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Diabetic Cheiroarthropathy — SCE Rheumatology MCQ

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ModerateSoft Tissue RheumatologyDiabetic CheiroarthropathySCE Rheumatology

A 55-year-old man with an 18-year history of type 2 diabetes reports gradually progressive, painless stiffness of both hands. He cannot completely oppose the palmar surfaces of his fingers when he presses his hands together, and he cannot place his palms and fingers flat on a tabletop. Examination shows bilateral limitation of finger extension with smooth, waxy thickening of the skin over the hands. There are no palpable palmar nodules or cords, and he has no Raynaud phenomenon. What is the most likely diagnosis?

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Correct answer: B — Diabetic cheiroarthropathy

Diabetic cheiroarthropathy, or limited joint mobility syndrome, causes painless, usually bilateral restriction of finger extension with smooth, waxy skin thickening. The inability to oppose the palmar surfaces fully is the prayer sign; inability to place the palm and fingers flat is the tabletop sign. Longstanding diabetes strongly supports the diagnosis. Dupuytren contracture instead produces discrete palmar nodules and cords, often with asymmetric contracture. Systemic sclerosis may cause sclerodactyly but would usually have additional features such as Raynaud phenomenon, digital vascular disease or other systemic manifestations. Eosinophilic fasciitis typically causes painful limb swelling followed by fascial induration and groove signs, rather than isolated classic hand signs. Complex regional pain syndrome is usually painful and accompanied by sensory, autonomic or trophic abnormalities.

Reference: Yoganathan K, Stevenson A, Martineau M. Prayer sign due to diabetic cheiroarthropathy. BMJ 2017;359:j4878. https://www.bmj.com/content/359/bmj.j4878