Association between obesity and the aggravation of limited range of ankle mobility in chronic venous disease

Aim The aim of the present study was to show that an increase in weight leads to the aggravation of limited joint mobility. Method One hundred sixteen patients with varicose veins of the lower limbs and body mass index (BMI) higher than 30 kg/m2 were evaluated at the Belczak Clinic in Maringá, Brazil. All patients were evaluated by the same physician, and the goniometric readings were performed on all patients by a physiotherapist. The participants were then divided into three groups based on BMI: Group I—BMI between 30 and 40. Group II—BMI between 40 and 50, and Group III—BMI > 50. Results There is a significant difference between the groups detected. Conclusion The present findings show that an increased BMI in obese individuals with chronic venous disease is associated with a progressive limitation of ankle mobility.

LIMITED JOINT MOBILITY IN A CHILD WITH TYPE 1 DIABETES MELLITUS.

Chronic uncontrolled type 1 diabetes mellitus (type 1DM) is a very major risk for chronic systemic complications; specifically, the microvascular and macrovascular ones. Limited joint mobility (LJM) is a rare disease that complicates all types of diabetes and might indicate the high-risk odd for the diabetic patients to develop microvascular complications. We are reporting a 13-year-old female child with chronic uncontrolled type 1DM presenting with full blown clinical picture of bilateral hand LJM associated with significant growth failure yet has no clinical or biochemical evidence of microvascular complications. Literature research studies have emphasized the rarity of this manifestation in pediatric type 1 diabetic patients; however, it is an important clue and warning sign for microvascular complication occurrence in these patients.

Skin disorders in patients with diabetes mellitus: a review

Diabetes mellitus (DM) is a frequent metabolic disease whose prevalence is estimated to be around 9.3 % in the world population in the age group 20—79, corresponding to 463 million affected subjects. Moreover, this prevalence will probably increase in the course of the next years. It accounts for more than 90% of the diabetic patients. Besides systemic complications, those ay also be observed in dermatology. According to the region, the prevalence of skin disorders in patients suffering DM is ranging from 35.4 to 98.8 %. This makes these symptoms a frequent cause of consultation in dermatological practice. The most occurring disorders are skin infections, but yellow nails, candidiasis, acrochordons, limited joint mobility and idiopathic guttate hypomelanosis may also be frequently observed. Diabetic dermopathy and diabetic foot syndrome are also common, such as pigmentation disorders such as acanthosis nigricans and vitiligo. Differences between patterns of lesions remain unclear among types of DM (type 1 or type 2). Overall, cutaneous infection and xerosis showed to be highly prevalent and important skin disorders in several studies, regardless DM type. Among cutaneous infections, fungal aetiology appears to be the most common and those with bacterial origin are the less frequent.DM affects the skin through several mechanisms — High levels of glycaemia strongly affect skin homeostasis by impairing the normal functioning of keratinocytes in vitro, decreasing their proliferation and differentiation. They also lead to advanced glycation end products (AGEs) formation. The latter are formed from glycation of proteins, lipids and nucleic acids. They have various deleterious effects at skin levels: inducing reactive oxygen species (ROS) formation, impairing ROS clearance, as well as intra and extracellular proteins function, and inducing pro inflammatory cytokine through nuclear factor κβ (NF-κβ) pathway. AGE alters collagen properties, decreasing flexibility and solubility and increasing its rigidity, thickening dermal collagen, with increased cross linking from non-enzymatic glycosylation, participating in the development of fibrosis. In diabetic patients, the vascular changes found in the skin are similar to those caused by UV-exposure, i. e. thickening of the vessels walls, increasing from thigh to foot and most marked in the capillaries and leading to failure of vascular responsivenessThis paper is aimed to summarize all these pathologies, reporting their prevalence, giving a brief description of the symptoms, of their pathogenesis and guidelines for their management. Dermatologists have a key role in their treatment, but also in detecting new cases of DM when taking in charge these pathologies. They must also promote glycaemic control by these patients.

Heel Rise and Non–Weight-Bearing Ankle Plantar-Flexion Tasks to Assess Foot and Ankle Function in People With Diabetes Mellitus and Peripheral Neuropathy

Objective To examine the effects of diabetes mellitus and peripheral neuropathy (DMPN), limited joint mobility, and weight bearing on foot and ankle sagittal movements; and characterize the foot and ankle position during heel rise. Methods Sixty people with DMPN and 22 controls participated. Primary outcomes were foot (forefoot on hindfoot) and ankle (hindfoot on shank) plantar-flexion/dorsiflexion angle during three tasks: unilateral heel rise, bilateral heel rise, and non–weight-bearing ankle plantar flexion. A repeated measures analysis of variance and Fisher exact test were used. Results Main effects of task and group were significant, but not the interaction in both foot and ankle plantar flexion. Foot and ankle plantar flexion were less in people with DMPN compared to controls in all tasks. Both DMPN and control groups had significantly less foot and ankle plantar flexion with greater weight bearing, however, the linear trend across tasks was similar between groups. The DMPN group had a greater percentage of individuals in foot and/or ankle dorsiflexion at peak unilateral heel rise compared to controls, but the foot and ankle position was similar at peak bilateral heel rise between DMPN and control groups. Conclusions Foot and ankle plantar flexion is less in people with DMPN. Less plantar flexion in non–weight bearing suggests that people with DMPN have limited joint mobility. However, peak unilateral and bilateral heel rise is less than the available plantar-flexion range of motion measured in non–weight bearing indicating that limited joint mobility does not limit heel rise performance. A higher frequency of people with DMPN are in foot and ankle dorsiflexion at peak unilateral heel rise compared to controls, but the position improved with lower weight bearing. Impact Proper resistance should be considered with physical therapist interventions utilizing heel rise because foot and ankle plantar-flexion position could be improved by reducing the amount of weight bearing.

