[notme]

I have had it for about 6 years and no surgery for my hands. I have no problem with muscle wasting, just pain. I take a small dose of Neurontin and it is controlled.

[Danny Coombs]

Hi Dave
I was diagnosed type 2 diabetes four years ago by then I had already had the onset of Neuropathy in feet which also developed in my hands soon after, a year later I was diagnosed with Retinopathy and within eight months suffered loss of sight and since having four operations on my eyes, my sight is very limited. Now I have developed the muscle wasting in my hands like you between the thumbs and forefinger, my GP said it is connected with the neuropathy but did not give a name to the condition, so I am trying to find out what the condition is called.

[yannah]

I am sorry Danny. I don't know what the condition is called, but I am sorry that you have gone through all this pain and suffering. I am so sorry.

Good luck to you. I wish I could do more.

[lorilei]

danny, the other posters are most likely right...wasting of the thenar eminence (thumb bulk) is part of carpal tunnel syndrome...an over the counter wrist cock up splint with neoprene and a metal stay at the wrist can sometimes maintain the integrity of the wrist joint (you have 8 wirst bones plus two from the radius and ulna and five from the digits where nerves and vessels run thru..entrapment at the carpal tunnel involves the thumb and first two digit muscles and often sensation)..keeping the wrist bones in a better position might relieve some of these symptoms or at least prevent more from occuring....should be worn especially during activity..and yes, putty or ball exercises can help ...things with opposition..

[DaveUK]

Danny, the muscle wasting I have sounds like yours and after tests they tell me it is Ulnar Tunnel Syndrome at the elbow. They will do an operation to release the Ulnar nerve to stop it getting any worse but the muscle loss will not improve apparently. I told them I am type 2 but they don't say anything about it being connected to diabetes, apparently this sort of thing can be brought on by leaning on an elbow too much or even too much repetative computer work.

You need to have them send you for nerve tests to find out where the problem is as soon as you can so they can sort it out before it gets worse, it can be at the wrist or the elbow.

I am ok with my feet so far although I had leakage close to the macular in one eye earlier this year and that gave me a shock. After that I started much tighter diet carb control and my eyesight keeps improving, I am now using my first glasses (15 yr old) for distance and using my latest distance glasses for reading, but before this I had to use strong bi-focals. I am totally amazed at the improvements I am getting to my eyesight so I must be doing something right.

Anyway, I really feel for you Danny and if I can be of any help let me know. I will keep you updated how the operation goes.

Dave

[lorilei]

dave...is your wasting in the hypothenar eminence (pinky bulk?) if so then ulnar tunnel ( we call it cubital tunnel sx here...never heard it called ulnar tunnel..) that makes sense to me...maybe I'm stretching my a&p too far back, but...cubital tunnel sx is common in taylors and jewelers as they tend to lean on their elbows, thus impinging at that spot where the ulnar nerve runs thru (funny bone spot)..carpal tunnel...often in cooks and computer peeople, incidentally...

[DaveUK]

Hi yes you are right it is cubital tunnel syndrome, I picked that other term up from a web site.... the doctor just referred to it as the Ulnar nerve not even cubital tunnel. Although I am a watchmaker I spend most of my time on the computer<g>, and the wasting is between the forefinger and thumb mainly but also along the other edge of my hand next to the pinky.

It worries me the thought of using a ball to exercise my hand until after the nerve restriction has been relieved, I think to do it now might aggravate the condition. I read that ibuprofen can be used to control pain and inflammation in adults with cubital tunnel syndrome and that seems to help me. Also I sleep with a splint on my arm to prevent me bending the elbow too much. I am mostly scared that the other hand might go the same way now as that would really screw me up.

Dave

[DaveUK]

This link is worth checking out for anyone with similar problems Focal Entrapment Neuropathies in Diabetes

[rotcoddam]

A nice reference that I will save for patients. Last year I had a patient whose feet problems were attributed by me (an internist) and a neurologist to "generic" diabetic neuropathy. He saw a neurosurgeon who diagnosed superimposed tarsal tunnel syndrome bilaterally and common peroneal entrapment on one side. Surgical release improved much of his symptoms (he has some residual diabetic neuropathy).

The first rule in neurologic diagnosis is "localize the lesion" - neuromuscular junction, peripheral nerve, spinal nerve root, spinal cord, brain, etc. Evaluation by a neurologist and often a nerve conduction study is absolutely imperative if someone has focal muscle wasting. Our guessing online with limited information is kind of iffy.

Something else to consider is diabetic cheiroarthropathy, where the skin of the hands gets tight and the hands therefore get stiff and clumsy.

[DaveUK]

rotcoddam, you really hit the nail on the head. I hadn't seen your post until now when I was just going to report that it appears the problem is diabetic cheiroarthropathy as both my hands are now quite stiff and clumsy, so you really confirmed this for me and a search on that term brings up all sorts of useful information.

