thorough physical examination, prayer test, tabletop sign, and passive extension of fingers. Patients who are diagnosed with diabetic cheiroarthropathy were then screened for microalbuminuria, fundus examination, and monofilament test and clinical examination to look for the presence of microvascular complications. Results Out of the 251 patients, 46 (18.3%) were found to have diabetic cheiroarthropathy. Fifteen (34.9%) cheiroarthropathy patients had neuropathy compared to 14.9% without diabetic cheiroarthropathy, which was statistically significant. We found that there was an increased incidence of diabetic neuropathy in subjects with cheiroarthropathy. Thirty (35.7%) patients with diabetic cheiroarthropathy had diabetic retinopathy compared to 9.6% without diabetic cheiroarthropathy. Twenty-six (26.8%) patients with diabetic cheiroarthropathy had diabetic nephropathy compared to 13% without diabetic cheiroarthropathy. We identified from our study that patients with diabetic cheiroarthropathy had an increased risk of developing microvascular complications. Conclusion There is an increased prevalence of diabetic nephropathy, diabetic neuropathy, and diabetic retinopathy in patients with diabetic cheiroarthropathy. The presence of diabetic cheiroarthropathy hence warrants better control of the patient's glycemic status to prevent further deterioration of diabetes-related complications.
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Mastrangelo G, Meneghel A, Martini G, Moretti C, Zulian F. Juvenile diabetes and systemic sclerosis: just a coincidence? Pediatr Rheumatol Online J 2022; 20:81. [PMID: 36089600 PMCID: PMC9465903 DOI: 10.1186/s12969-022-00741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited joint mobility (LJM), previously known as cheiroarthropathy, refers to the presence of reduced extension at the finger joints in people with diabetes and may be associated with scleroderma-like syndromes such as diabetic sclerodactyly. While scleroderma-like syndromes and LJM have been observed in patients with long-term diabetes and associated complications, the coexistence of diabetes with Juvenile systemic sclerosis (jSSc) is rarely described. CASE PRESENTATION We describe the case of a 14-year-old boy with long-lasting type 1 diabetes (T1D) and suspected LJM associated with Raynaud phenomenon, sclerodactyly and tapering of the fingertips. A comprehensive work-up showed positive autoantibodies (ANA, anti-Ro-52, anti-Mi-2b), abnormal nailfold capillaroscopy with a scleroderma pattern, interstitial lung disease and cardiac involvement. The overall clinical picture was consistent with the diagnosis of jSSc. CONCLUSIONS LJM can be the initial sign of underlying systemic sclerosis. Nailfold capillaroscopy may help differentiate jSSc from classical LJM in pediatric patients with T1D and finger contractures or skin induration of no clear origin. This case report provides a starting point for a novel hypothesis regarding the pathogenesis of jSSc. The association between T1D and jSSc may be more than a coincidence and could suggest a relationship between glucose metabolism, fibrosis and microangiopathy.
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Affiliation(s)
- Greta Mastrangelo
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Alessandra Meneghel
- grid.5608.b0000 0004 1757 3470Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Giorgia Martini
- grid.5608.b0000 0004 1757 3470Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Carlo Moretti
- grid.5608.b0000 0004 1757 3470Diabetology Unit, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Francesco Zulian
- grid.5608.b0000 0004 1757 3470Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Padova, Italy
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Predictive factors and clinical effects of diabetic hand: A prospective study with 1-year follow-up. J Plast Reconstr Aesthet Surg 2022; 75:3285-3292. [PMID: 35710776 DOI: 10.1016/j.bjps.2022.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/31/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022]
Abstract
AIMS Diabetes mellitus is considered an etiological factor for hand-related conditions that are grouped under the term "diabetic hand" (DH), which includes limited joint mobility, Dupuytren's contracture, carpal tunnel syndrome, and trigger finger. This study aimed to identify predictive factors and the clinical effects of DH development among patients with diabetes. PATIENTS AND METHODS Consecutive Japanese adults with diabetes were prospectively recruited at a single outpatient center. We assessed the presence of DH at baseline and at the 1-year follow-up, which was considered present if the patient exhibited one or more of the hand disorders at either examination. RESULTS The 590 eligible subjects had a mean age of 57 years and included 155 patients (26%) with DH. Binary logistic regression analysis revealed that DH was significantly associated with older age, longer diabetes duration, and higher body mass index. Patients with DH had significantly lower hand function and quality of life (QOL) scores. We assessed 476 patients at the 1-year follow-up, including 96 patients (20%) who had DH at baseline. Although 25 of the 96 patients (26%) experienced resolution of DH without specific treatment, 83 of 380 patients (22%) without DH at baseline had developed new DH-related conditions. At the 1-year follow-up, the group with DH was significantly older than that without DH. CONCLUSION Older age and prolonged duration of diabetes predicted the development of DH. Patients who are not old and do not have a prolonged duration of diabetes may experience DH resolution without specific treatment.
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Saad M, Iqbal SMS, Pereira FA, Hussain SA, Muhammad A, Khan HMU, Hussain Z. Frequency of musculoskeletal disorder of upper limb in Type 2 Diabetes patients. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Diabetes is a frequently occurring chronic metabolic disease that is characterized by a high blood glucose levels. If left unchecked, it can lead to severe functional impairments such as blindness, renal failure, and coronary artery disease. Approximately 463 million adults (20-79 years) are living with diabetes; by 2045 this will rise to 700 million. Material and method: A cross-sectional survey was conducted in National Institute of Diabetes and Endocrinology, Dow University Hospital, Ojha campus. Patients who had T2DM, and were above 35 years of age were included in the study. Anthropometric measurements were recorded, and the remaining data was collected via a self-reporting questionnaire. Results and discussions: In this study n=55(36.2%) participants were male and n=97(63.8%) were female, with the average age of 52.9 years, and an average BMI of 29.5kg/m2. The mean HBA1C of those diabetic patients was 8.8, and average duration of diabetes of our sample was 6.7 years. Prevalence of MSK disorders was 55.3%. Conclusions: There is a high prevalence of musculoskeletal disorders among diabetic pa-tients. There was poor knowledge that upper limb musculoskeletal problems could occur due to diabetes, and a small percentage of patients sought physical therapy treatment for these disor-ders.
Keywords: diabetes mellitus, musuculoskeletal diseases, upper extremity
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Affiliation(s)
- M Saad
- “Dow University of Health Sciences”, Karachi, Pakistan
| | - SMS Iqbal
- “Shaheed Benazir Bhutto Dewan University”, Karachi, Pakistan
| | - FA Pereira
- “Shaheed Benazir Bhutto Dewan University”, Karachi, Pakistan
| | - SA Hussain
- “Shaheed Benazir Bhutto Dewan University”, Karachi, Pakistan
| | - A Muhammad
- “University Institute of Physical Therapy, University of Lahore”, Lahore, Pakistan
| | - HMU Khan
- “National Institute of Physical Therapy and Rehabilitation Sciences”, Karachi Pakistan
| | - Z Hussain
- “University Institute of Physical Therapy, University of Lahore”, Lahore, Pakistan
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Kamiab Z, Shafaee N, Askar PS, Abbasifard M. Prevalence and Prevention of Rheumatologic Manifestations and their Relationship with Blood Glucose Control in Patients with Type II Diabetes. Int J Prev Med 2021; 12:142. [PMID: 34912518 PMCID: PMC8631128 DOI: 10.4103/ijpvm.ijpvm_369_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Musculoskeletal disorders in diabetic patients are associated with pain and disability, and thus, a significant reduction in quality of life. The current study was conducted with the aim of evaluating the frequency and prevention of rheumatologic manifestations and their association with blood glucose levels in diabetic patients. Methods: In this cross-sectional study, a total of 273 patients with type II diabetes, referred to the diabetes clinic, were selected by using the census method. Using a checklist, demographic, and clinical data, including duration of diabetes, blood glucose level, HbA1c, type of diabetes, BMI, history of smoking, blood pressure, serum cholesterol level, triglyceride, HDL, LDL, and musculoskeletal disorder type were analyzed using SPSS20 software application using independent t-test. Modeling was performed to obtain the best fit using logistic regression. The significance level was considered less than 0.05. Results: 62.6% of patients had at least one of the rheumatologic complications. The most common complication was related to carpal tunnel syndrome (26.4%), followed by muscle contraction (23.8%). By moderating the effects of other variables, the odds ratio for rheumatoid complications was obtained as 1.74 with one unit of increase in HbA1c, which was statistically significant. In examining the influential variables, high age, gender, smoking, and BMI showed statistically significant effects (). Conclusions: Given the high prevalence of musculoskeletal disorders in diabetic patients, early diagnosis and timely treatment of the complications are crucial. It is recommended that musculoskeletal examinations be included as an important part of regular care for these patients.
