Limited Joint Mobility in Diabetes Mellitus: The Clinical Implications

Limited joint mobility (LJM) is a common complication of diabetes mellitus (DM). LJM often is characterized by hand stiffness, but other joints may be involved. The prayer and tabletop signs may be used to detect limitation of joint mobility in the hands. Range of motion should be checked in the large joints as well as in the hand and finger joints. LJM should be distinguished from other musculoskeletal conditions that also are seen frequently in the hands of patients with DM. LJM may be associated with the duration of DM. Treatment is controversial. Strict control of blood glucose usually is advocated. Physical therapy may improve function. No medications have been approved for clinical use. (J Musculoskel Med. 2011;28:118-124) Limited joint mobility (LJM), or diabetic cheiroarthropathy, is a condition characterized by hand stiffness resulting from flexion contractures of the fingers and by thickened, tight, waxy skin.1 “LJM” is the newer, preferred term used in describing the condition because joints other than those in the hands (eg, in the wrists and elbows, feet, and spine) also may be involved.2 Lundbaek3 first reported LJM in 5 patients with diabetes mellitus (DM) in 1957, but the syndrome did not receive more attention until 1974, when Rosenbloom and Frias4 described it again in children with DM. The existence of this clinical entity was confirmed by larger studies of children with insulin-dependent (type 1) DM5-7 and, subsequently, was demonstrated in adult and geriatric patients with non–insulin-dependent (type 2) DM.8-12 LJM is a common complication of DM, occurring in 8% to 58% of patients; most studies suggest that the prevalence is about 30% to 40%.1,7,13,14 Although early investigators did not find sex differences, one study reported that adolescents who have DM with LJM are predominantly male.15 No racial differences have been found. The onset of LJM is insidious and may predate the recognition of overt DM (Table 1). Although there is moderate limitation of finger joint mobility, LJM usually is neither painful nor disabling. In making the diagnosis, it is important to differentiate LJM from other DM-related hand conditions. LJM has been linked to poor glycemic control and other complications of DM in retrospective studies, but whether it predates the appearance of renal or ophthalmic disease and whether careful blood glucose control with insulin therapy can reduce the rate of its development has not been conclusively determined. However, quick and easy office assessment for LJM should be a part of the routine assessment of patients with DM, and its presence should alert the physician to the likely presence of microvascular or macrovascular disease or both. In this article, we describe the diagnosis and differential diagnosis of LJM, the physical examination and testing, and the association of LJM with DM and various musculoskeletal conditions. We also discuss the controversies involved in treatment of patients with this condition. Clinical course In patients with LJM, asymptomatic contractures first develop in the distal interphalangeal and