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| CLINICAL IMAGE |
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| Year : 2022 | Volume
: 19
| Issue : 2 | Page : 120-121 |
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Retracting fingers?: A sign of uncontrolled blood sugars!
Jaspreet Kaur, Daljinderjit Kaur, Amtoj Singh Lamba
Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| Date of Submission | 05-Dec-2021 |
| Date of Decision | 27-Jan-2022 |
| Date of Acceptance | 01-Feb-2022 |
| Date of Web Publication | 24-Mar-2022 |
Correspondence Address:
Jaspreet Kaur
Department of General Medicine, Government Medical College and Hospital, Sector 32, Chandigarh - 160 030
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/am.am_141_21
How to cite this article:
Kaur J, Kaur D, Lamba AS. Retracting fingers?: A sign of uncontrolled blood sugars!. Apollo Med 2022;19:120-1 |
Dupuytren disease (DD) a benign, myeloproliferative fibrosing disorder causes progressive thickening and shortening of palmar fascia, leading to debilitating digital contractures.[1] Diabetes mellitus, particularly uncontrolled long-standing, has been identified as a risk factor along with smoking, thyroid disorders, and liver diseases.
Forty-eight-year-old gentleman presented to hospital with Type 2 diabetes mellitus from the past 12 years. He came with the complaints of flexion deformity of left hand since past 1 year which has been progressively increasing over time leading to significant limitation of his daily routine activities. There is no history of hand trauma, smoking, significant alcohol consumption, use of antiepileptics, thyroid disorder, or any liver disease.
Physical examination revealed no peripheral stigmata of chronic liver disease. Hand examination showed flexion contracture deformity at metacarpophalangeal joint of left ring finger with thickening of the skin of his hands [Figure 1] and [Figure 2] along with restricted movements. The right hand showed no obvious deformity but thickening of palmar aponeurosis was felt [Figure 3]. The respiratory, gastrointestinal, genitourinary systems were unremarkable. On investigations, HbA1c was 13.2% with random blood sugar of 464mg/dl. His liver and renal function tests and lipid profile were unremarkable. Abdominal ultrasonography and chest roentgenogram were normal. Hepatitis B, C, HIV, and Venereal Disease Research Laboratory (VDRL) serologies were negative. He was managed for his uncontrolled blood glucose levels and was referred to plastic surgeon. | Figure 1: Left hand of the patient showing Dupuytren contracture of the ring finger and skin thickening
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| Figure 2: Showing both the hands of the patient with Dupuytren contracture in left hand
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DD, a late complication in Type 2 diabetes mellitus, has prevalence between 1.6% and 32%.[2] Dysregulation of metallopeptidases along with breakdown of constituents of extracellular matrix has been implicated in its etiology.[3] Physical examination including Hueston tabletop test is the mainstay in diagnosing. Conservative management including optimizing the blood sugars, collagenase injection, needle aponeurotomy, along with surgical resection (flexion deformity ≥15°),[4] and fasciectomy can help improve patients life.[5] Detailed bilateral hand examination in diabetics can help in early recognition and treatment of this entity.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Soreide E, Murad MH, Denbeigh JM, Lewallen EA, Dudakovic A, Nordsletten L, et al. Treatment of Dupuytren's contracture: A systematic review. Bone Joint J 2018;100-B: 1138-45.  |
| 2. | Yi IS, Johnson G, Moneim MS. Etiology of Dupuytren's disease. Hand Clin 1999;15:43-51, vi. |
| 3. | Derosa G, D'Angelo A, Tinelli C, Devangelio E, Consoli A, Miccoli R, et al. Evaluation of metalloproteinase 2 and 9 levels and their inhibitors in diabetic and healthy subjects. Diabetes Metab 2007;33:129-34. |
| 4. | Rayan GM. Dupuytren disease: Anatomy, pathology, presentation, and treatment. J Bone Joint Surg Am 2007;89:189-98. |
| 5. | Hovius SE, Zhou C. Advances in minimally invasive treatment of Dupuytren disease. Hand Clin 2018;34:417-26. |
[Figure 1], [Figure 2], [Figure 3]
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