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Oh My Aching Hands: It May Not Be Neuropathy

by Thomas Rivera Ley

Arthur Segal had Type 2 diabetes for many years. So when he began to have trouble opening medication bottles and turning door knobs, using a knife and counting his change, he assumed it was neuropathy and that nothing could be done.

A senior's hand rests on a walking cane.Most people with diabetes have heard of a condition called diabetic neuropathy. Diabetic neuropathy takes many forms and its effects vary from person to person. Because of this, treatment is often difficult and outcomes vary depending on the nature of the individual case.

However, your pain may not be due to diabetic neuropathy at all. Long-term diabetics with hand pain may actually be suffering from other hand conditions. These two often-overlooked conditions are carpal tunnel syndrome and trigger finger. According to Dr. Keith Segalman, orthopedic hand surgeon with the Curtis Hand Center at Union Memorial Hospital in Baltimore, MD, both of these conditions are more prevalent in diabetics than in the general public.

Surprisingly, these conditions are not caused by poor circulation, nor are they forms of diabetic neuropathy. In long-term diabetics, advanced glycation end-products, or AGEs, can collect on the tendons in the palms of the hand. The accumulation causes the tendons to thicken, thereby causing nerve compression by pressing on the nerve in the carpal tunnel. This leads to numbness and tingling, similar to neuropathy symptoms, especially when the hands are in certain positions.

Many diabetics also find that they have stiffness or restricted movement in one or more fingers. This may be due to trigger finger. Trigger finger results when the thickened tendons can no longer slide easily through the cartilage rings along the fingers. The rubbing causes the tendon to swell even further to the point where the tendon can no longer slide through the ring.

You may notice that one or more of your fingers will not close all the way when you attempt to make a fist or hold an object. If you are able to force your finger to close, the tendon is forced through the ring but then cannot slide back. Your finger gets stuck in the closed position; thus the term trigger finger. This can be quite painful and cause a dramatic decrease in the usability of the hand and fingers.

The good news is that both of these conditions can usually be treated very successfully. For carpal tunnel syndrome, laparoscopic surgery can be used to open the tunnel relieving the pressure on the nerve. Trigger finger can be treated with local injections of cortisone into the joint, and if this is not successful, minor surgery can be performed to loosen the ring of cartilage to allow the tendon to pass freely once again.

The important lesson is that not all problems with the diabetic hand are caused by diabetic neuropathy, and in the case of carpal tunnel and trigger finger, treatments are usually quite successful. Your hands are an invaluable tool for managing your diabetes, especially if you have visual complications. So seek the advice of a hand specialist as soon as symptoms appear.