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Affiliation(s)
- Zahra Kamiab
- Department of Family Medicine, School of Medicine, Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Negar Shafaee
- General Physician, Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Poya Saied Askar
- Medical Student, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mitra Abbasifard
- Department of Internal Medicine, School of Medicine; Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Löfgren JP, Zimmerman M, Dahlin LB, Nilsson PM, Rydberg M. Diabetes Mellitus as a Risk Factor for Trigger Finger –a Longitudinal Cohort Study Over More Than 20 Years. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:708721. [PMID: 36994346 PMCID: PMC10012113 DOI: 10.3389/fcdhc.2021.708721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022]
Abstract
Background and AimTrigger finger (TF) or stenosing tenosynovitis has been associated with diabetes mellitus (DM), although today’s knowledge is mostly based on cross-sectional and case-control studies. Thus, the aim of the present population-based cohort study over more than 20 years was to investigate DM as a risk factor for TF.MethodsData from Malmö Diet and Cancer Study (MDCS), including 30,446 individuals, were analysed with regards to baseline DM and known or potential confounders. Information regarding TF diagnosis until study end date of Dec 31st, 2018, was retrieved from the Swedish National Patient Register (NPR) using ICD-codes. Survival probability was investigated in Kaplan-Meier plots. Cox proportional hazard regression model was used to evaluate DM as risk factor for TF, adjusted for several confounders and presented as Hazard Ratio (HR) with 95% confidence intervals (CI).ResultsAt baseline, 4.6% (1,393/30,357) participants had DM. In total, 3.2% (974/30,357) participants were diagnosed with TF during the study period. Kaplan-Meier plot showed that the probability for incident TF was significantly higher in participants with baseline DM compared with individuals without baseline DM. Adjusted HR for DM as risk factor for TF was 2.0 (95% CI: 1.5-2.6, p<0.001).ConclusionThis longitudinal study showed that DM is an important risk factor for developing TF. When adjusting for sex, age, BMI, manual work, statin use, smoking and alcohol consumption, DM remained the main risk factor for TF.
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Affiliation(s)
- Jin Persson Löfgren
- Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
- *Correspondence: Jin Persson Löfgren,
| | - Malin Zimmerman
- Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B. Dahlin
- Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Mattias Rydberg
- Department of Translational Medicine, Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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Luna R, Talanki Manjunatha R, Bollu B, Jhaveri S, Avanthika C, Reddy N, Saha T, Gandhi F. A Comprehensive Review of Neuronal Changes in Diabetics. Cureus 2021; 13:e19142. [PMID: 34868777 PMCID: PMC8628358 DOI: 10.7759/cureus.19142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 12/11/2022] Open
Abstract
There has been an exponential rise in diabetes mellitus (DM) cases on a global scale. Diabetes affects almost every system of the body, and the nervous system is no exception. Although the brain is dependent on glucose, providing it with the energy required for optimal functionality, glucose also plays a key role in the regulation of oxidative stress, cell death, among others, which furthermore contribute to the pathophysiology of neurological disorders. The variety of biochemical processes engaged in this process is only matched by the multitude of clinical consequences resulting from it. The wide-ranging effects on the central and peripheral nervous system include, but are not limited to axonopathies, neurodegenerative diseases, neurovascular diseases, and general cognitive impairment. All language search was conducted on MEDLINE, COCHRANE, EMBASE, and GOOGLE SCHOLAR till September 2021. The following search strings and Medical Subject Headings (MeSH terms) were used: "Diabetes Mellitus," "CNS," "Diabetic Neuropathy," and "Insulin." We explored the literature on diabetic neuropathy, covering its epidemiology, pathophysiology with the respective molecular pathways, clinical consequences with a special focus on the central nervous system and finally, measures to prevent and treat neuronal changes. Diabetes is slowly becoming an epidemic, rapidly increasing the clinical burden on account of its wide-ranging complications. This review focuses on the neuronal changes occurring in diabetes such as the impact of hyperglycemia on brain function and structure, its association with various neurological disorders, and a few diabetes-induced peripheral neuropathic changes. It is an attempt to summarize the relevant literature about neuronal consequences of DM as treatment options available today are mostly focused on achieving better glycemic control; further research on novel treatment options to prevent or delay the progression of neuronal changes is still needed.
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Affiliation(s)
- Rudy Luna
- Neurofisiología, Instituto Nacional de Neurologia y Neurocirugia, CDMX, MEX
| | | | | | | | - Chaithanya Avanthika
- Medicine and Surgery; Pediatrics, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Nikhil Reddy
- Internal Medicine, Kamineni Academy of Medical Science and Research Centre, Hyderabad, IND
| | - Tias Saha
- Internal Medicine, Diabetic Association Medical College, Faridpur, BGD
| | - Fenil Gandhi
- Medicine, Shree Krishna Hospital, Anand, IND
- Research Project Associate, Memorial Sloan Kettering Cancer Center, New York, USA
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Low J, Kong A, Castro G, Rodriguez de la Vega P, Lozano J, Varella M. Association Between Diabetes Mellitus and Carpal Tunnel Syndrome: Results From the United States National Ambulatory Medical Care Survey. Cureus 2021; 13:e13844. [PMID: 33859898 PMCID: PMC8038929 DOI: 10.7759/cureus.13844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper limb. While various risk factors have been linked to CTS, the role of diabetes mellitus (DM) in the development of CTS remains unclear. Previous studies have failed to consistently demonstrate a clear association between DM and CTS due to variations based on the geographic setting and differences in the study design. The objective of this study was to assess if there is an association between DM and CTS using population-based data from the United States. Methodology We used data from patients ≥18 years old who contributed to the National Ambulatory Medical Care Survey between 2006 and 2015. The outcome was CTS identified by the International Classification of Diseases-9-Clinical Modification codes (354.0 and 354.1), and the main independent variable was physician-reported diabetes status. Multivariable logistic regression was used to adjust for confounding variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Stata v15 was used for all analyses. Results Among the patients included in this study (n = 322,092), 13.5% were reported to have diabetes while 0.55% reported CTS. The unadjusted odds of having CTS among patients with diabetes was 0.92 (95% CI: 0.74-1.14; p = 0.447). After adjusting for confounding variables, the association remained not statistically significant (adjusted odds ratio [aOR]: 0.84; 95% CI: 0.65-1.09; p = 0.203). Other variables independently associated with CTS included age 50-59 (aOR: 1.91; 95% CI: 1.49-2.45; p < 0.001), female gender (aOR: 1.31; 95% CI: 1.09-1.58; p < 0.004), and current tobacco users (aOR: 1.32; 95% CI: 1.07-1.63; p < 0.01). Conclusions No association was found between DM and CTS in adult ambulatory patients in the United States, but results should be considered in light of potential outcome misclassification.
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Affiliation(s)
- Jason Low
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, USA
| | - Adrian Kong
- Department of Orthopedics, Florida International University Herbert Wertheim College of Medicine, Miami, USA
| | - Grettel Castro
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, USA
| | - Pura Rodriguez de la Vega
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, USA
| | - Juan Lozano
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, USA
| | - Marcia Varella
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, USA
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AlOayan LI, Zawawi AH. Musculoskeletal manifestations among diabetic patients in Saudi Arabia. J Family Med Prim Care 2021; 9:5597-5600. [PMID: 33532401 PMCID: PMC7842468 DOI: 10.4103/jfmpc.jfmpc_654_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/06/2022] Open
Abstract
Context: Diabetes mellitus (DM) is one of the most common diseases worldwide. Patients with DM are prone to develop multiple musculoskeletal (MSK) manifestations, which may lead to disability and an impact on patients’ quality of life. These manifestations include but not limited to, adhesive capsulitis, shoulder hand syndrome, diabetic hand syndrome, diffuse idiopathic skeletal hyperostosis, Dupuytren's contracture. Aims: The aim of this study is to assess the prevalence of MSK manifestations in diabetic patients in Saudi Arabia. Settings and Design: The study was carried out in NGHA hospital and PHC in Saudi Arabia. Methods and Materials: This is a retrospective study carried out between 2015 and 2019 where all patients with DM type II between the age of 18 and 65 and were diagnosed with MSK manifestations included in the study. Statistical Analysis Used: Statistical Package for the Social Sciences (IBM-SPSS) software (Version 23). Results: A total of 208 patients were found to have MSK manifestations. The average age of patients was 53 years old ranging from (31-63). The mean reading of A1C was 8%. A total of 34.1% were controlled and 65.9% were uncontrolled. Carpal tunnel syndrome (CTS) was found in 10%. Adhesive capsulitis in 2.4%. Septic arthritis in 1%. Trigger finger was found in 7.2%. Osteomyelitis was found in 0.5%. Plantar fasciitis was found in 4.8%. Osteoarthritis (OA) was found in 149 subjects (71.3%). Two subjects had ankle OA, one hand OA, nine shoulder OA, one hip arthritis. The rest had knee OA. Rotator cuff tendonitis was found in 1%. No significant correlation between age, A1c and all the MSK manifestations that were mentioned above (P value >0.05). Conclusions: MSK manifestations are common among diabetic patients. OA was the most frequently seen disorder. Physicians should be aware of the high prevalence and the huge impact on patients when treating patients with type II DM.
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Affiliation(s)
- Laura I AlOayan
- Department of Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,Department of Family Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Alia H Zawawi
- Department of Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,Department of Family Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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Zah V, Pelivanovic J, Tatovic S, Vukicevic D, Imro M, Ruby J, Hurley D. Healthcare Costs and Resource Use of Patients with Dupuytren Contracture Treated with Collagenase Clostridium Histolyticum or Fasciectomy: A Propensity Matching Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:635-643. [PMID: 33177851 PMCID: PMC7649243 DOI: 10.2147/ceor.s269957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/06/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Studies examining differences in US healthcare resource utilization (HCRU) and associated healthcare costs between collagenase clostridium histolyticum (CCH) and fasciectomy for Dupuytren contracture (DC) are limited. This study evaluated US HCRU and direct healthcare cost for the treatment of DC in privately insured patients using insurance claims. Methods This retrospective observational cohort study analyzed data from large nationwide insurance claims databases; it included individuals diagnosed with DC between July 1, 2011, and June 30, 2017, who were adults at index date (date of first treatment: CCH or fasciectomy). Participants had continuous health plan coverage 24 months pre-index and 12 months post-index date. All-cause and DC-related HCRU and healthcare costs from the payers’ perspective were compared between propensity score–matched cohorts. Generalized linear models assessed factors associated with all-cause total healthcare costs. Results Of 83,983 patients diagnosed with DC, 1932 adults receiving fasciectomy and 953 adults receiving CCH were included. The mean ± standard deviation total all-cause healthcare cost was significantly lower with CCH than with fasciectomy (US$11,897 ± US$14,633 versus US$15,528 ± US$22,254, respectively; P<0.001). After propensity score matching, 702 and 999 patients remained in the CCH and fasciectomy cohorts, respectively. In this analysis, all-cause and DC-related total costs were significantly lower in the CCH cohort versus the fasciectomy cohort (all-cause: US$11,044 ± US$12,856 versus US$12,912 ± US$19,237, respectively, P=0.02; DC-specific: US$3417 ± US$3671 versus US$5800 ± US$4985, P<0.001), mainly due to the lower frequency of outpatient visits. CCH treatment and the use of a consumer-driven healthcare plan were associated with lower healthcare costs. Conclusion Based on matched cohort data, adjusted 1-year healthcare costs for CCH-treated individuals were significantly lower compared with costs for fasciectomy-treated individuals.
