Anybody ever get De Quervain’s Tendinitis? If so, do you think there was any connection to your diabetes? You know, the ol’ locked shoulder, trigger finger thing, but in your thumb?
I’ve had DeQuervain’s, two trigger thumbs and a trigger finger, both carpal tunnels, and Dupuytren’s syndrome. Every doctor I see blames it on a combination of heredity and diabetes…with the diabetes being the biggest factor. I’ve already had 7 procedures in four operations and am facing at least two more.
So, yup, I blame the diabetes for most of this. On the other hand, I’ve had very few (and those are pretty mild) other complications, so I consider myself fairly lucky.
Do you know what component of diabetes causes (or contributes) to these conditions? I mean beyond blood glucose levels…like what exactly is happening to the tendon or sheath? Anything you know and can share is appreciated!
I think that it can also be caused by physical stress / pressure to the hands. I do not want to say it loud but it could be connected to your biking - just as a thought.
I found out that I had DeQuervain’s in my right wrist in ~1988. That was about 6 years before I was diagnosed with Type I in '94. It is in the outer portion of the wrist in the tendon that leads to the thumb. I had a couple of cortisone shots into the tendon over the years that really helped a lot. Every so often I feel a twinge, and it only infrequently bothers me. About the only time it really bugs me is after a long shooting session with a heavy caliber handgun. That is because of a generally extreme position due to a grip that causes my hand to be tipped up at a 90 degree angle, whereas a better target style grip would put the top of the hand in line with the forearm. My theory is that the grip angle starts it, and the recoil exacerbates it, coupled with holding that position for a long period of time.
Personally, I don’t see a linkage. Perhaps some knee-jerk reaction to blame things on DM. My orthopedist at the time described it as a repetitive stress condition. He told me at the time that if the injections did not achieve useful relief, then he would consider opening up the sheath surrounding the tendon surgically. That would relieve the pressure and the pain. He also offered prescription number 1 - if it hurts - don’t do it!
I know that cortisone is not the optimal thing to have used as a treatment, but when mixed with lidocaine it does yield results.
Hope this helps.
I don’t have De Quervain’s Tendinitis, but I have Carpal Tunnel Syndrome (CTS). Statistics don’t lie. Diabetes is highly correlated with CTS. One can argue that maybe the CTS and similar conditions cause the diabetes, but I am not buying it. There are several physiological reasons that diabetes could cause these problems. Elevated blood sugars is known to thicken tendons and connective tissues. Elevated blood sugars are known to cause nerve inflammation and damage. De Quervain’s Tendinitis is caused by a compression of the tendons as they pass through your wrist. Exactly the compression that is thought to cause CTS. I believe even the basic surgical treatment is the same, a cutting of the tendons that wrap around your wrist, freeing the tunnel in your wrist.
I blame diabetes squarely for my CTS. It was my first complication and emerged even before I was officially diagnosed. I don’t doubt that some of my activities have aggravated the CTS, but I have performed exercises for nearly 5 years and still have a severely impeded range of motion due to the thickening of my connective tissue. In the end, I’ve come to realize that I will require surgery, it is just a question of when.
I have DeQuervain’s in my left hand…I also have joint issues in both shoulders, a knee, multiple fingers, was diagnosed with early charcot foot in the left, etc. Of course all of the docs have blamed it on Diabetes–of course not definitively–you know “it very well COULD be related.” I mean, I do think it’s attributed, b/c I don’t know anyone else who is otherwise healthy with so many joint issues… Prior to type I, never experienced any ailments, and since…crap, I’ve had everything, especially weird stuff! If it helps, I’ve had mine injected with cortisone, and worn a brace during the initial diagnosis, and haven’t had any major flare ups in a couple of years
Yeah…not what I want to hear, but it pretty much has to be a contributing factor. I hit 3000 miles on the bike in 2009. It sure keeps my TDD low!
I found this piece on the web - It sounds authoritative. http://www.diabetic-lifestyle.com/articles/dec01_whats_1.htm
Great piece, Joe.