These links are particularly interesting >>>
Diabetic Stiff Hand
Musculoskeletal Complications of Diabetes Mellitus

For anyone who is interested my symptoms started with a severe left Frozen Shoulder and stiff neck about 3 years ago, my doctor thought it had nothing to do with diabetes and took no action. After 2 years the shoulder pain subsided but after another 6 months I started to notice occasional weakness in some of my fingers of my left hand, in particular the first finger, as well as a kind of locking or cramp in my fingers. After a further month to 45 days I suddenly noticed muscle loss in my left hand. After nerve conduction tests it seems my problem is cubital tunnel syndrome and they intend to operate on my left elbow soon. Over the following 2 months I have noticed more and more stiffness in both hands and I am concerned in case the same muscle wasting might also occur in my right hand as that is also becoming clumsy. My hands feel like the skin is very dry so I have to use hand cream, plus they become virtually useless when they get very cold so temperature has a big effect. Unusually I have not particularly suffered from numbness, tingling or pins and needles other than on very rare occasions.

If you notice any of these symptoms then I suggest you take action straight away to investigate as I am told the conditions are not reversible. I hope this information helps someone.

rotcoddam I am very appreciative of your post and would welcome any other help you might be able to offer. What I really need to know is what action should I take with my right hand to stop it deteriorating the same way as my left hand. Should I maybe have an operation on my right elbow now before muscle loss occurs, or do I wait and keep a sharp lookout for any of the symptoms I experienced in my left hand, while taking into consideration it might take around 3 to 4 months to get an operation?

Thanks Dave,
On diet only but now considering going on Metformin
(last HbA1c 7.9% July 2008 with a reducing trend)

[rotcoddam]

Originally Posted by DaveUK

rotcoddam, you really hit the nail on the head. I hadn't seen your post until now when I was just going to report that it appears the problem is diabetic cheiroarthropathy as both my hands are now quite stiff and clumsy, so you really confirmed this for me and a search on that term brings up all sorts of useful information.

These links are particularly interesting >>>
Diabetic Stiff Hand
Musculoskeletal Complications of Diabetes Mellitus

For anyone who is interested my symptoms started with a severe left Frozen Shoulder and stiff neck about 3 years ago, my doctor thought it had nothing to do with diabetes and took no action. After 2 years the shoulder pain subsided but after another 6 months I started to notice occasional weakness in some of my fingers of my left hand, in particular the first finger, as well as a kind of locking or cramp in my fingers. After a further month to 45 days I suddenly noticed muscle loss in my left hand. After nerve conduction tests it seems my problem is cubital tunnel syndrome and they intend to operate on my left elbow soon. Over the following 2 months I have noticed more and more stiffness in both hands and I am concerned in case the same muscle wasting might also occur in my right hand as that is also becoming clumsy. My hands feel like the skin is very dry so I have to use hand cream, plus they become virtually useless when they get very cold so temperature has a big effect. Unusually I have not particularly suffered from numbness, tingling or pins and needles other than on very rare occasions.

If you notice any of these symptoms then I suggest you take action straight away to investigate as I am told the conditions are not reversible. I hope this information helps someone.

rotcoddam I am very appreciative of your post and would welcome any other help you might be able to offer. What I really need to know is what action should I take with my right hand to stop it deteriorating the same way as my left hand. Should I maybe have an operation on my right elbow now before muscle loss occurs, or do I wait and keep a sharp lookout for any of the symptoms I experienced in my left hand, while taking into consideration it might take around 3 to 4 months to get an operation?

Thanks Dave,
On diet only but now considering going on Metformin
(last HbA1c 7.9% July 2008 with a reducing trend)

A tough queston. Regarding cheiroarthropathy, I haven't looked it up lately, but I don't think that there's any specific treatment. Other things that can cause somewhat similar symptoms would be CREST syndrome (an acronym for the various manifestations of that condition) or Raynaud's, although Raynaud's doesn't usually cause the permanent skin changes. CREST would be pretty easy to diagnose because of the telangectasias which would not be limited to the hands.
I would think that if the right side is developing early cubital tunnel syndrome that a NCS/EMG would be able to tell that. I would probably not suggest surgery if the NCS/EMG is normal.

As an aside, I'm not an expert, but it seems to me that since most diabetics don't get these conditions, I wonder if maybe these are various autoimmine diseases that just run together along with diabetes, rather than a complication of poorly controlled diabetes. Just thinking out loud, not really of any help...

[DaveUK]

As an aside, I'm not an expert, but it seems to me that since most diabetics don't get these conditions, I wonder if maybe these are various autoimmine diseases that just run together along with diabetes, rather than a complication of poorly controlled diabetes. Just thinking out loud, not really of any help...

rotcoddam, that might be the case but I guess I have been more stubborn than most diabetics by not taking medication (a warning to others maybe?) and through my own searching I have ended up discounting autoimmine diseases for one reason or another. Anyway I have written to the specialist and no doubt will get to see him again before the operation in Feb and will let you know what he thinks.

Thanks Dave

[DaveUK]

Ok my surgeon tells me the nerve conductivity studies I had done did not highlight any problems that would be suggestive of diabetic neuropathy, so this looks like something else.

Dave