One of the complications of diabetes that may affect the hand is diabetic sclerodactyly. This may be a component in the more extensive diabetic hand.
Pathogenesis: chronic microvascular disease
It tends to occur in older adults with long-term diabetes that has been poorly controlled.
Clinical features:
(1) tight and thickened skin over the fingers and hand
(2) reduced movements of the metacarpophalangeal and interphalangeal joints with difficulty flexing the digits and forming a fist
A skin biopsy may show thickened collagen within the reticular dermis with increased mucin deposition.
Components of a diabetic hand may include:
(1) diabetic sclerodactyly
(2) diabetic scleredema
(3) diabetic cheiroarthropathy
(4) tropical diabetic hand status post cellulitis
(5) Dupuytren's contracture
(6) trigger finger
The differential diagnosis includes scleroderma and scleroderma mimics. Serologic tests for the antibodies associated with scleroderma are negative.