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Affiliation(s)
- Vladimir Zah
- Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON, Canada
| | - Jovana Pelivanovic
- Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON, Canada
| | - Simona Tatovic
- Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON, Canada
| | - Djurdja Vukicevic
- Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON, Canada
| | - Martina Imro
- Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON, Canada
| | - Jane Ruby
- Medical Affairs, Endo Pharmaceuticals Inc., Malvern, PA, USA
| | - David Hurley
- Medical Affairs, Endo Pharmaceuticals Inc., Malvern, PA, USA
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Salari N, Heydari M, Hassanabadi M, Kazeminia M, Farshchian N, Niaparast M, Solaymaninasab Y, Mohammadi M, Shohaimi S, Daneshkhah A. The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis. J Orthop Surg Res 2020; 15:495. [PMID: 33115483 PMCID: PMC7594412 DOI: 10.1186/s13018-020-01999-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally. Methods In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I2 index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0. Results By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05). Conclusion The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Hassanabadi
- Lecturer in International Business & Strategy, Faculty of Business & Law, University of Northampton, Northampton, UK
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nikzad Farshchian
- Department of Otolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Yousef Solaymaninasab
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Alireza Daneshkhah
- School of Computing, Electronics and Maths, Coventry University, London, UK
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Demino C, Fowler JR. Diagnostic Value of Ultrasound in CTS in Diabetic Versus Nondiabetic Populations. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:267-271. [PMID: 35415520 PMCID: PMC8991754 DOI: 10.1016/j.jhsg.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose Diabetes mellitus (DM) is a well-known risk factor for carpal tunnel syndrome (CTS). However, few studies have compared differences in the cross-sectional area (CSA) of the median nerve in patients with and without DM. The purpose of this study was to compare the utility of ultrasound for the diagnosis of CTS in diabetic versus nondiabetic patients. Method A total of 248 hands of 155 patients were evaluated: 154 hands belonged to non-DM patients with CTS, 80 to DM patients with CTS, 13 patients with DM but no CTS, and 51 patients without DM or CTS. All hands underwent ultrasonography of the median nerve at the wrist for determination of CSA; patients completed a CTS Symptom Severity Scale and Functional Status Scale for each hand. Results Average CSA (mm2) of non-DM patients with CTS was 11.25 whereas the average in DM patients with CTS was 12.23 (P = .17). Cross-sectional area of 9.5 or greater was the most powerful predictor of CTS in patients without DM, and CSA of 10.5 or greater in patients with DM. Conclusions Cross-sectional area of the median nerve was similar for patients with and without DM; however, cutoff values for positive diagnosis may need to be adjusted in patients with DM. Ultrasonography of the wrist is a valuable resource for diagnosing CTS in patients with and without DM. Type of study/level of evidence Diagnostic II.
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14
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Li D, Zhu J, Liu F, Li B, Liu F, Li W. A quantitative evaluation of sciatic nerve stiffness after compression by shear wave elastography in diabetic rats. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:682. [PMID: 32617302 PMCID: PMC7327375 DOI: 10.21037/atm-19-4534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Our study investigates the feasibility of using quantitative evaluation for nerve entrapment visualization by shear wave elastography (SWE) in diabetic rats. Methods A total of 24 male Sprague-Dawley (SD) rats were included in this study. Before injection of streptozotocin (STZ), the experimental groups were assigned as the diabetic nerve compression (DNC) group (DNC, n=18) and the control group (CON, n=6). The DNC model was created by wrapping a silicone tube around the nerve, and then the DNC group was divided into the DNC 2-week (DNC2W, n=6), 4-week (DNC4W, n=6), and 8-week (DNC8W, n=6) groups according to the different duration time of sciatic nerve compression. The nerve stiffness was detected by SWE. Meanwhile, motor nerve conduction velocity (MNCV) was detected. These 2 indicators and histology of sciatic nerves were compared across the different groups. Results The stiffness of the nerve depicted by SWE at the compression site increased markedly along with the duration time of compression (P<0.01). The MNCV decreased along with the duration time of nerve compression (P<0.05). The nerve stiffness depicted by SWE was negatively correlated with MNCV (r=−0.926; P<0.01). Myelinated fiber density significantly decreased as the duration time of nerve compression increased (P<0.01). Some differences were found between DNC4W and DNC8W groups, and CON and DNC2W groups (P<0.05) in average axon diameter, myelin sheath thickness, and g ratio. Conclusions The increased values of SWE, along with the increased duration of nerve compression, could reflect the severity of nerve entrapment in diabetic rats. Therefore, SWE may be used as a noninvasive and effective method to quantitatively evaluate the severity of diabetic nerve entrapment.
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Affiliation(s)
- Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Bing Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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15
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Moon HI, Shin J, Kim YW, Chang JS, Yoon S. Diabetic polyneuropathy and the risk of developing carpal tunnel syndrome: A nationwide, population‐based study. Muscle Nerve 2020; 62:208-213. [DOI: 10.1002/mus.26901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/19/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hyun Im Moon
- Department of Rehabilitation MedicineBundang Jesaeng General Hospital Gyeonggi‐do Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine and Public HealthAjou University, School of Medicine Suwon Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation MedicineYonsei University College of Medicine Seoul Republic of Korea
| | - Jee Suk Chang
- Department of Radiation OncologyYonsei University College of Medicine Seoul Republic of Korea
| | - SeoYeon Yoon
- Department of Rehabilitation MedicineBundang Jesaeng General Hospital Gyeonggi‐do Republic of Korea
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Nichols AE, Oh I, Loiselle AE. Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing. J Orthop Res 2020; 38:13-22. [PMID: 31166037 PMCID: PMC6893090 DOI: 10.1002/jor.24388] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023]
Abstract
Over 300,000 tendon repairs are performed annually in the United States to repair damage to tendons as a result of either acute trauma or chronic tendinopathy. Individuals with type II diabetes mellitus (T2DM) are four times more likely to experience tendinopathy, and up to five times more likely to experience a tendon tear or rupture than non-diabetics. As nearly 10% of the US population is diabetic, with an additional 33% pre-diabetic, this is a particularly problematic health care challenge. Tendon healing in general is challenging and often unsatisfactory due to the formation of mechanically inferior scar-tissue rather than regeneration of native tendon structure. In T2DM tendons, there is evidence of an amplified scar tissue response, which may be associated with the increased the risk of rupture or impaired restoration of range of motion. Despite the dramatic effect of T2DM on tendon function and outcomes following injury, there are few therapies available to promote improved healing in these patients. Several recent studies have enhanced our understanding of the pro-inflammatory environment of T2DM healing and have assessed potential treatment approaches to mitigate pathological progression in pre-clinical models of diabetic tendinopathy. This review discusses the current state of knowledge of diabetic tendon healing from molecular to mechanical disruptions and identifies promising approaches and critical knowledge gaps as the field moves toward identification of novel therapeutic strategies to maintain or restore tendon function in diabetic patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:13-22, 2020.
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Affiliation(s)
- Anne E.C. Nichols
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642
| | - Irvin Oh
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642
| | - Alayna E. Loiselle
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642,Corresponding Author Alayna E. Loiselle, PhD, Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, Phone: (585) 275-7239, Fax: (585) 276-2177,
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Hill NE, Roscoe D, Stacey MJ, Chew S. Cheiroarthropathy and tendinopathy in diabetes. Diabet Med 2019; 36:939-947. [PMID: 30920669 DOI: 10.1111/dme.13955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 12/25/2022]
Abstract
Joint problems commonly occur in people with diabetes. Cheiroarthropathy affects the hands and results in painless limited finger joint extension, appearing to be associated with longer diabetes duration and the presence of microvascular complications. The prevalence of cheiroarthropathy seems to be falling, perhaps as a result of improvements in glycaemic management. Non-enzymatic glycation of collagen results in abnormally crosslinked protein resistant to degradation with subsequent increased build-up of collagen in joints. The management of cheiroarthropathy is predominantly conservative, with occupational and hand therapy at the forefront. Tendinopathy is more common in people with diabetes than those without, and is associated with obesity and insulin resistance. As with cheiroarthropathy, the exact causative mechanism of tendinopathy in diabetes is not known, but may be linked to inflammation, apoptosis and increased vascularity of affected tendons, driven by hyperinsulinaemia. Local fat pads have also been suggested to play a role in the pathogenesis of tendinopathy.