While non-diabetics can, and do, get these things too, my doctors have all said that diabetics are just much more prone to getting these things, and more prone to getting multiples (CTS, trigger fingers, Dupuytren’s, instead of just CTS). Also, with diabetics, it tends to be more severe and more recurring. While cortisone injections can help tremendously for some of these things, if the situation recurs, then eventually you can’t have any more cortisone in the same area because too much can break down bone eventually, plus the cortisone stops working for the problem.
By the way, my rheumatologist worked out a way for me to prevent the highs from cortisone injections, but you need to be on a pump. If anyone is on a pump and planning to get a steroid injection, I’d be happy to share his “formula” for preventing highs.
That is a great article.
I had surgery for De Quervain’s in November along with something called Intersection Syndrome. I have also had 6 trigger finger releases. My understanding is the diabetes promotes the inflammation that causes these problems, along with the ‘gunk’ that is cleaned out when they do surgery. Sorry, I’m not sure what the ‘gunk’ is called. The surgery does not necessarily get rid of the inflammation, but reduces the cause, i.e. where the tendon catches. Intersection syndrome is a similar, yet more rare condition affecting the 2nd dorsal compartment on your wrist. My thumb is doing better, now about 6 weeks after surgery, but I had to wear a cast on both my thumb and wrist for 2 weeks to let the tendons heal. I will be doing physical therapy for another 2-3 weeks. I’d be happy to answer any questions.
I have had carpal tunnel in both wrists, trigger fingers and also DeQuervain’s in my right wrist. I had surgery for the carpal tunnels - on both wrists - back in the 1980’s. I had cortisone injections and got rid of the trigger fingers. I had surgery for the DeQuervain’s on my right wrist. I had frozen shoulders/have frozen shoulders - both (started about 15 years ago). I have tried physical therapy, anti-inflammatory medications, accupuncture, steroid shots. NOTHING seems to help. I am suffering a lot of pain in my right shoulder. I am just beside myself with pain. Why does surgery/therapy work for some joints and not others? Trigger fingers ( 2 on right/one of left) all eventually went away with steroid shots. Why are steroid shots working for trigger fingers but not “frozen shoulders”??? I know its different joints, obviously, but the right shoulder is so painful. I am on my third orthopedic doctor. ? Any suggestions ? BTW I have had type 1 for 55 years and I don’t want to hear “oh, well, its because of diabetes”.
I’ve had it twice, and I don’t think it had a thing to do with my diabetes. Its more of a repetitive stress on that tendon. I was apparently picking up my children improperly, bending that tendon, etc. I had it once with my girls, but learned and didn’t have it with my 3 child (or I ran out of arms to injure). My doc didn’t think it had anything to do with my diabetes. And the 1st time I had it, I had been diabetic 2 years, the 2nd time was 5 years along.
A shot of cortisone and a splint for a few weeks did the trick. But holy cow, painful as hell. And the shot was nearly worse than labor. Get a cortisone shot, so worth it because the pain was just unbearable for me. Wonder if its something to do with your biking and how you hold your hand?
3000 Miles that is very impressive. What about other types of handle bars? With a different angle for the hands or the arms pointing into the driving direction (I don’t know the specific name of this handle)?
How was your De Quervain’s treated prior to surgery? How long did the other treatments (if any) go on before surgery became to logical option?
I had steroid shots until the doctor said no more and I had surgery for De Quervain’s which cleared it up right away. I did not have shots for the carpal tunnel and I had surgery on both wrists at the same time ! The pain immediately went away and that was over 20 years ago. The shoulders are a real problem and at the tender age of 58 (ssshhhh) I don;t think I want to go through surgery but nothing seems to be working.
I have had DeQuervain’s twice. The hand doctor did not blame it on my Type I diabetes, which I control very well. He said it happens to men and women, and there is common among musicians. (I’m a musician!) I have read of another cause, which my Ear, Nose and Throat doctor agrees with. I have used the antibiotic Levaquin. There is currently a lawsuit out against the company that makes that drug, which some people say has caused them tendonitis. Some claimants say it has caused their achilles tendons to snap!
