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RE: [IP] What is Cheiroapathy...The Answer

I'm glad someone wrote to say this cheiroapathy isn't only affecting the
hands and fingers.

I seem to have had this problem for years on end.  Yes, I had carpel tunnel
in both hands when I was 25, had surgery as I was in stage 4 and it returned
9 yrs later. I have not gone back for surgery.

I have had eight fingers operated on for trigger finger.  Praying that the
other two hold up for a long, long time.

My problem is consistent pain, stiffness, etc. etc. in different parts of
the body at different times.  They come and they go and I don't do anything
other than take advil if the pain becomes so unbearable that I can't take
it.  Other than that, I will limp or bear the pain until it goes away.

My hubby always asks me "what's the matter with this or that?"  and I just
tell him, "oh, this or that gave way...and it will go the same way it

I have seen several orthopedist and have had sedrate (sp?) tests taken which
only show slight arthritis, nothing major.  No one can figure out why I have
all these problems...

Glad to know it isn't all in my head and there is a relation between the
diabetes and these problems (which I always thought was so anyway)

Kathy B.

-----Original Message-----
From: email @ redacted
[mailto:email @ redacted]On Behalf Of Dr. Chance
Sent: Wednesday, February 05, 2003 1:27 PM
To: email @ redacted
Subject: [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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