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Affiliation(s)
- N E Hill
- Imperial College Healthcare NHS Trust, London
| | - D Roscoe
- Defence Medical Rehabilitation Centre, Loughborough
- University of Loughborough, Loughborough
| | - M J Stacey
- Imperial College Healthcare NHS Trust, London
- Defence Medical Services, Lichfield, UK
| | - S Chew
- Imperial College Healthcare NHS Trust, London
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18
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Shen PC, Chang PC, Jou IM, Chen CH, Lee FH, Hsieh JL. Hand tendinopathy risk factors in Taiwan: A population-based cohort study. Medicine (Baltimore) 2019; 98:e13795. [PMID: 30608391 PMCID: PMC6344158 DOI: 10.1097/md.0000000000013795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
De Quervain's disease, carpal tunnel syndrome (CTS), and trigger finger (digit) are three common pathological conditions of the hand. They are considered overuse syndromes and occur predominantly in females. The prevalence rate and cause-specific risks of these three tendinopathies have not yet been clarified. Data from 41,871 cases listed in the Taiwan National Health Insurance Research Database (NHIRD) from 2010 to 2014 were analyzed. The prevalence rate of these 3 conditions by age, sex, and the risk factors of female-dominant diseases (e.g., osteoporosis, rheumatoid arthritis [RA], and tendinopathy), diabetes mellitus, and hormone antagonist treatment was evaluated. We found that 1.59% of the population developed CTS, 0.49% developed de Quervain's, and 1.07% developed trigger finger. Cases were more likely to develop the three hand tendinopathies if they were female, between 50 and 59 years old, and, according to a multivariate analysis, comorbid with RA, diabetes, using hormone antagonists. Our findings should provide an understanding of the risk factors associated with hand tendinopathy.
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Affiliation(s)
- Po-Chuan Shen
- Department of Orthopedics, Tainan Hospital, Ministry of Health and Welfare, Tainan
| | - Po-Chun Chang
- Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical Unirversity
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital
| | - Chung-Hwan Chen
- Departments of Orthopedics, College of Medicine, Kaohsiung Medical University
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
| | - Fang-Hsin Lee
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jeng-Long Hsieh
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
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Musculoskeletal Disorders in Patients with Diabetes Mellitus: A Cross-Sectional Study. Int J Rheumatol 2018; 2018:3839872. [PMID: 30018643 PMCID: PMC6029479 DOI: 10.1155/2018/3839872] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/11/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction A variety of musculoskeletal disorders (MS) have been associated with diabetes mellitus (DM). This study aimed at assessing the prevalence and associated factors of MS disorders in Moroccan diabetic patients. Methods A cross-sectional study enrolled consecutive patients with DM. We recorded demographic features of patients and characteristics of DM. MS disorders and vascular complications were assessed by clinical examinations and investigations. Associated factors of MS disorders were assessed by univariate and multivariate analyses. Result 376 subjects were included; 84.6% had type 2 DM. The participants' median age was 54 years [45-62]; 41% had one or more vascular complications. 34.4% had one or more MS disorders. Osteoarthritis was present in 19.4% of patients. Hand disorders were seen in 14.4%. Shoulder capsulitis was present in 12.5%. Long duration of diabetes and dyslipidemia were associated with increased prevalence of hand abnormalities (P = 0.017; P = 0.019, respectively). Age and dyslipidemia were associated with shoulder capsulitis (P = 0.019; P = 0.047, respectively). Female gender, overweight, and nephropathy were associated with increased odds of osteoarthritis (P = 0.009, P = 0.004, and P = 0.032, respectively). Conclusion MS disorders are frequent in this population and associated with various factors. HbA1c level does not appear to be associated with development of MS disorders.
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Gutefeldt K, Hedman CA, Thyberg ISM, Bachrach-Lindström M, Arnqvist HJ, Spångeus A. Upper extremity impairments in type 1 diabetes with long duration; common problems with great impact on daily life. Disabil Rehabil 2017; 41:633-640. [DOI: 10.1080/09638288.2017.1397202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kerstin Gutefeldt
- Department of Endocrinology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Christina A. Hedman
- Department of Endocrinology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingrid S. M. Thyberg
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Margareta Bachrach-Lindström
- Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Hans J. Arnqvist
- Department of Endocrinology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna Spångeus
- Department of Endocrinology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Ko JS, Zwiebel S, Wilson B, Becker DB. Perioperative antibiotic use in diabetic patients: A retrospective review of 670 surgeries. J Plast Reconstr Aesthet Surg 2017; 70:1629-1634. [DOI: 10.1016/j.bjps.2017.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/01/2017] [Accepted: 06/25/2017] [Indexed: 11/16/2022]
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Mineoka Y, Ishii M, Hashimoto Y, Tanaka M, Nakamura N, Katsumi Y, Isono M, Fukui M. Relationship between limited joint mobility of hand and carotid atherosclerosis in patients with type 2 diabetes. Diabetes Res Clin Pract 2017; 132:79-84. [PMID: 28802699 DOI: 10.1016/j.diabres.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Abstract
AIM Limited joint mobility (LJM) of hand, which is one of a complication of diabetic hand, has a close association with diabetic microangiopathy. However, it remains to be elucidated about the relationships between LJM of hand and subclinical atherosclerosis in patients with type 2 diabetes. Therefore, we conducted a cross-sectional study to evaluate the relationships between LJM of hand and carotid intima-media thickness (IMT) and plaque score in patients with type 2 diabetes. METHODS We evaluated the relationships between LJM of hand, and carotid IMT and plaque score, evaluated by carotid ultrasound examination, in 341 consecutive patients with type 2 diabetes. LJM of hand was diagnosed using a 'prayer sign' or 'table test'. RESULTS LJM of hand was present in 72 patients. Carotid IMT and plaque score were higher in patients with LJM of hand than those in patients without (1.45±0.66vs. 1.14±0.68mm, P=0.013 and 8.0±5.3vs. 5.4±4.8mm, P<0.001). Multivariate linear regression analysis revealed that LJM of hand was positively correlated with plaque score (β=0.423, P=0.043) after adjusted for age, sex, durations of diabetes, body mass index, hemoglobin A1c, creatinine, uric acid, smoking, hypertension and dyslipidemia. CONCLUSIONS Our results demonstrate a relation between LJM of hand and subclinical atherosclerosis, especially plaque score, in patients with type 2 diabetes. Diagnosis of diabetic hand is simple and non-invasive, and thus is a useful method for assessment of subclinical atherosclerosis in patients with type 2 diabetes.
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Affiliation(s)
- Yusuke Mineoka
- Department of Internal Medicine, Otsu Municipal Hospital, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu Municipal Hospital, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Muhei Tanaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Naoto Nakamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan; Department of Internal Medicine, Saiseikai Kyoto Hospital, Japan
| | | | - Motohide Isono
- Department of Internal Medicine, Otsu Municipal Hospital, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan.
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Investigation of Nerve Conduction Studies of Carpal Tunnel Syndrome Cases With Different Risk Factors: An Electrodiagnostic Study. J Clin Neurophysiol 2017; 34:139-143. [PMID: 27753734 DOI: 10.1097/wnp.0000000000000352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to determine whether there are electrodiagnostic differences between carpal tunnel syndrome (CTS) patients with diabetes mellitus, CTS + hypothyroidism (HT), CTS + fibromyalgia syndrome, CTS + rheumatoid arthritis (RA), and idiopathic CTS cases, by comparing nerve conduction studies. METHODS This research examined electrophysiologic studies of 47 untreated HT + CTS, 47 diabetes mellitus + CTS, 49 RA + CTS, 52 fibromyalgia syndrome + CTS, 50 idiopathic CTS cases, and a healthy control group of 50 individuals (a total of 293 patients and 433 hands with CTS). RESULTS There were no significant differences between the groups in terms of sex and age. There was no significant difference between the CTS groups-in terms of numbers-with mild, moderate, and severe CTS. When the CTS groups were compared with the control group, in all CTS groups on both left and right hands, there was a significant prolongation in median motor latency and median sensory latency (in the 3rd finger); also a significant decrease in median sensory velocity in the 3rd finger. In diabetes mellitus, HT, and RA groups, the median motor amplitudes in both hands were significantly decreased compared with the idiopathic group. There was a moderate significant negative correlation between disease duration and median motor amplitudes (of both right and left sides) in RA (right; P = 0.028, r = 0.761, left; P = 0.041, r = 0.694) and HT groups (right; P = 0.035, r = 0.637, left; P = 0.049, r = 0.697). CONCLUSIONS Electrodiagnostic results showed both demyelinating injury and axonal damage in diabetes mellitus, HT, and RA patients with CTS, in these patients during treatment for CTS. Early treatment planning should include the risk factor diseases.
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Hou WH, Li CY, Chen LH, Wang LY, Kuo KN, Shen HN, Chang MF. Prevalence of hand syndromes among patients with diabetes mellitus in Taiwan: A population-based study. J Diabetes 2017; 9:622-627. [PMID: 27485041 DOI: 10.1111/1753-0407.12455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/29/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Population-based data for diabetic hand syndrome (DHS) are limited. The aim of the present epidemiological study was to estimate the overall and cause-specific prevalence and rate ratio (RR) of DHS in patients with diabetes. METHODS The present study was a cross-sectional study based on a random sample of 57 093 diabetics and matched controls, both identified from Taiwan National Health Insurance claims in 2010. The DHS analyzed in the present study included carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren's disease (DD). RESULTS The prevalence of overall DHS was estimated at 2472 per 105 for the diabetics, compared with 1641 per 105 for the controls, representing a prevalence RR of 1.51 (95 % confidence interval [CI] 1.39-1.64). Stratified analyses further revealed that the significantly increased prevalence of overall DHS was more evident in females than males (1.59 vs 1.36) and was only noted in diabetics aged ≥35 years. Cause-specific analysis suggested that patients with diabetes had the highest prevalence of CTS (1244 per 105 ), followed by SFT (1209 per 105 ), LJM (39 per 105 ), and DD (6 per 105 ). In addition, diabetes was only significantly associated with CTS (RR 1.34; 95 % CI 1.20-1.51) and SFT (1.74; 95 % CI 1.54-1.97). CONCLUSION The prevalence of overall and certain cause-specific DHS was significantly elevated in patients with diabetes in Taiwan.
