Difficult Intubation in a Diabetic with Limited Joint Mobility (Stiff Joint) Syndrome

Diabetic Cheiroarthropathy is a diabetic disorder with limited joint mobility and thickened and waxy skin,

Joints with limited mobility may include:

(1) atlanto-occipital joint: limits extension of the head and neck

(2) temporomandibular joints: limits mouth opening

Palm print (prayer sign) arises from an inability to completely bring the hands together due to limited mobility in the hand ("stiff hand").

(1) If the palms are brought together as in prayer, there are gaps present, especially for the proximal fourth and fifth fingers.

(2) If a palm print is made (first putting the palm and fingers in ink then pressing to paper), then there are gaps in ink over proximal fingers and portions of the palm.

If preparing to intubate a diabetic, then it is prudent to look for evidence of limited joint mobility prior to attempting intubation.