Deteriorating tactile sensation in patients with hand syndromes associated with diabetes: a two year observational study

Aims: To observe the natural history of hand function during a two-year period in participants with hand syndromes associated with diabetes and to determine factors related to changing function. Methods: Hand function was measured over three annual visits using Disability of the Arm, Shoulder and Hand (DASH) and SF-36v2 questionnaires, grip strength, light touch and 9-hole peg tests. Light touch was tested with WEST monofilaments at 7 sites on the hand (score 35 to 0). Data were analyzed using repeated-measures ANOVA, Spearman's correlation, and Wilcoxon signed-rank tests. Results: Participants (n = 60) were aged 61 ± 10.5 years, 57% female, diagnosed with diabetes and at least one of four associated hand disorders. Presentations of carpal tunnel syndrome, or past release (n = 27, 45%) and trigger finger (n = 24, 40%) were common. Tactile sensation was reduced during the two-year period (median, range; 30 months, 25-40 months). Initial median (inter-quartile range) scores for the dominant hand of 25.5 (22-28.5) were reduced to 23 (21.5-27). This sensory loss was weakly associated with HbA1c (r = 0.30, p = 0.05) and occurred predominantly in participants with trigger finger (p = 0.05). Conclusions: Light touch perception was reduced in longstanding diabetic hand syndromes. Tactile abnormalities that were detected by clinical examination progressed during a two year period and were related to metabolic control and musculoskeletal diagnosis.