Prof. G.S.Patnaik  MS { ortho }  FAOI { USA } ,FACS Consultant Orthopedic Surgeon
 
<ul><li>Multi-system disease </li></ul><ul><li>Persistent Hyperglycemia </li></ul><ul><li>Acute and chronic biochemical an...
<ul><li>Variety of alterations in Locomotor system </li></ul><ul><li>Neuroarthropathy </li></ul><ul><li>Hyperostosis </li>...
<ul><li>Carpal tunnel syndrome </li></ul><ul><li>Diabetic stiff hands syndrome </li></ul><ul><li>Neuropathic joints  </li>...
<ul><li>1/3 rd  of diabetic patient </li></ul><ul><li>Prevalence increases with duration of disease </li></ul><ul><li>Diab...
<ul><li>EMG/nerve conduction studies can confirm the diagnosis </li></ul><ul><li>Conservative treatments include medicatio...
<ul><li>20% of diabetic cases </li></ul><ul><li>Stiffened  glenohumeral joint caused by thickening and contraction of join...
<ul><li>Therapy is largely conservative </li></ul><ul><li>Mobilization of shoulder joint </li></ul><ul><li>Physical therap...
 
<ul><li>Flexor Tenosynovitis (trigger finger) frequent complication of diabetic hand </li></ul><ul><li>Catching or locking...
<ul><li>Primary treatment include rest, ice, compression, elevation (RICE) </li></ul><ul><li>Local Hydro corticosteroids I...
<ul><li>Affects palmer fascia </li></ul><ul><li>Causes flexion contractures of fingers </li></ul><ul><li>Usually the 4 th ...
<ul><li>Charcot’s or neuropathic arthropathy is a condition involving destructive ,lytic  joint changes </li></ul><ul><li>...
<ul><li>Treatment </li></ul><ul><li>Challenging treatment </li></ul><ul><li>Good Glycemic control </li></ul><ul><li>Splint...
<ul><li>D.M. associated with variety of musculo -skeletal disorders </li></ul><ul><li>Most commonly seen in Type 1 but Typ...
 
 
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Musculoskeletal manifestations of diabetes mellitus

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This was a presentation done at Kanungo Institute of diabetic Specialitis Bhubaneswar . the audience included the students from Karolinkska Institute Sweden

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Musculoskeletal manifestations of diabetes mellitus

  1. 1. Prof. G.S.Patnaik MS { ortho } FAOI { USA } ,FACS Consultant Orthopedic Surgeon
  2. 3. <ul><li>Multi-system disease </li></ul><ul><li>Persistent Hyperglycemia </li></ul><ul><li>Acute and chronic biochemical and anatomical sequel </li></ul><ul><li>Can affect the connective tissue in a variety of ways </li></ul>
  3. 4. <ul><li>Variety of alterations in Locomotor system </li></ul><ul><li>Neuroarthropathy </li></ul><ul><li>Hyperostosis </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Cheiroarthropathy </li></ul><ul><li>Limited joint mobility </li></ul><ul><li>Muscular infarctions </li></ul>
  4. 5. <ul><li>Carpal tunnel syndrome </li></ul><ul><li>Diabetic stiff hands syndrome </li></ul><ul><li>Neuropathic joints </li></ul><ul><li>Calcific tendinitis </li></ul><ul><li>Complex Regional pain syndrome </li></ul><ul><li>Diabetic Muscle Infarctions </li></ul>
  5. 6. <ul><li>1/3 rd of diabetic patient </li></ul><ul><li>Prevalence increases with duration of disease </li></ul><ul><li>Diabetes induced connective tissue changes, including sclerosis and collagen degradation. </li></ul><ul><li>Diagnosis based on history and clinical findings </li></ul><ul><li>Burning ,Paraesthesia or sensory loss in median nerve distribution </li></ul>
  6. 7. <ul><li>EMG/nerve conduction studies can confirm the diagnosis </li></ul><ul><li>Conservative treatments include medications, splints, change of working environment </li></ul><ul><li>Local Corticosteroid injection </li></ul><ul><li>If no significant relief then surgery is an option </li></ul><ul><li>Safe surgery </li></ul>
  7. 8. <ul><li>20% of diabetic cases </li></ul><ul><li>Stiffened glenohumeral joint caused by thickening and contraction of joint capsule </li></ul><ul><li>Shoulder stiffness, decreased range of movement and pain </li></ul><ul><li>Abduction and external rotation worst affected </li></ul><ul><li>Internal rotation is affected least </li></ul>
  8. 9. <ul><li>Therapy is largely conservative </li></ul><ul><li>Mobilization of shoulder joint </li></ul><ul><li>Physical therapy </li></ul><ul><li>Gentle stretching and range of motion exercises </li></ul><ul><li>Analgesics </li></ul><ul><li>Intra-articular injection </li></ul>
  9. 11. <ul><li>Flexor Tenosynovitis (trigger finger) frequent complication of diabetic hand </li></ul><ul><li>Catching or locking episodes </li></ul><ul><li>Palpable nodule and thickening along the affected flexor tendon sheath overlying palmer aspect of MP joint </li></ul>
  10. 12. <ul><li>Primary treatment include rest, ice, compression, elevation (RICE) </li></ul><ul><li>Local Hydro corticosteroids Injection </li></ul><ul><li>Surgery in chronic conditions resistant to medical conditions. </li></ul>
  11. 13. <ul><li>Affects palmer fascia </li></ul><ul><li>Causes flexion contractures of fingers </li></ul><ul><li>Usually the 4 th finger </li></ul><ul><li>1/3 rd of diabetic patients </li></ul><ul><li>Local H.C. injections </li></ul><ul><li>Surgical intervention in severe cases </li></ul>
  12. 14. <ul><li>Charcot’s or neuropathic arthropathy is a condition involving destructive ,lytic joint changes </li></ul><ul><li>Severe destructive form of degenerative arthritis </li></ul><ul><li>Most commonly affects pedal bones </li></ul><ul><li>Classical radiographical findings </li></ul><ul><li>CT and MRI scans </li></ul>
  13. 15. <ul><li>Treatment </li></ul><ul><li>Challenging treatment </li></ul><ul><li>Good Glycemic control </li></ul><ul><li>Splinting and bracing to protect foot from weight bearing </li></ul><ul><li>Debridement </li></ul><ul><li>Amputation </li></ul>
  14. 16. <ul><li>D.M. associated with variety of musculo -skeletal disorders </li></ul><ul><li>Most commonly seen in Type 1 but Type 2 are not immune </li></ul><ul><li>Clinicians should be aware to intervene and provide best care for affected patients </li></ul><ul><li>Ask patients for symptoms rather than wait for him to speak. </li></ul>

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