Diabetes mellitus

Numerous musculoskeletal conditions may be associated with diabetes mellitus, among them gout, calcium pyrophosphate dihydrate crystal deposition disease, soft tissue and muscle syndromes, osteomyelitis, septic arthritis and neuropathic osteoarthropathy.

Periarthritis involving the shoulder may be associated with normal radiographs, or calcific bursitis or tendinitis may be apparent. Glenohumeral joint periarthritis can be accompanied by the shoulder hand syndrome.

A syndrome of diabetic cheiroarthropathy (reflex sympathetic dystrophy) is seen in many patients with insulin-dependent juvenile diabetes. In this condition, skin abnormalities resembling those of scleroderma, joint contractures of the fingers, and short stature are typical, but there is no evidence of palmar fascial thickening.

Dupuytrens contracture has been recognized in patients with diabetes; it is characterized by insidious development of nodular or plaque-like thickening of the palmar fascia and extension of the fibrous process to the metacarpophalangeal and proximal interphalangeal joints, leading to finger contracture.

Another abnormality of the fingers in diabetes mellitus is flexor tenosynovitis (trigger finger, stenosing tenovaginitis), in which one or more fingers are affected by snapping, pain, locking, and limitation of motion of the interphalangeal joint due to obstruction of the flexor tendon in a constricted tendon sheath.

Carpal tunnel syndrome, or entrapment of the median nerve within the carpal tunnel on the volar aspect of the wrist, has been reported in patients with diabetes mellitus.

Soft tissue ulceration and infection, which are frequent in diabetes, may lead to contamination of contiguous bones and joints, causing osteomyelitis or septic arthritis. The foot is involved especially frequently. Initially radiographic abnormalities are seen as defects in soft tissue contour, loss of tissue planes and swelling. Extension of the infection into the bone can result in spontaneous fracture, subluxation and dislocation, often combined with neuropathic osteoarthropathy; destructive or resorptive abnormalities can lead to abnormalities resembling a Lisfrancs fracture dislocation.

Osteolysis of the forefoot and osteopenia also have been described in patients with diabetes mellitus.

Arterial calcifications commonly are observed on radiographs from patients with diabetes mellitus, and calcification in the interdigital arteries of the feet can aid in the diagnosis of clinically unsuspected diabetes.

DR