Bahamian Diabetic Patients may be suffering from Treatable Hand and Shoulder Related

Diabetes is a systemic disease with wide ranging manifestations due to defects in insulin production or organ receptor sensitivity to this critical hormone. It has profound effects on the cells comprising the circulatory, nervous and connective tissue systems. This widespread involvement of systems is expressed in the hand and diabetes patients often have symptoms that are due to these problems but go unrecognized. Numbness or tingling in the fingers is often ignored until it becomes persistent or painful. This if often interpreted as neuropathy which occurs commonly in the foot. In the hand, this tingling, or “paresthesias”, is more often due to a nerve compression in the upper extremity. Most commonly, carpal tunnel syndrome is present, which is a median nerve compression at the wrist level. It is actually due more to inflammation of the surrounding flexor tendons, rather than direct pathology of the nerve itself. Patients typically complain of numbness or tingling in the thumb or central fingers which is often worse at night and can cause difficulty sleeping. Chronic and severe compression of the nerve leads to weakness of the thumb with subsequent difficulty in many daily tasks. The cause of carpal tunnel syndrome is really a thickening and inflammation of the tendons that pass in the tunnel along with the delicate nerve. This same tendonitis deep in the wrist causes mechanical problems and pain farther along in the palm. Inflammation of these flexor tendons as they travel to the finger leads to pain in the palm of the hand with occasional “triggering” or catching of the tendon in the tunnel as the patient attempts to extend the finger after flexing. The treatment of tendonitis is quite simple, involving either reducing the tendon inflammation or opening the tunnel through which it passes. A corticosteroid injection along the tendon sheath is very effective, unless the patient experiences locking where the mechanical problem is more profound and requires a mechanical solution. A trigger finger release is done by a small incision in the palm and opening the tight sheath containing the tendon allowing it to glide once again. In isolated cases of trigger finger, we can even do this percutaneously, without making an incision. This is also done under local anesthesia, and the dressing is removed the very next morning by the patient themselves. Similar releases are done at the wrist level for DeQuervain’s tendonitis. There is a common misconception that cortisone injections are harmful to patients, particularly diabetics. This is not the case when the injections are limited to several low dose injections spanned out over time and in different locations. This treatment is also used in other locations such as lateral epicondylitis (tennis elbow) or bursitis of the shoulder, where an arthroscopic excision of bursa can be done to alleviate and usually cure the problem. It is important that the patient as well as the primary physician have a good understanding of these conditions and to involve the hand surgeon at an early stage.   ALEJANDRO Badia dORAL, MIAMI fLORIDA