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 Table of Contents  
REVIEW ARTICLE
Year : 2012  |  Volume : 4  |  Issue : 3  |  Page : 117-119

Trigger digits and diabetes mellitus


Wiwanitkit House, Bangkhae, Bangkok, Thailand

Date of Web Publication16-Mar-2012

Correspondence Address:
Somsri Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok, Thailand 10160
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.93879

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  Abstract 

The problem of finger in the patient with diabetes mellitus is important consideration in diabetology. Generally, peripheral neuropathy that manifests with finger paresthesia is common. However, some recent reports mention the concern on trigger digits in diabetic patients. In this brief article, the authors focus review and discussion on this specific topic. The searching of standard database, PubMed, on available publication on this area selecting by keywords trigger digits and diabetes mellitus was done and all derived papers were extracted and further synthesized in this review article. Epidemiology and management of the condition are the mainly focused reviewed areas and presented in this article.

Keywords: Diabetes mellitus, Problem, Trigger digits


How to cite this article:
Wiwanitkit S, Wiwanitkit V. Trigger digits and diabetes mellitus. North Am J Med Sci 2012;4:117-9

How to cite this URL:
Wiwanitkit S, Wiwanitkit V. Trigger digits and diabetes mellitus. North Am J Med Sci [serial online] 2012 [cited 2019 Nov 22];4:117-9. Available from: http://www.najms.org/text.asp?2012/4/3/117/93879


  Introduction Top


The problem of finger in the patient with diabetes mellitus is important consideration in diabetology. Generally, peripheral neuropathy that manifests with finger paresthesia, numbness, and blanching is common. [1] The symptoms are usually bilateral. [1] Nerve conduction studies, vibration and temperature threshold measurements, and neurovascular function tests are useful for assessment of these cases. [2] However, some recent reports mention the concern on trigger digits in diabetic patients. In this brief article, the authors focus review and discussion on this specific topic.


  Epidemiology of Trigger Digits in Diabetic Patients Top


Indeed, trigger digits can be seen in any population. However, some recent publications report on the importance of this disease in diabetes mellitus. Koh et al. studied on the incidence of this condition and found that "the incidence of trigger digits was about four times higher than in the general population." [3] However, this publication is a questionnaire study without confirmation for actual pathology. Another interesting report is from India by Sarkar et al. [4] In this work, the trigger digits can be seen in 1:20 (cases with trigger digits: All diabetic patients). [4] However, some other reports such as that by Aydeniz et al. [5] show no significant increase in the incidence of this condition in diabetic patients.

It is concluded that the trigger digits are an important problem for the diabetic patients. [6] Koh et al. suggested that "Screening for diabetes may be warranted in patients with involvement of more than three digits." [6] The summary of the important publications reporting on the prevalence of the problem can be seen in [Table 1] . [7],[8],[9],[10],[11] Although there is a difference in the rate of reported prevalence and whether the prevalence among diabetic patients is higher than that of normal population or not is still questionable, it cannot be refused for the important of the problem on trigger digits among diabetic patients.
Table 1: Summary on some important publications reporting the prevalence of trigger digits among diabetic patients

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However, there is no clear evidence that diabetes mellitus increases the risk for development of trigger digits. The study shows only a possible relationship. [12] Although it is not questionable that overall musculoskeletal problems increases in diabetic patients, there is no conclusion on the specific trigger digits problem. [5]

Focusing on the existed evidences, trigger digits are common in old diabetic patients but not relating to sex, age, and type of diabetes. [7],[8],[9],[10],[11],[13] It is of interest that there is an observation that limited joint mobility is related to multiple digits involvement in diabetic patients with trigger digits, but there is no relationship with age, sex, type of diabetes. [14]


  Management of the Trigger Digits in Diabetic Patients Top


Although the trigger digits can be seen and similarly diagnosed in both normal and diabetic patients, natural history of the condition in diabetic patients and the outcome of treatment may not be the same. [9] There is an association between trigger digits and diabetes control. [15] Hence, the first thing to do is the good control of blood glucose. It is reported that the insulin-dependant cases usually have more sever symptoms and multiple digits involvement and require surgical release for relief of symptoms. [16]

Focusing on treatment, physiotherapy is generally used. The steroid injection might be used although it does not provide a good success rate (about 30%). [17],[18],[19]

In addition to use of steroid injection, the use of nonsteroidal anti-inflammatory drugs can provide a little relief from the symptoms. [17],[18],[19] The use of steroid injection (either methylprednisolone acetate or triamcinolone acetonide) is proved to be safe; [20] however, there is also a report showing that the use of steroid injection can result in hyperglycemia. [21] In addition, the recurrent rate is very high in the diabetes type 1 cases. [22],[23] Focusing in detail, the recurrence is earlier seen in the case with methylprednisolone acetate injection. [20] For the surgical treatment, it is used in the severe cases. [17],[24],[25],[26] The recommended surgical technique is "surgical release of the first annular (A1) pulley." [23] The surgery might be a definitive treatment (success rate up to 99%) but the complications can be seen and the postsurgical physiotherapy is still required for a long time. [17],[23] Of interest, a recent report indicated that diabetes was not a risk factor for trigger digits and postoperative complications of trigger digits surgery. [27] However, closed observation and special care are still recommended for the cases with diabetes mellitus due to the risk for existence of microangiopathy. [27],[28]


  Conclusion Top


Trigger digits is an important problem in diabetic patients, especially for the old ones. However, the cause-result relationship between diabetes mellitus and trigger digits is still the topic for further study. In management, glucose control is important and the standard managements for the general population can be effectively used for the diabetic cases.

