A quantitative assessment of limited joint mobility in patients with diabetes

Abstract

Objective. The syndrome of limited joint mobility is a common but not widely recognized musculoskeletal complication of diabetes. The purpose of this study was to further characterize this syndrome using quantitative goniometric measures.Methods. Cross-sectional analysis of a sample population was performed to establish the prevalence, location, and severity of limited joint mobility and to determine its relationship to extraarticular manifestations and complications of diabetes. Passive range of motion of both upper extremities was measured by goniometry in 70 adult patients with insulin-dependent diabetes mellitus and 70 nondiabetic controls who were group-matched for age, sex, and general activity level. Joint mobility was assessed by both individual joint motions and a composite scoring technique. Results. Analysis of individual joints and composite scores revealed significant differences between dominant and nondominant extremities in both the control and the diabetic groups. Diabetic patients were generally less flexible than nondiabetic subjects throughout the arm, especially in shoulder and finger joints. In the full study population, multivariate analysis revealed that advanced age, male sex, and the presence of diabetes were associated with decreased passive range of motion for a majority of joints (P < 0.05). In the diabetes group, passive range of motion was significantly correlated (P < 0.05) with age, sex, duration of diabetes, and to a variable extent, glucose control, but was not correlated with the presence of clinically significant neuropathy, retinopathy, nephropathy, or peripheral vascular disease, with activity level, or with hand dominance. Stepwise regression analysis failed to identify single key joint motion(s) to serve as possible screening tests in predicting generalized limited joint mobility of the upper extremity. Finally, the effect of limb usage on range of motion in flexion may differ in diabetic and nondiabetic subjects.Conclusion. Limited joint mobility is a generalized phenomenon occurring throughout the upper extremities of many diabetic patients. It is significantly related to age, sex, and to a variable extent duration of diabetes and glucose control. It is not related to the standard complications of diabetes as defined in this study.

The Prevalence of Cutaneous Manifestations in IDDM Patients and Their Association With Diabetes Risk Factors and Microvascular Complications

“…There is controversy regarding the relation of LJM to the development of microvascular complications such as retinopathy and nephropathy (5,15,16). Our finding is in agreement with an extensive study on LJM that did not find any relationship to microvascular complications (17). Scleroderma-like skin changes were related to disease duration but not to parameters of diabetes control, similar to the findings of Seibold (6).…”

Limited Joint Mobility in Type 1 Diabetic Patients

“…*P Ͻ 0.001 vs. subjects without LJM; †P Ͻ 0.05. CONCLUSIONS -Associations between LJM and microvascular complications have been confirmed since the first description presented in diabetic children (4,5) and adult type 1 diabetic patients in several cross-sectional studies (1,7,21), but it remains unclear whether LJM only accompanies other diabetic complications or can also predict them (8,9) (perhaps only under certain conditions). In many studies, the severity of LJM was classified according to the method of Rosenbloom et al (4).…”

“…In many studies, the severity of LJM was classified according to the method of Rosenbloom et al (4). These classifications were ideal for comparing the extent of LJM among different groups (21) and also within the same individual during the course of a study. Because we were primarily interested in the differences between subjects with and without LJM, we restricted our assessment of LJM to the qualitative test of the prayer maneuver (completed by passive finger extension), which discriminates between the presence and absence of LJM with excellent reproducibility and can be easily done without time-consuming examinations in a clinical setting (7,10).…”

Passive Ankle Stiffness in Subjects With Diabetes and Peripheral Neuropathy Versus an Age-Matched Comparison Group

“…Several authors 24,36,37 have described limited joint mobility in patients with diabetes and attributed this syndrome to changes in the ultrastructure of collagen in various periarticular tissues.…”