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Affiliation(s)
- Wen-Hsuan Hou
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chung-Yi Li
- Department and Graduate Institute of Public Health, College of Medical, Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, Sin-Lau Christian Hospital, Tainan, Taiwan
| | - Lu-Hsuan Chen
- Department of Family Medicine, Sin-Lau Christian Hospital, Tainan, Taiwan
| | - Liang-Yi Wang
- Department and Graduate Institute of Public Health, College of Medical, Cheng Kung University, Tainan, Taiwan
| | - Ken N Kuo
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Nien Shen
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Ming-Fong Chang
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
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25
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Wang PH, Yang CC, Su WR, Wu PT, Cheng SC, Jou IM. Effects of decompression on behavioral, electrophysiologic, and histomorphologic recovery in a chronic sciatic nerve compression model of streptozotocin-induced diabetic rats. J Pain Res 2017; 10:643-652. [PMID: 28360533 PMCID: PMC5365322 DOI: 10.2147/jpr.s125693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose To determine susceptibility to decompression surgery in diabetic and nondiabetic peripheral neuropathy using a chronic compression neuropathy model. Materials and methods Twenty-four streptozotocin-induced diabetic rats were randomly divided into three groups: group I, chronic compression of the left sciatic nerve for 4 weeks with decompression; group II, similar without decompression; and group III, sham exposing the sciatic nerve only. The other 24 nondiabetic rats were assigned to groups IV–VI, which received compression–decompression, compression, and the sham operation, respectively. Mixed-nerve-elicited somatosensory evoked potentials (M-SSEPs) and compound muscle action potentials (CMAPs) were measured to verify the compression neuropathy in the posttreatment follow-up. Behavioral observations in thermal hyperalgesia tests were quantified before electrophysiologic examinations. Treated and contralateral nerves were harvested for histomorphologic analysis. Results Chronic compression of sciatic nerve induced significant reduction of amplitude and increment of latency of M-SSEP and CMAP in both diabetic and nondiabetic rats. Diabetic group changes were more susceptible. Decompression surgery significantly improved both sensory and motor conduction, thermal hyperalgesia, and the mean myelin diameter of the rat sciatic nerve in both diabetic and nondiabetic groups. Near full recovery of motor and sensory function occurred in the nondiabetic rats, but not in the diabetic rats 8 weeks postdecompression. Conclusion Behavioral, electrophysiologic, and histomorphologic findings indicate that decompression surgery is effective in both diabetic and nondiabetic peripheral neuropathy.
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Affiliation(s)
| | - Cheng-Chang Yang
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University
| | - Wei-Ren Su
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan
| | - Po-Ting Wu
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan
| | | | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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Lipman MD, Carstensen SE, Deal DN. Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014. Hand (N Y) 2017; 12:13-20. [PMID: 28082837 PMCID: PMC5207289 DOI: 10.1177/1558944716647101] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.
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Affiliation(s)
- Marc D. Lipman
- University of Virginia Health System, Charlottesville, VA, USA
| | | | - Dylan Nicole Deal
- University of Virginia Health System, Charlottesville, VA, USA,Dylan Nicole Deal, Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 801016, Charlottesville, VA 22908, USA.
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Hou WH, Li CY, Chen LH, Wang LY, Kuo LC, Kuo KN, Shen HN, Chiu CT. Medical claims-based case-control study of temporal relationship between clinical visits for hand syndromes and subsequent diabetes diagnosis: implications for identifying patients with undiagnosed type 2 diabetes mellitus. BMJ Open 2016; 6:e012071. [PMID: 27798003 PMCID: PMC5073620 DOI: 10.1136/bmjopen-2016-012071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate whether a temporal relationship is present between clinical visits for diabetes-related hand syndromes (DHSs) and subsequent type 2 diabetes mellitus (T2DM) diagnosis and, accordingly, whether DHSs can be used for identifying patients with undiagnosed T2DM. DESIGN This study had a case-control design nested within a cohort of 1 million people from the general population, which was followed from 2005 to 2010. The odds of prior clinical visits for DHSs, namely carpal tunnel syndrome (CTS), flexor tenosynovitis, limited joint mobility and Dupuytren's disease, were estimated for cases and controls. We used a conditional logistic regression model to estimate the OR and 95% CI of T2DM in association with a history of DHSs. The validity and predictive value of using the history of DHSs in predicting T2DM diagnosis were calculated. SETTING Taiwan National Health Insurance medical claims. PARTICIPANTS We identified 33 571 patients receiving a new diagnosis of T2DM (cases) between 2005 and 2010. Each T2DM case was matched with 5 controls who had the same sex and birth year and were alive on the date of T2DM diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was T2DM diagnosis. RESULTS The OR of T2DM in association with prior clinical visits was significantly increased for overall DHS and CTS, being 1.15 (95% CI 1.10 to 1.20) and 1.22 (95% CI 1.16 to 1.29), respectively. Moreover, 11% of patients with T2DM made clinical visits for CTS within 3 months prior to T2DM diagnosis. The history of DHSs had low sensitivity (<0.1% to 5.2%) and a positive predictive value (9.9% to 11.7%) in predicting T2DM. CONCLUSIONS Despite the unsatisfactory validity and performance of DHSs as a clinical tool for detecting patients with undiagnosed T2DM, this study provided evidence that clinical visits for DHSs, particularly for CTS, can be a sign of undiagnosed T2DM.
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Affiliation(s)
- Wen-Hsuan Hou
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chung-Yi Li
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Lu-Hsuan Chen
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Liang-Yi Wang
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ken N Kuo
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Nien Shen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chang-Ta Chiu
- Department of Dentistry, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
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Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R. Dupuytren’s Disease Risk Factors. ACTA ACUST UNITED AC 2016; 29:423-6. [PMID: 15336742 DOI: 10.1016/j.jhsb.2004.06.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 06/09/2004] [Indexed: 11/27/2022]
Abstract
Dupuytren’s is a common problem, but little is known about its a etiology. We have undertaken a large case-control study to assess and quantify the relative contributions of diabetes and epilepsy as risk factors for Dupuytren’s in the community. Cases were patients with a diagnosis of Dupuytren’s disease and, for each, two controls were individually matched by age, sex, and general practice. Our dataset included 821 cases and 1,642 controls. Five hundred and eighty-eight (72%) of the cases were men. The mean age at diagnosis was 62 (range 24–97) years. Diabetes was a significant risk factor for Dupuytren’s disease (OR = 1.75) and there was an increased risk for medicinally treated diabetes (metformin – R = 3.56; sulphonylureas – OR = 1.75) and particularly insulin controlled (OR = 4.39) rather than diet-controlled diabetes. Epilepsy (OR = 1.12) and antiepileptic medications were not associated with Dupuytren’s disease. Ascertainment bias in previous studies may explain the reported association with epilepsy.
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Affiliation(s)
- J M Geoghegan
- Department of Trauma and Orthopaedics, Derbyshire Royal Infirmary, UK.
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Renart I. La mano diabética. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2015. [DOI: 10.1016/j.ricma.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
La diabetes es una de las enfermedades con mayor prevalencia y repercusión sociosanitaria, no solo por su elevada frecuencia, sino también por el impacto de las complicaciones crónicas de la enfermedad y el papel que desempeña como factor de riesgo en la afección cardiovascular. Sin embargo, la diabetes también puede involucrar al sistema musculoesquelético y a los tejidos blandos de forma muy diversa, siendo la mano una de las regiones más afectadas. De hecho, se estima que el 40% de los pacientes diabéticos tienen problemas significativos de la mano que requieren una atención médica.En el presente artículo se revisan las principales enfermedades de la mano que van asociadas a la diabetes, haciendo especial hincapié en el tratamiento y el pronóstico de cada una de ellas.
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Chen LH, Li CY, Kuo LC, Wang LY, Kuo KN, Jou IM, Hou WH. Risk of Hand Syndromes in Patients With Diabetes Mellitus: A Population-Based Cohort Study in Taiwan. Medicine (Baltimore) 2015; 94:e1575. [PMID: 26469895 PMCID: PMC4616773 DOI: 10.1097/md.0000000000001575] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to assess the overall and cause-specific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications.The DM and control cohorts comprised 606,152 patients with DM and 609,970 age- and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders.Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI] = 1.48-1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI = 2.15-3.24 and 2.99, 95% CI = 2.55-3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR = 1.90, 95% CI = 1.86-1.95) and DD (HR = 1.83, 95% CI = 1.39-2.39) than with CTS (HR = 1.31, 95% CI = 1.28-1.34) and LJM (HR = 1.24, 95% CI = 1.13-1.35).Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians.
