excerpts from book of dr gourishankar patnaik bearing same title

1. Prof. G.S.Patnaik
MBBS;MS (ortho) FAOI(USA),FACS, PhD
Consultant Orthopedic Surgeon

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