Carpal Tunnel Syndrome and Hand Neuropathy in Diabetes

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Carpal Tunnel Syndrome and Hand Neuropathy in Diabetes

Dear CDE,

I am 43 years old, with T1 diabetes for 23 years. Lately I have noticed burning, tingling, and numbness sensations in my R wrist and hand with increasing tightness and stiffness in my fingers. My doctor says he thinks I may have carpal tunnel syndrome. Is this because of diabetes? - Laurie

Hi Laurie –

What you are describing may well be signs and symptoms of a nerve entrapment disorder, such as carpal tunnel syndrome, but it could also be caused by peripheral neuropathy, osteoarthritis, adhesive capsulitis of the joints, or a combination of any of these conditions together. Peripheral neuropathy in the hands and fingers is a very common diabetes-related condition that does not receive as much attention as neuropathy in the feet and toes. However, it is not uncommon for women with diabetes to develop neuropathy, osteoarthritis, and muscle weakness in their fingers and hands. Neuropathy in the hands is gaining more acknowledgment in the diabetes clinical community.

Neuro-osteo-arthropathy (nerve-bone-joint) damage can occur in those with diabetes of 15 to 20 or more years. Some of the changes to the joints and tendons in the fingers, hands, elbows, and shoulders result from wear and tear of daily use and living with the blood glucose swings of advanced duration T1 diabetes. The glycation process (presence of excess glucose end-products in the body) of diabetes can lead to a condition called adhesive capsulitis where accumulated glucose end-products can cause contracted fingers (Dupuytren’s contractures), trigger fingers, frozen shoulder, and diabetes stiff hand syndrome. Another condition that can affect the hands is chiro-neuro-myopathy (hand-nerve-muscle) syndrome, which is nerve damage and muscle wasting in the hand, which can result from untreated carpal tunnel syndrome, or carpal tunnel syndrome that was unsuccessfully treated, or nerve and muscle changes in the hand unrelated to carpal tunnel syndrome.

As a woman with diabetes, what can you do about neuro-osteo-arthropathy changes in your hands? It is always advisable to do your best to keep your BG levels in good control to avoid developing complications in the first place and down the road. However, even those who strive to do their very best will sometimes develop comorbid body changes from diabetes that require surrender and lifestyle adaptation. For example, as you age you may find you are having more difficulty performing self-care tasks that require fine motor skills – like tying your shoes, changing your pump or CGM insertion sites. You may benefit from having a few sessions with an occupational therapist for hand strengthening exercise therapy, or to learn adaptive skills to manipulate your self-care equipment successfully.

Women with hand and finger issues will need to be evaluated by a knowledgeable provider familiar with the neurologic and orthopedic issues that people with advanced duration diabetes face. Your doctor may order a nerve conduction study, an MRI, and other tests to rule out and determine the exact nature of what is causing your symptoms. Be sure to inform all members of your medical team that you have lived with T1 diabetes for over 20 years. In the end, you may or may not have carpal tunnel syndrome. The only way to tell is to seek medical advice from an experienced and knowledgeable provider who is familiar with the various stages and manifestations of neuro-osteo-arthropathy syndromes in people with diabetes.

Good luck and good health!