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Affiliation(s)
- Lu-Hsuan Chen
- From the Department and Graduate Institute of Public Health (L-HC, C-YL, L-YW), College of Medicine, National Cheng Kung University, Tainan; Department of Public Health (C-YL), College of Public Health, China Medical University, Taichung; Department of Occupational Therapy (L-CK), College of Medicine, National Cheng Kung University, Tainan; Center of Evidence-Based Medicine (KNK, W-HH), Taipei Medical University, Taipei; Department of Orthopedics (I-MJ), National Cheng Kung University Hospital, Tainan; Master Program in Long-Term Care (W-HH), College of Nursing, Taipei Medical University, Taipei; School of Gerontology Health Management (W-HH), College of Nursing, Taipei Medical University, Taipei; and Department of Physical Medicine and Rehabilitation (W-HH), Taipei Medical University Hospital, Taipei, Taiwan
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Mustafa KN, Khader YS, Bsoul AK, Ajlouni K. Musculoskeletal disorders of the hand in type 2 diabetes mellitus: prevalence and its associated factors. Int J Rheum Dis 2015; 19:730-5. [PMID: 26259148 DOI: 10.1111/1756-185x.12617] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM To assess the prevalence of musculoskeletal disorders of the hand among adult patients with type 2 diabetes mellitus (T2DM) and their relation to disease duration, glycemic control and microvascular complications. METHODS A cross-sectional study was conducted at the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. RESULTS One thousand patients with T2DM were included in this study (mean age 57.8 ± 9.5 years, 52.2% females and 47.8% males). Hand disorders were seen in 69.5% of patients, limited joint mobility (LJM) was the most prevalent (63.1%) condition followed by Dupuytren's contracture (DC) (18.6%). Trigger finger, thick skin and carpal tunnel syndrome (CTS) were found in 7.2%, 6.2% and 5.5% of patients, respectively. One disorder was seen in 45.4% of patients, two in18.2%, three in 4.9%, four in 0.9%, while only 0.1% of patients had all disorders. Female gender, age over 60 years and long duration of diabetes were associated with hand abnormalities. Hypertension was significantly associated with DC while retinopathy was associated with increased odds of thick skin, DC and CTS with P-values 0.037, < 0.005 and 0.002, respectively. CONCLUSION Hand disorders are very common in T2DM. Female gender, old age, duration of diabetes, retinopathy and hypertension were significantly associated with hand disorders in T2DM.
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Affiliation(s)
- Khader N Mustafa
- Section of Rheumatology, Department of Internal Medicine, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Amal K Bsoul
- Faculty of Nursing/Adult Health Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
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Gerrits EG, Landman GW, Nijenhuis-Rosien L, Bilo HJ. Limited joint mobility syndrome in diabetes mellitus: A minireview. World J Diabetes 2015; 6:1108-1112. [PMID: 26265997 PMCID: PMC4530324 DOI: 10.4239/wjd.v6.i9.1108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 06/16/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023] Open
Abstract
Limited joint mobility syndrome (LJMS) or diabetic cheiroarthropathy is a long term complication of diabetes mellitus. The diagnosis of LJMS is based on clinical features: progression of painless stiffness of hands and fingers, fixed flexion contractures of the small hand and foot joints, impairment of fine motion and impaired grip strength in the hands. As the syndrome progresses, it can also affect other joints. It is important to properly diagnose such a complication as LJMS. Moreover, it is important to diagnose LJMS because it is known that the presence of LJMS is associated with micro- and macrovascular complications of diabetes. Due to the lack of curative treatment options, the suggested method to prevent or decelerate the development of LJMS is improving or maintaining good glycemic control. Daily stretching excercises of joints aim to prevent or delay progression of joint stiffness, may reduce the risk of inadvertent falls and will add to maintain quality of life.
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Raje YR, Cracknell G, Davoren PM. Frequency of hand and shoulder symptoms in patients with type 1 diabetes. Diabet Med 2015; 32:968-71. [PMID: 25644754 DOI: 10.1111/dme.12704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
AIMS To characterize the frequency of joint symptoms in patients with Type 1 diabetes mellitus and to determine the subset of patients at risk of developing these symptoms. METHODS We invited patients with Type 1 diabetes to complete a survey in which upper limb joint symptoms were scored using a composite of the Shoulder Pain and Disability Index and a visual analogue scale. Family or friends of the participants, without diabetes, completed control surveys. RESULTS A total of 131 patients and 79 age- and sex-matched control subjects completed the surveys. Patients with Type 1 diabetes had higher composite symptom scores than did the control subjects [median (range) score 25 (0-208) vs. 12 (0-145); P < 0.001]. Patients with long-standing diabetes had significantly higher median (range) scores than those with diabetes of shorter duration [diabetes >30 years: 63(0-208), 15-30 years: 46(0-168), diabetes <15 years: 17(0-143)]. Patients with diabetic nephropathy had higher scores than those without [median (range) score 103 (0-173) vs. 22 (0-208); P = 0.007 between groups]. Neither blood glucose control nor age at diagnosis predicted higher scores. CONCLUSION Upper limb joint symptoms occur with greater frequency in patients with Type 1 diabetes. Longer duration of disease is the best predictor of symptoms. Blood glucose control does not appear to be associated with development of symptoms.
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Affiliation(s)
- Y R Raje
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - G Cracknell
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - P M Davoren
- Gold Coast University Hospital, Southport, Queensland, Australia
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Kazamel M, Dyck PJ. Sensory manifestations of diabetic neuropathies: anatomical and clinical correlations. Prosthet Orthot Int 2015; 39:7-16. [PMID: 25614497 DOI: 10.1177/0309364614536764] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetes mellitus is among the most common causes of peripheral neuropathy worldwide. Sensory impairment in diabetics is a major risk factor of plantar ulcers and neurogenic arthropathy (Charcot joints) causing severe morbidity and high health-care costs. OBJECTIVE To discuss the different patterns of sensory alterations in diabetic neuropathies and their anatomical basis. STUDY DESIGN Literature review. METHODS Review of the literature discussing different patterns of sensory impairment in diabetic neuropathies. RESULTS The different varieties of diabetic neuropathies include typical sensorimotor polyneuropathy (lower extremity predominant, length-dependent, symmetric, sensorimotor polyneuropathy presumably related to chronic hyperglycemic exposure, and related metabolic events), entrapment mononeuropathies, radiculoplexus neuropathies related to immune inflammatory ischemic events, cranial neuropathies, and treatment-related neuropathies (e.g. insulin neuritis). None of these patterns are unique for diabetes, and they can occur in nondiabetics. Sensory alterations are different among these prototypic varieties and are vital in diagnosis, following course, treatment options, and follow-up of treatment effects. CONCLUSIONS Diabetic neuropathies can involve any segment of peripheral nerves from nerve roots to the nerve endings giving different patterns of abnormal sensation. It is the involvement of small fibers that causes positive sensory symptoms like pain early during the course of disease, bringing subjects to physician's care. CLINICAL RELEVANCE This article emphasizes on the fact that diabetic neuropathies are not a single entity. They are rather different varieties of conditions with more or less separate pathophysiological mechanisms and anatomical localization. Clinicians should keep this in mind when assessing patients with diabetes on the first visit or follow-up.
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Affiliation(s)
- Mohamed Kazamel
- Neuromuscular Pathology Laboratories, Department of Neurology, Mayo Clinic, Rochester, USA
| | - Peter J Dyck
- Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, Rochester, USA
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Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy 2014; 101:147-54. [PMID: 25442298 DOI: 10.1016/j.physio.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 07/25/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the severity of, and relationships between, upper extremity impairments, pain and disability in patients with diabetes mellitus, and to compare upper extremity impairments in patients with diabetes with non-diabetic controls. DESIGN Case-control, cross-sectional design. SETTING University-based, outpatient diabetes centre and physical therapy research clinic. PARTICIPANTS Two hundred and thirty-six patients with diabetes attending an outpatient diabetes clinic completed the Shoulder Pain and Disability Index (SPADI) questionnaire. A detailed shoulder and hand examination was conducted on a subgroup of 29 volunteers with type 2 diabetes, and 27 controls matched for age, sex and body mass index. INTERVENTIONS None. MAIN OUTCOME MEASURES SPADI score, passive shoulder range of motion (ROM) and strength, grip strength, hand sensation, dexterity and limited joint mobility of the hand. RESULTS Sixty-three percent (149/236) of patients with diabetes reported shoulder pain and/or disability [median SPADI score 10.0 (interquartile range 0.0 to 39.6)]. Compared with the control group, the subgroup of patients with diabetes had substantial reductions in shoulder ROM, shoulder muscle strength, grip and key pinch strength (P<0.05). Patients with diabetes had a greater prevalence of decreased sensation (26/27 vs 14/27) and limited joint mobility of the hand (17/27 vs 4/27) compared with the control group. Total SPADI score was negatively correlated (P<0.05) with shoulder ROM (r=-0.42 to -0.74) and strength measures (r=-0.44 to -0.63) in patients with diabetes. CONCLUSIONS Upper extremity impairments in this sample of patients with diabetes were common, severe and related to complaints of pain and disability. Additional research is needed to understand the unique reasons for upper extremity problems in patients with diabetes, and to identify preventative treatments.
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Affiliation(s)
- K M Shah
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA.
| | - B R Clark
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA
| | - J B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - M J Mueller
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA; Department of Radiology, Washington University School of Medicine in St. Louis, USA
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López-Martín I, Benito Ortiz L, Rodríguez-Borlado B, Cano Langreo M, García-Martínez FJ, Martín Rodríguez MF. [Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients]. Semergen 2014; 41:70-5. [PMID: 24906788 DOI: 10.1016/j.semerg.2014.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/17/2014] [Accepted: 03/18/2014] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple "prayer sign" test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. PATIENTS AND METHODS A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. RESULTS A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P<.001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. CONCLUSIONS The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients.
