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[IP] What is Cheiroapathy...The Answer

Cheiroarthropathy is a state of limited joint mobility associated with 
Diabetes..especially Type I.  It usually only affects the small joints of 
the hands, but may also affect large joints such as wrists, shoulder, 
ankles, knees, hip. The condition is usually painless, but numbness and pain 
may be present if neuropathy of the hands are involved. Many people will be 
diagnosed with Carpal Tunnel Syndrome or Arthiritis when they actually have 

The affected fingers are swollen and have a "shinny or leathery" apperance 
with thick and waxy skin that is difficult to bend.  usually the main joint 
or finger aafected is that of the "pinky", but will spread almost in order 
until it reaches the thunmb.

Indicators of this disease are difficult.  Autoimmune reactivity, antibody 
titers, rheumatoid factor are usually absent.  X-rays are also unremarked.

An easy way to determine if you may suffer from this is to do the Prayer 
Test.  Put your hands together as if to pray...palms flat against each 
other.  If you can see light or a gap at the end of the "tunnel made by your 
hands when you look through the prayer sign, then you probably have it to an 
extent.  If you are unable to touch the palmar surfaces of your hands 
(joints) together, the test is considered positive.  A slightly more 
complicated version of the test involves painting the patient's palmar 
surfaces.  The patient then pushes both palms firmly down onto a sheet of 
paper on a flat surface.  This quickly identifies any areas that do not make 

Cheiroarthropathy occurs mostly in type I diabetics with an increased 
duration of the disease.  Non-diabetics tend to carry an accurance rate of 
14% in the population and diabetics tend to carry an occurance of about 55 
to 76%.

Cheiroarthropathy is also related to other complications..retinopathy, 
nephropathy, neuropathy and most importantly vascular complications.  It may 
occur concurrently with fibrosis of the breasts and restrictive pulmonary 

The cause is greatly unknown but it is thought to be caused by hyperglycemia 
over a long duration.  The impaired joint mobility may be due to changes in 
the vascular structures and neuropathic function in the hands and body which 
cause fibrosis of the connective tissue. Collagen abnormalities cause the 
bowed fingers and reduced extention.  The swelling is caused by the build up 
of sorbitol and other polyols in vascular and neural pathways that cause 
movement of water into cells and thus swelling.

There is no well established treatment for managing this.  Physical therapy 
is important to maintain range of motion.  Glycemic control is essential to 
reduce the effects.  Injection of long-acting corticosteroid into the 
affected flexor tendon has been found to be effective.  Surgical 
intervention with tenolysis also has led to improvement in affected joints 
in the fingers.  Some studies show that use of Sorbinil resulted in dramatic 
improvement in patients with severe stiffness and weakness.  BUT Sorbinil is 
not marketed because of it's toxic effect on the liver.

The best doctor to see is an Orthopedic Surgeon that has knowledge of 
diabetes and changes to bone and tissues.  Usually most Orthopedic surgeons 
that specialize in "hands" have pretty good treatment and management tools.

Chance (Very tired from typing)

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