Evaluating the Effect of Conservative Therapy in Patients with Wilkes Stage III Temporomandibular Joint Derangement

The authors evaluated effects of physiotherapy in patients experiencing Wilkes III temporomandibular joint (TMJ) derangement with clinically limited joint mobility, but no pain. The group consisted of 31 patients with unilateral temporomandibular joint involvement, 3 men and 28 women (average age was 30.93, ranging from age 12 to 61). None of the patients in the group had experienced any previous TMJ therapy. The patients underwent conservative therapy in the form of home exercise (mobilisation and isometric exercises) as the first step in treatment. The authors evaluated the improvement in jaw movement (maximal interincisal opening – MIO) and the patients’ subjective assessments of their condition. Disc position before and after two months of exercise was also evaluated using ultrasound examination. The average MIO value in patients before starting the exercises was 33.5 mm, and after two months of exercises, 42.4 mm. Subjective assessment by patients: 26 patients (83%) described their condition as completely satisfactory, not requiring further therapy. Of these patients, ultrasound examination showed 10 patients with complete disc reduction, 9 patients with a change in disc displacement with reduction, and 7 patients with a continuing (unchanged) state of disc displacement. Results of our study show the effect of conservative therapy in patients with painless TMJ due to disc displacement (WIII). Effect of home exercises which were easy to perform, simple and acceptable to the patient were demonstrated.

O que significa “Mão Diabética” e qual o papel da Saúde Ocupacional?

Introduction / background / objective As the workforce ages and rates of metabolic diseases increase, it is likely that more cases of “diabetic hand” manifestations will appear in Occupational Health services. While some health professionals know how to quickly track the “diabetic foot”, the “diabetic hand” is often undervalued, diagnosed in isolation, without recognition or association with the high prevalence of metabolic syndrome, especially in the Western world. These manifestations have an impact on functionality, and inevitably affect work performance, and should be subject to screening, monitoring and intervention by occupational health teams, in order to enhance the function and minimize the negative impacts that they cause both individually and collectively. Thus, the main objective of this work is to elaborate a review on the concept of “diabetic hand” and what is the implication that it can have in the worker’s health and Occupational Health practice. Methodology It is a Scoping Review, initiated through a search in the PUBMED (Medline), EBSCO (Cinahl; Medline; Cochrane; Library Information Science & Technology Abstracts; Nursing Allied Health Collection; MedicLatina) and RCAAP databases, conducted in the months of July and August of 2020, covering all articles (in Portuguese and English languages), with no limit of time, that could explain the concept of diabetic hand. The search words used were: “diabetic hand” ou “cheiroarthropathy”. Results Several conditions have been linked to the concept of diabetic hand, namely cheiroarthropathy (limited joint mobility and stiffness), Dupuytren’s contracture, trigger finger (flexor stenosing tenosynovitis), and carpal tunnel syndrome. Conclusions These manifestations share mechanisms with the classic complications of diabetes, and the recognition that microvascular changes occur concomitantly may provide insights for early screening of metabolic biomarkers. Acknowledging so can contribute to reduce disability (delay hand and fist related manifestations’ progression), and also to reduce future morbidity of workers (minimizing the risks of metabolic diseases), helping to maintain a more capable and productive workforce, where corrective measures and early treatments can be implemented. The diabetic hand may be a concept of interest, then can be further addressed soon, as the complications of metabolic syndrome (and associated comorbidities) increase worldwide.

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

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.

LIMITED JOINT MOBILITY SYNDROME IN DIABETES MELLITUS

Patients with diabetes mellitus (DM) often show changes in the locomotor apparatus (LMA), in particular cheiroarthropathy, a specific lesion of the connective tissue structures of the hand in the presence of persistent hyperglycemia, which leads to limited joint mobility (LJM) generally in the absence of pain syndrome. Some authors use the term «LJM syndrome» to describe LMA lesion in DM, since in the long course of the disease, the small and large joints of not only the upper, but also the lower limbs are involved in the pathological process. LJM is one of the little studied and poorly diagnosed conditions in comparison with traditional micro- and macro-vascular complications of DM, which, due to their direct correlation with life expectancy, receive more attention. The LJM syndrome is associated with other late complications of DM and can significantly impair functional activity, self-care, and quality of life. Damages to periarticular tissue and joints in DM are believed to be caused by the accumulation of glycation end products. A clinical examination plays a key role in the diagnosis of cheiroarthropathy.