الفهرس | Only 14 pages are availabe for public view |
Abstract Diabetes mellitus (DM) is a chronic metabolic disease of high morbidity and mortality. The prevalence of type 2 DM are increases more than that of type 1 DM because of the increase in obesity and the reduction in physical activities as countries become more industrialized. Most published studies reported that capsulitis and tendonitis in the shoulder are the most common conditions, whereas carpal tunnel syndrome (CTS), Dupuytren’s contracture and trigger finger are the commonest abnormalities of the hand observed in the diabetic patients. Musculoskeletal ultrasound (US) is an imaging tool with a wide set of advantages over other imaging modalities, being safe, easily accessible, relatively cheap, not invasive and lacking of any contraindications. The aim of our study was to evaluate the hand musculoskeletal disorders found in diabetic patients and their correlation with disease duration, severity and control of DM by using the relatively new method (ultrasound). The mean age of diabetic patients in our study was slightly older than control subjects (49.6 years versus 47.4 years). 80% of our participants were females, and also 80% of the cases were housewives, with non significant difference. The majority of our cases and controls were from rural areas (80%). Regarding smoking, only five diabetic cases were smokers (8.3%) versus one of the controls (5%). The majority of our cases and controls were married, all these showed non significant differences. On the other hand, family history of DM was positive in 38% of our cases, compared to only 15% among the control subjects, with Summary and Conclusion 111 significant difference. The disease duration of our study cases varied greatly, from 1-15 years, with a mean of 7 years, which is reflected by the wide standard deviation (3.7 years). Regarding treatment, two thirds of the cases treated by oral drugs (39 cases, 65%) and only 21 cases (35%) treated by insulin. Age at diagnosis of DM ranged from 27-63 years, with a mean of 42.5±7.9 years. The general signs and symptoms did not show significant difference between cases and controls. The only exceptions were Phalen’s test, Tinel’s sign and VAS, which were significantly higher among cases compared to controls. As expected, we found that the mean fasting blood sugar (FBS), random blood sugar (RBS) and HbA1C was significantly higher among DM cases, compared to controls. Also, serum uric acid, was higher among cases, with significant difference. Diabetic cases in our study showed higher synovitis scores by BM mode, both dorsal and palmar sides; more erosions (only from dorsal view), osteophytes (both palmar and dorsal) and more tenosynovitis; all with significant to highly significant differences on the right hand and left hand. Cross sectional area of the median nerve (CSA) and the depth of the carpal tunnel (DCT) were significantly higher among DM cases compared to controls, all of the US scores of the hands were worse among DM cases compared to controls. Conclusion Muscoloskeletal ultrasound is a good and non invasive technique that can be used for early detection of the hands in diabetic patients, which are greatly under-estimated by most clilnicians. |