 
  References Top

1.Bracker MD, Ralph LP. The numb arm and hand. Am Fam Physician 1995;51:103-16.  Back to cited text no. 1
    
2.Westerman RA, Lindblad LE, Wajnblum D, Roberts RG, Delaney CA. Confounding factors in non-invasive tests of neurovascular function in diabetes mellitus. Clin Exp Neurol 1992;29:149-60.  Back to cited text no. 2
    
3.Koh S, Nakamura S, Hattori T, Hirata H. Trigger digits in diabetes: Their incidence and characteristics. J Hand Surg Eur Vol. 2010;35:302-5.  Back to cited text no. 3
    
4.Sarkar P, Pain S, Sarkar RN, Ghosal R, Mandal SK, Banerjee R. Rheumatological manifestations in diabetes mellitus. J Indian Med Assoc 2008;106:593-4.  Back to cited text no. 4
    
5.Aydeniz A, Gursoy S, Guney E. Which musculoskeletal complications are most frequently seen in type 2 diabetes mellitus? J Int Med Res 2008;36:505-11.  Back to cited text no. 5
    
6.Papanas N, Maltezos E. The diabetic hand: A forgotten complication? J Diabetes Complications 2010;24:154-62.  Back to cited text no. 6
    
7.Ravindran RS, Bhansali A, Walia R, Dutta P, Bansal V, Shanmugasundar G. Prevalence and pattern of hand soft-tissue changes in type 2 diabetes mellitus. Diabetes Metab 2011;37:312-7.  Back to cited text no. 7
    
8.Ray S, Datta AK, Sinhamahapatra P, Ray I, Mukhopadhyay P, Dasgupta S. Prevalence of rheumatic conditions in patients with diabetes mellitus in a tertiary care hospital. J Indian Med Assoc 2011;109:74-8.  Back to cited text no. 8
    
9.Melamed E, Goldstein S, Angel D. Hand disorders in diabetic patients. Harefuah 2010;149:382-406.  Back to cited text no. 9
    
10.Sarkar P, Pain S, Sarkar RN, Ghosal R, Mandal SK, Banerjee R. Rheumatological manifestations in diabetes mellitus. J Indian Med Assoc 2008;106:593-4.  Back to cited text no. 10
    
11.Yosipovitch G, Yosipovitch Z, Karp M, Mukamel M. Trigger finger in young patients with insulin dependent diabetes. J Rheumatol 1990;17:951-2.  Back to cited text no. 11
    
12.De la Parra-Márquez ML, Tamez-Cavazos R, Zertuche-Cedillo L, Martínez-Pérez JJ, Velasco-Rodríguez V, Cisneros-Pérez V. Risk factors associated with trigger finger. Case-control study. Cir Cir 2008;76:323-7.  Back to cited text no. 12
    
13.Poirier JL, Hérisson C, Guillot B, Marcelli C, Barnéon G, Momas I, et al. Diabetic cheiroarthropathy. Rev Rhum Mal Osteoartic 1989;56:511-7.  Back to cited text no. 13
    
14.Kameyama M, Meguro S, Funae O, Atsumi Y, Ikegami H. The presence of limited joint mobility is significantly associated with multiple digit involvement by stenosing flexor tenosynovitis in diabetics. J Rheumatol 2009;36:1686-90.  Back to cited text no. 14
    
15.Yosipovitch G, Mukamel M, Karp M. Diabetic hand syndrome in juvenile diabetics. Harefuah 1990;119:63-6.  Back to cited text no. 15
    
16.Griggs SM, Weiss AP, Lane LB, Schwenker C, Akelman E, Sachar K. Treatment of trigger finger in patients with diabetes mellitus. J Hand Surg Am 1995;20:787-9.  Back to cited text no. 16
    
17.Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. J Diabetes Complications 1997;11:287-90.  Back to cited text no. 17
    
18.Baumgarten KM, Gerlach D, Boyer MI. Corticosteroid injection in diabetic patients with trigger finger. A prospective, randomized, controlled double-blinded study. J Bone Joint Surg Am 2007;89:2604-11.  Back to cited text no. 18
    
19.Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the wrist and hand region. Am Fam Physician 2003;67:745-50.  Back to cited text no. 19
    
20.Sibbitt WL Jr, Eaton RP. Corticosteroid responsive tenosynovitis is a common pathway for limited joint mobility in the diabetic hand. J Rheumatol 1997;24:931-6.  Back to cited text no. 20
    
21.Wang AA, Hutchinson DT. The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients. J Hand Surg Am 2006;31:979-81.  Back to cited text no. 21
    
22.Rozental TD, Zurakowski D, Blazar PE. Trigger finger: Prognostic indicators of recurrence following corticosteroid injection. J Bone Joint Surg Am 2008;90:1665-72.  Back to cited text no. 22
    
23.Nimigan AS, Ross DC, Gan BS. Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil 2006;85:36-43.  Back to cited text no. 23
    
24.Blyth MJ, Ross DJ. Diabetes and trigger finger. J Hand Surg Br 1996;21:244-5.  Back to cited text no. 24
    
25.Saldana MJ. Trigger digits: Diagnosis and treatment. J Am Acad Orthop Surg 2001;9:246-52.  Back to cited text no. 25
    
26.Lekholm C, Sundkvist G, Lundborg G, Dahlin L. The diabetic hand-Complications of diabetes. Lakartidningen 2001;98:306-12.  Back to cited text no. 26
    
27.Cakmak F, Wolf MB, Bruckner T, Hahn P, Unglaub F. Follow-up investigation of open trigger digit release. Arch Orthop Trauma Surg 2011. [In press]  Back to cited text no. 27
    
28.Chammas M, Bousquet P, Renard E, Poirier JL, Jaffiol C, Allieu Y. Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am 1995;20:109-14.  Back to cited text no. 28
    



 
 
    Tables

  [Table 1]


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