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Affiliation(s)
- I López-Martín
- Servicio de Medicina Familiar y Comunitaria, Centro de Salud San Fernando II, San Fernando de Henares, Madrid, España.
| | - L Benito Ortiz
- Servicio de Medicina Familiar y Comunitaria, Centro de Salud San Fernando II, San Fernando de Henares, Madrid, España
| | - B Rodríguez-Borlado
- Servicio de Medicina Familiar y Comunitaria, Centro de Salud de Goya, Madrid, España
| | - M Cano Langreo
- Servicio de Medicina Familiar y Comunitaria, Centro de Salud San Fernando II, San Fernando de Henares, Madrid, España
| | - F J García-Martínez
- Servicio de Dermatología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | - M F Martín Rodríguez
- Servicio de Medicina Familiar y Comunitaria, Centro de Salud Soto del Real, Soto del Real, Madrid, España
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Poole JL, Santhanam DD, Latham AL. Hand impairment and activity limitations in four chronic diseases. J Hand Ther 2014; 26:232-6; quiz 237. [PMID: 23622819 DOI: 10.1016/j.jht.2013.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/17/2013] [Accepted: 03/22/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort. INTRODUCTION Hand involvement in osteoarthritis (OA) and rheumatoid arthritis (RA) are well known to occupational and physical therapists; however, it is not known whether the impairments and activity limitations with diabetes (DMII) and systemic sclerosis (SSc) are as severe as those observed with OA and RA. PURPOSE To compare the hand impairments and activity limitations in the 4 diseases. METHODS A convenience sample of 156 participants received evaluations of hand impairments: strength, joint motion, and dexterity and completed a hand activity limitations questionnaire. RESULTS The SSc and RA participants had weaker pinch, decreased joint motion and more activity limitations than the DMII and OA groups. There were no significant differences between the groups for right hand grip strength and pegboard dexterity, and applied dexterity. CONCLUSIONS OA and DMII groups had significantly less impairments and activity limitations than the SSc and RA groups. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Janet L Poole
- Occupational Therapy Graduate Program MSC09 5240, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Font YM, Castro-Santana LE, Nieves-Plaza M, Maldonado M, Mayor AM, Vilá LM. Factors associated with regional rheumatic pain disorders in a population of Puerto Ricans with diabetes mellitus. Clin Rheumatol 2014; 33:995-1000. [PMID: 24522480 DOI: 10.1007/s10067-013-2474-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/25/2013] [Accepted: 12/20/2013] [Indexed: 12/26/2022]
Abstract
The aim of the study was to determine the prevalence and factors associated with bursitis/tendonitis disorders in Puerto Ricans with diabetes mellitus (DM). A cross-sectional study was performed in 202 adult Puerto Ricans (100 DM patients and 102 non-diabetic subjects). For each participant, a complete medical history and a musculoskeletal exam were systematically performed. Socio-demographic parameters, health-related behaviors, comorbidities, and pharmacotherapy were determined for all subjects. For DM patients, disease duration, glycemic control, and DM long-term complications were also examined. Multivariate logistic regression analyses were used to determine the factors associated with bursitis/tendonitis disorders. The mean (SD) age for DM patients and non-diabetic controls were 53.3 (12.9) and 50.0 (13.1) years; 64.0 and 64.7 % of DM patients and controls were females, respectively. Overall, the prevalence of bursitis/tendonitis was higher in DM patients than among non-diabetics (59.0 % vs. 29.4 %, p < 0.01). In multivariate analyses, DM patients had 2.47 (95 % CI 1.05, 5.84) the odds of having bursitis/tendonitis as compared to non-diabetics. Specifically, DM patients had a higher frequency of flexor tenosynovitis, De Quervain's tenosynovitis, lateral epicondylitis, medial epicondylitis, trochanteric bursitis, and anserine bursitis than non-diabetic subjects (p < 0.05). Among DM patients, multivariate analyses showed that those with bursitis/tendonitis were more likely to be female [OR (95 % CI) 4.55 (1.42, 14.55)] and have peripheral vascular disease [OR (95 % CI) 8.48 (1.71, 41.93)]. In conclusion, bursitis/tendonitis disorders were common in this population of Hispanics with DM. Among DM patients, bursitis/tendonitis disorders were more frequent in women and those with long-term complications such as peripheral vascular disease.
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Affiliation(s)
- Yvonne M Font
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA
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Lewko J, Polityńska B, Kochanowicz J, Zarzycki W, Mariak Z, Górska M, Krajewska-Kułak E. Median nerve conduction impairment in patients with diabetes and its impact on patients' perception of health condition: a quantitative study. Diabetol Metab Syndr 2013; 5:16. [PMID: 23522691 PMCID: PMC3623792 DOI: 10.1186/1758-5996-5-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/21/2013] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Impaired mobility and compromised manual dexterity leading to difficulties with the activities of daily living (ADL) are an inherent part of the clinical picture in diabetes. Hand function in diabetes is influenced by a variety of pathologies: the median nerve, the most important nerve of the hand, can suffer from metabolic disturbances, ischemia and/or entrapment neuropathies. The resulting deterioration in functional capacity is likely to have significant consequences for the ability to perform ADL, influencing adjustment to diabetes and affecting quality of life. The aim of the present study was to examine the influence of hand function as measured by median motor nerve conduction on quality of life, taking into account various aspects of functioning in patients with diabetes, including activities of daily living, psychological status and acceptance of illness. PATIENTS AND METHODS Seventy one hospital patients with diabetes participated in the study. Electrophysiological recordings of conductance in the median nerve were obtained for both hands and the relationship between hand function and functional status (BI), depression and anxiety (HADS), adjustment to illness (AIS) and their effect on quality of life (SF-36v2 and QLI) was studied. RESULTS Damage to the median nerve of the left hand was associated with significant differences in functioning in the physical, but not the mental component of the SF-36v2, p = 0.03 and in functional status (p = 0.006). QOL was associated with depression, patient age, acceptance of illness, functional ability and to a small, but significant extent with median nerve damage to the right hand on the measure of conduction velocities (R2 =0.726). CONCLUSIONS Nerve conductance studies demonstrated a small, but significant effect of hand function on quality of life. Impairment of the median nerve in the left hand was associated with functional difficulties in the activities of daily living and a diminished quality of life in the area of physical functioning. No dependencies of this kind were found for the right hand, which may reflect the greater compensatory capacity of the right hand resulting from improved efficiency due to practice.
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Affiliation(s)
- Jolanta Lewko
- Department of Integrated Medical Care, Medical University of Bialystok, M. Skłodowskiej-Curie str. 7A, Bialystok, 15-096, Poland
| | - Barbara Polityńska
- Department of Philosophy and Human Psychology, Medical University of Bialystok, Szpitalna str. 37, Białystok, 15-295, Poland
| | - Jan Kochanowicz
- Department of Invasive Neurology, Medical University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
- Department of Neurosurgery, Medical University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Wiesław Zarzycki
- Department of Endocrinology, Diabetes and Internal Medicine, Medical, University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Zenon Mariak
- Department of Neurosurgery, Medical University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Maria Górska
- Department of Endocrinology, Diabetes and Internal Medicine, Medical, University of Bialystok, Marii Skłodowskiej-Curie str. 24A, Białystok, 15-276, Poland
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Medical University of Bialystok, M. Skłodowskiej-Curie str. 7A, Bialystok, 15-096, Poland
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Schulman R, Levchenko A, Lombardo SR, Walkoski SA, Moroz A. Trigger Finger in a Male with Diabetes Successfully Treated with Acupuncture and Osteopathic Manipulative Treatment. Med Acupunct 2013. [DOI: 10.1089/acu.2012.0896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert Schulman
- Marin Integrative Physiatry, Marin County, CA
- Helms Medical Institute (HMI), Berkeley, CA
| | - Aleksandr Levchenko
- Department of Physical and Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine at New York University, New York, NY
| | - Sergio R. Lombardo
- Department of Physical and Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine at New York University, New York, NY
- Department of Graduate Medical Education, Medical Corps, United States Navy
| | - Stevan A. Walkoski
- Helms Medical Institute (HMI), Berkeley, CA
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Alex Moroz
- Department of Physical and Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine at New York University, New York, NY
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Kidwai SS, Wahid L, Siddiqi SA, khan RM, Ghauri I, Sheikh I. Upper limb musculoskeletal abnormalities in type 2 diabetic patients in low socioeconomic strata in Pakistan. BMC Res Notes 2013; 6:16. [PMID: 23327429 PMCID: PMC3556491 DOI: 10.1186/1756-0500-6-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/11/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Musculoskeletal manifestations of diabetes in the upper limb are well recognized. No data has been available in this regard from Pakistan. Our aim was to find out the frequency of upper limb musculoskeletal abnormalities in diabetic patients. METHODS This was an observational study in which type 2 diabetes patients attending our diabetic clinic were enrolled along with age and gender matched controls. Data was analyzed on SPSS 16. RESULTS In total, 210 Type 2 diabetics (male 34.3%, female 65.7%) and 203 controls (male 35%, female 65%) were recruited. The mean age was 50.7± 10.2 years in diabetic group as compared to 49.5±10.6 years in the control group. The frequencies of hand region abnormalities were significantly higher in the diabetic subjects as compared to the controls (20.4%, p-value <0.001). Limited joint mobility (9.5% vs 2.5%), carpal tunnel syndrome (9% vs 2%), trigger finger (3.8% vs 0.5%), and dupuytren's contracture (1% vs 0%) were found more frequent as compared to controls (all p-values <0.05). In the shoulder region of diabetic subjects, adhesive capsulitis and tendonitis was found in 10.9% and 9.5% respectively as compared to 2.5% and 2% in control group [p- value <0.001]. A weak but positive relationship was observed between age and duration of diabetes with these upper limb abnormalities. However, no correlation was found between the frequencies of these abnormalities with control of diabetes. CONCLUSION A higher frequency of upper limb musculoskeletal abnormalities was observed in Type 2 diabetic patients as compared to control group.