I had frozen shoulder on the left side in the late '90s. Only thing I found that worked was physical therapy, putting that hand as high on the wall ads I could get it to go without hurting too much, then leaning down toward the wall to flex it until somewhat painful. Repeated 3 times per day, and it took about 2 years to clear up the problem.
Frozen shoulder, and presumably trigger finger, which I’ve also had, are caused by “adhesive capsulitis”. There are small capsules of flexible lubricating fluid in a soft shell. With high bg levels over many years (now 53 for me) the lubricant in these capsules or the shell stiffens up, and then they lock up the joint rather than let it float. Sort of like ball bearings, but necessarily soft, I suppose.
So the therapy works them free, but bg needs to be controlled as tightly as possible at the same time until the capsules get back to being flexible. Rather like the stiffened red blood cells that cause neuropathy. So being inflexible about bg control keeps your joints flexible… another diabetes irony, I guess.
Trigger finger is different in that the tendon is a lot easier to reach, and the tube it travels through can be easily slit so that it’s an open slot, rather than a restricting pipe, relieving the problem. No capsules either, as far as I’ve heard, but the tendons aren’t surrounded totally by a bone socket like the shoulder is, so they aren’t needed there.
Thanks to all who replied. As always, I find it enlightening to learn from those who share our condition.
Here’s what I think:
I probably don’t have a thumb version of Frozen Shoulder, nor is it useful to to think about it in those terms. My problem is much much simpler, and isolated to a single tendon. Theodore pointed out this condition is more appropriately called adhesive capsulitis. Here’s a really good piece on it at American Family Physician.
I don’t have De Quervain’s tendinitis. There is no indication when I tuck my thumb in my fist and rotate my wrist, stretching the tendon in the classic test for De Quervain’s. Nice explanation here on De Quervain’s.
I don’t have Dupuytren’s disease.
I probably have trigger finger in my thumb. (Yeah, a lot of you are saying “I told you so!” ) Also called stenosing tenosynovitis. According to Mayo Clinic.com it is “caused by a narrowing of the sheath that surrounds the tendon in the affected finger.” Caused by overuse and inflammation. While having diabetes is not the sole cause, it is a risk factor. Excerpt from MayoClinic.com: “if the tenosynovium becomes inflamed from repetitive strain injury or overuse or due to inflammatory conditions, such as rheumatoid arthritis, the space within the tendon sheath can become narrow and constricting. The tendon can’t glide through the sheath easily, at times catching the finger in a bent position before popping straight. With each catch, the tendon itself becomes irritated and inflamed, worsening the problem. With prolonged inflammation, scarring and thickening (fibrosis) can occur and bumps (nodules) can form.”
5. I still don't understand, as well as I'd like to, why diabetes is a risk factor. But I need to wrap my brain around this thing - Type 1's are susceptible to diabetic cheirarthropathy. Flexor tenosynovitis (or trigger finger) is thought to have the same pathogenisis as diabetic cheirarthropathy. As stated in Diabetic Lifestyle/EndocrineWeb - "Increased glycosylation of collagen in the skin and periarticular tissue, decreased collagen degradation, diabetic microangiopathy, and possibly diabetic neuropathy are thought to be some of the contributing factors." Duration and severity of diabetes affects it greatly.
So my conclusion? Riding a bike 3000 miles per year is rough on your hands when you’re 50 years old. I’ve only had T1 for 5 years - so I hope diabetes isn’t a huge contributing factor. I’ll see a hand specialist in two weeks. Maybe a shot or two will do the trick. And Holger is on to something when he suggested a change in handlebars. Cyclists who experience hand pain sometimes switch to recumbent bikes/trikes - so I’ll continue my research into recumbent trikes- see my post here if you’re interested in that avenue.
Thanks again to all.