Limited joint mobility

Objective.Diabetes is associated with several disorders of the hand, including stenosing flexor tenosynovitis (SFTS). The feature of SFTS in diabetics is a higher prevalence of multiple digit involvement. We examined the magnitude of the tendency for involvement of more digits by SFTS in diabetic patients than in nondiabetic patients, and attempted to clarify the factors influencing multiple digit involvement by SFTS in diabetics.Methods.The study comprised 302 diabetic patients with SFTS and 235 nondiabetic patients with SFTS. The total number of digits exhibiting SFTS within the 1-year period following the initial visit to the Department of Orthopaedic Surgery was investigated in a prospective manner. We compared the difference in the frequency of multiple digit involvement by SFTS between diabetic and nondiabetic patients using the chi-squared test. Multiple regression analysis was performed to examine the contribution of independent variables [defined as 12 factors including age, sex, type of diabetes, estimated duration of diabetes, HbA1c values, carpal tunnel syndrome, Dupuytren contracture, limited joint mobility (LJM), de Quervain's disease, diabetic retinopathy, diabetic nephropathy, and dyslipidemia] to the total number of digits affected by SFTS in diabetic patients.Results.Diabetic patients showed a significantly higher prevalence of multiple digit involvement than nondiabetic patients (p < 0.0001). Multiple regression analysis in diabetic patients revealed that the presence of LJM was positively associated with the prevalence of multiple digit involvement (r = 0.626, p < 0.0001).Conclusion.LJM in diabetics is closely associated with SFTS involving multiple digits.

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Can non-invasive features including limited joint mobility be used to predict glucose control?

BMJ Innovations ◽

10.1136/bmjinnov-2019-000415 ◽

2020 ◽

Vol 7 (1) ◽

pp. 26-32

Author(s):

Sterling Ramroach ◽

Andrew Dhanoo ◽

Brian Cockburn ◽

Ajay Joshi

Keyword(s):

Glycaemic Control ◽

Glucose Control ◽

Glycated Haemoglobin ◽

Diabetes Research ◽

Joint Mobility ◽

Limited Joint Mobility ◽

Non Invasive ◽

Full Dataset ◽

Machine Learning Model

IntroductionLimited joint mobility (LJM) has been linked to deficient glycaemic control but is an understudied area of type 2 diabetes research. We set out to investigate the correlation between glycated haemoglobin (HbA1c) and the quantification of LJM of finger joints and non-invasive anthropometrics.MethodsBlood samples were taken from 170 participants at diabetes awareness drives in Trinidad. These participants were aged 59.61 ± 15.46, with a body mass index (BMI) of 29.73 ± 7.65 and HbA1c levels of 8.42 ± 2.22. There were 110 women and 60 men. Finger joint angles were recorded using a goniometer.ResultsThe K-Nearest Neighbour machine learning model was tested via 10-fold cross validation to differentiate good from poor glycaemic control (HbA1c ≤ 6.5%) using non-invasive features. There is some correlation between LJM and HbA1c. Our model scored a mean accuracy of 74.71% ± 1.81 (p=0.01) classifying the full dataset, 82.14% ± 2.20 (p=0.01) and 72.76% ± 1.41 (p=0.059) on the male/female subsets, respectively.DiscussionThe time since diagnosis, age and BMI were important features linked to glucose control. Our results support the notion that the first signs of LJM in the fingers occur in the first and fifth fingers as these particular angles were ranked highly in the list of most important features.ConclusionOur results show that LJM has some role to play in monitoring HbA1c, although not as important as more conventional anthropometrics. Our results support the idea that there should be a separate test for each sex.

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Healing ulcers and preventing their recurrences in the diabetic foot

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.197238 ◽

2016 ◽

Vol 49 (03) ◽

pp. 302-313 ◽

Cited By ~ 4

Author(s):

S. Raja Sabapathy ◽

Madhu Periasamy

Keyword(s):

Cost Of Care ◽

Joint Mobility ◽

Foot Care ◽

Limited Joint Mobility ◽

Reconstructive Procedures ◽

Risk Class ◽

Class 1 ◽

Life Threatening ◽

The Individual ◽

The Cost

ABSTRACTFifteen percent of people with diabetes develop an ulcer in the course of their lifetime. Eighty-five percent of the major amputations in diabetes mellitus are preceded by an ulcer. Management of ulcers and preventing their recurrence is important for the quality of life of the individual and reducing the cost of care of treatment. The main causative factors of ulceration are neuropathy, vasculopathy and limited joint mobility. Altered bio-mechanics due to the deformities secondary to neuropathy and limited joint mobility leads to focal points of increased pressure, which compromises circulation leading to ulcers. Ulcer management must not only address the healing of ulcers but also should correct the altered bio-mechanics to reduce the focal pressure points and prevent recurrence. An analysis of 700 patients presenting with foot problems to the Diabetic Clinic of Ganga Hospital led to the stratification of these patients into four classes of incremental severity. Class 1 – the foot at risk, Class 2 – superficial ulcers without infection, Class 3 – the crippled foot and Class 4 – the critical foot. Almost 77.5% presented in either Class 3 or 4 with complicated foot ulcers requiring major reconstruction or amputation. Class 1 foot can be managed conservatively with foot care and appropriate foot wear. Class 2 in addition to measures for ulcer healing would need surgery to correct the altered bio-mechanics to prevent the recurrence. The procedures called surgical offloading would depend on the site of the ulcer and would need an in-depth clinical study of the foot. Class 3 would need major reconstructive procedures and Class 4 would need amputation since it may be life-threatening. As clinicians, our main efforts must be focused towards identifying patients in Class 1 and offer advice on foot care and Class 2 where appropriate surgical offloading procedure would help preserve the foot.

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