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Affiliation(s)
- Saera Suhail Kidwai
- Jinnah Medical College Hospital, SR-6, Sector 7-A, Korangi Industrial Area, Karachi, 75440, Pakistan
| | - Lubna Wahid
- Jinnah Medical College Hospital, SR-6, Sector 7-A, Korangi Industrial Area, Karachi, 75440, Pakistan
| | - Shaista A Siddiqi
- Jinnah Medical College Hospital, SR-6, Sector 7-A, Korangi Industrial Area, Karachi, 75440, Pakistan
| | | | - Ishaq Ghauri
- Jinnah Medical College Hospital, SR-6, Sector 7-A, Korangi Industrial Area, Karachi, 75440, Pakistan
| | - Ishaque Sheikh
- Jinnah Medical College Hospital, SR-6, Sector 7-A, Korangi Industrial Area, Karachi, 75440, Pakistan
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Alvarez-Nemegyei J, Canoso JJ. Evidence-based soft tissue rheumatology: epicondylitis and hand stenosing tendinopathy. J Clin Rheumatol 2012; 10:33-40. [PMID: 17043459 DOI: 10.1097/01.rhu.0000111312.98454.f8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lateral and medial epicondylitis represent overuse tendinopathies of wrist extensor and wrist flexor muscles, respectively. In lateral epicondylitis, a short-term therapeutic efficacy of glucocorticoid injection and limited evidence on the efficacy of acupuncture has been shown. De Quervain tendinopathy is caused by tendinous impingement by a thickened retinaculum. There is limited evidence on the efficacy of glucocorticoid injection in this condition.Trigger finger usually results from tendon entrapment beneath a thickened A1 flexor pulley. An association with hand tool use and diabetes has been shown in this condition, and there is evidence on the therapeutic efficacy of glucocorticoid injection. No other therapeutic modality has shown efficacy or has been assessed in a placebo-controlled clinical trial in these conditions.It can be concluded that epicondylitis and stenosing tendinopathy are readily diagnosed, and most patients recover with current therapies. However, still unsolved issues preclude a purely evidence-based approach to these entities.
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Affiliation(s)
- Jose Alvarez-Nemegyei
- From the *Servicio de Reumatología, Hospital de Especialidades, Centro Médico Nacional “Ignacio García Téllez”, Instituto Mexicano del Seguro Social, Mérida, Yucatán, México; and †ABC Medical Center, Mexico City, México, and Tufts University School of Medicine, Boston, Massachusetts
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Whitlock LA, McLaughlin AC. Identifying Usability Problems of Blood Glucose Tracking Apps for Older Adult Users. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/1071181312561001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Almost two-thirds of adults aged 65 and older in the United States are affected by diabetes or prediabetes (Cowie et al., 2009), and the health consequences of poor glycemic control are severe. Blood glucose tracking applications for mobile devices have the potential to help improve glycemic control but design issues may limit their use by older adults. We examined the usability of three existing blood glucose tracking applications via hierarchical task analysis and heuristic evaluation of their graph displays, and describe the problems we found and their implications for older users. We propose the inclusion of decision aids in the apps to better inform users’ health-based behavior.
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Poole JL, Cordova JS, Sibbitt WL, Skipper B. Quality of life in American Indian women with arthritis or diabetes. Am J Occup Ther 2010; 64:496-505. [PMID: 20608280 DOI: 10.5014/ajot.2010.09079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated quality of life (QOL) in American Indian women with different chronic diseases. METHOD Sixty American Indian women with diabetes mellitus (DM), rheumatoid arthritis (RA), or both DM and RA (DM + RA), and healthy control women received evaluations of joint motion, hand strength dexterity, pain, activity and participation limitations and QOL. RESULTS The DM + RA and RA groups had significantly more pain, less joint motion, decreased hand strength, and more activity limitations. Participation was similar for all groups except the DM + RA group. Past and present QOL were similar; however, the DM + RA group reported significantly decreased future QOL. CONCLUSION Results suggest that the presence of more than one chronic disease affects activity and participation. Factors that related to QOL were different for each disease group, with the exception of pain. Identification of factors related to QOL can help occupational therapists identify areas for intervention.
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Affiliation(s)
- Janet L Poole
- Department of Pediatrics, Occupational Therapy Graduate Program, University of New Mexico, MSCO9 5240, Albuquerque, NM 87131-0001, USA.
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Yagci I, Gunduz OH, Sancak S, Agirman M, Mesci E, Akyuz G. Comparative electrophysiological techniques in the diagnosis of carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Res Clin Pract 2010; 88:157-63. [PMID: 20223548 DOI: 10.1016/j.diabres.2010.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 12/25/2009] [Accepted: 02/15/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine utility of comparative electrophysiological techniques in differentiating carpal tunnel syndrome (CTS) in the background of diabetic polyneuropathy (DPN). DESIGN Ninety diabetic patients were classified into three groups: normal, CTS, and DPN according to nerve conduction studies (NCSs). The patients in the DPN group were divided into two subgroups of DPN and DPN-CTS according to clinical criteria. The comparative electrophysiological parameters including median-radial sensory distal latency difference (M-RSLD), median-ulnar sensory distal latency difference (M-USLD) and lumbrical-interosseous median-ulnar distal latency difference (LIMULD) were compared in subgroups of DPN, DPN-CTS and CTS. RESULTS Thirty-five (38.8%), 47 (52.3%), and 8 (8.9%) patients were diagnosed as CTS, DPN, and normal, respectively, according to NCS. After clinical stratification, 25 patients were diagnosed as DPN and 22 patients were diagnosed as DPN-CTS. The mean M-USLD and LIMULD values were similar in CTS and DPN-CTS groups, but larger than DPN statistically (p<0.05 for all). LIMULD, M-RSLD and M-USLD were positive in 88.4, 73 and 54% in the DPN-CTS group, respectively. CONCLUSIONS Electrophysiological abnormalities were common in diabetic patients and LIMULD can identify CTS in diabetic DPN patients better than M-RSLD and M-USLD.
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Affiliation(s)
- Ilker Yagci
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Turkey.
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Yuen HK, Tress ME, Salinas CF, Slate EH. Effectiveness of oral self-care among adult Gullah-speaking African Americans with diabetes. SPECIAL CARE IN DENTISTRY 2009; 29:128-33. [PMID: 19938252 DOI: 10.1111/j.1754-4505.2009.00077.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated the efficacy of plaque removal after an oral self-care demonstration among adult Gullah-speaking African Americans with diabetes. Fifty-four adults with diabetes completed an observed, uninstructed oral self-care demonstration with their normal mode of oral self-care. Before and after the oral self-care demonstration, the plaque levels of six test teeth were assessed using the Plaque Index. The mean percentage of plaque removal after the oral self-care demonstration was 27.4%. The mandibular teeth and the lingual surface had less plaque removal compared with the maxillary teeth and buccal surfaces. Only approximately 10% of participants achieved 50% or more plaque removal after the oral self-care demonstration. Thus, the majority of the participants did not achieve an acceptable level of plaque removal. Dental health professionals should emphasize better oral home care for people with diabetes and teach them how to access the lingual surfaces, especially of the mandibular teeth.
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Affiliation(s)
- Hon K Yuen
- Occupational Therapy Division, Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA.
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Ramchurn N, Mashamba C, Leitch E, Arutchelvam V, Narayanan K, Weaver J, Hamilton J, Heycock C, Saravanan V, Kelly C. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med 2009; 20:718-21. [PMID: 19818294 DOI: 10.1016/j.ejim.2009.08.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 07/02/2009] [Accepted: 08/10/2009] [Indexed: 12/28/2022]
Abstract
INTRODUCTION An increased prevalence of musculoskeletal disease is recognised in diabetes and is a common source of disability. It is known to predominantly affect the upper limbs especially the hand and shoulder. The relationship with other complications of diabetes and glycaemic control is uncertain. We designed this study to clarify these relationships, and to assess differences between types 1 and 2 diabetes. METHODS We identified a group of 96 people with established diabetes and examined them for the presence of locomotor disease focussing on the upper limbs. We recorded the mean HbA1c and the presence of diabetic complications, together with the health assessment questionnaire (HAQ) score. We explored correlations between locomotor disease and these variables using logistic regression. We compared data between type 1 and type 2 diabetics and contrasted the amalgamated data with that of a matched control population of medical out patients using Students t tests. RESULTS Locomotor disease was present in 75% of diabetics with the upper limb the commonest site for abnormalities. This prevalence was significantly higher than that seen in the controls (53%) [p=0.02]. Shoulder capsulitis (25%), carpal tunnel syndrome (20%), tenosynovitis (29%), limited joint mobility (28%) and Dupuytrens contracture (13%) were the most frequent findings and were much commoner than in controls. Capsulitis usually coexisted with other upper limb abnormalities and best predicted the presence of retinopathy and/or neuropathy. The mean HbA1c was significantly higher in patients with combined shoulder and hand problems (9.1%) than in those with no upper limb problems (8.0%) [p=0.018]. The pattern of results was similar in type 1 and type 2 diabetes, although the prevalence of abnormalities and mean HAQ were significantly greater in type 2 patients, which may be in part a function of their greater mean age. CONCLUSION Upper limb locomotor abnormalities are very common in diabetes and are associated with worse glycaemic control and more diabetic complications. Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications.
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Affiliation(s)
- Navdha Ramchurn
- Department of Rheumatology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
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Abstract
Musculoskeletal injuries and diseases are common in persons with obesity and diabetes mellitus. High body mass index is associated with an increased risk for musculoskeletal injuries, diseases, and disability. There is a significant positive correlation between the level of obesity and musculoskeletal injuries, and disability and health-related costs. The prevalence of obesity and diabetes is inversely proportional to health-related quality of life.
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Affiliation(s)
- Robert P Wilder
- Department of Physical Medicine and Rehabilitation, University of Virginia, 545 Ray C. Hunt Drive, Suite 310, Charlottesville, VA 22908, USA.
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