Diabetes Mellitus & the hand:
35 Hand Signs!

(Including e.g. the 'diabetic stiff-hand syndrome')

Diabetes mellitus is a group of metabolic diseases in which a person has high blood sugar. Regarding the hand, scientific studies have pointed out that the so-called 'diabetic stiff-hand syndrome' (a.k.a. diabetic cheiroarthropathy) characterized by stiffness (without the joints directly getting involved) and thickening of skin, is recognized to represent a common complication in the later stages of the disease of both diabetes mellitus type 1 (up to 50%) and type 2 (up to 75%).20 Actually, there is a large group of significant hand signs that may represent a clue for diabetes mellitus type 1 and/or type 2. This article presents an overview of 35 individual hand signs that are significant for diabetes mellitus (featured with illustrative statistics).

The statistics indicate for both forms (type 1 & type 2) that the development of diabetes mellitus typically manifests inside the hand with especially abnormalities in the skin quality (and/or fingernails) & motorics; though of much lesser concern, also dermatoglyphics (in the lower palm) & major palmar creases may present significant clues!

TOP 5 HAND SIGNS IN DIABETES MELLITUS

Diabetes Mellitus TYPE 1:

1 - Thick, waxy skin (sclerodactyly) [Diabetes h.s. 6-1: LOR = +4.58]
2 - Dry scally palm [Diabetes hand sign 6-8: LOR = +3.47]
3 - Limited joint mobility [Diabetes hand sign 7-1: LOR = +2.98]
4 - Pink patches on back of hand [Diabetes hand sign 6-3: LOR = + 2.73]
5 - Shiny patches on back of hand [Diabetes h.s. 6-6: LOR = + 2.71]

Diabetes Mellitus TYPE 2:

1 - Limited joint mobility [Diabetes hand sign 7-1: LOR = +3.36]
2 - Half white, half pink nails [Diabetes hand sign 2-3: LOR = +3.09]
3 - Pink patches on back of hand [Diabetes hand sign 6-3: LOR = + 2.73]
4 - Shiny patches on back of hand [Diabetes h.s. 6-6: LOR = + 2.71]
5 - Little pebbles on back of hand [Diabetes h.s. 6-6: LOR = + 2.64]


35 Hand signs significant for Diabetes Mellitus
The TOP 10 Hand signs in respective Diabetes Mellitus type 1 & 2!
How to make a hand-diagnosis for Diabetes Mellitus: 4 requirements!



Multi-perspective palm reading.

How to make a Palm Reading Assessment
for DIABETES MELLITUS (Type 1 & 2)

Key-elements of the hand in Diabetes Mellitus (type 1 & 2) in a nutshell: skin / nail problems and or motoric problems, palmar dermatoglyphic stereotypes below the ring finger & the hypothenar, high occurence of the simian crease.

Diabetes Mellitus.
Phantom picture for Diabetes Mellitus.

[Phantom picture for Diabetes Type 1 & 2 will be available later]


Studies have shown that there not much difference between recognizing diabetes mellitus type 1 and type 2 from the hand only. An advanced hand diagnosis for Diabetes Mellitus requires a person to have multiple significant hand markers that follow the MAJOR REQUIREMENT + the additional requirements described below:

MAJOR REQUIREMENT: The person requires to have significant hand markers for Diabetes Mellitus in at least three out of the seven dimensions of the hand; most likely a combination of the dimensions: SKIN QUALITY, FINGERNAILS, MOTORICS & DERMATOGLYPHICS.

- ADDITIONAL REQUIREMENT A: The person requires to have at least one hand marker that relates to one of the following two perspectives: SKIN QUALITY (= hand perspective 6) or MOTORICS (= hand perspective 7)

- ADDITIONAL REQUIREMENT B: The person requires to have at least one hand marker that relates to FINGERNAILS (= hand perspective 2), DERMATOGLYPHICS (= hand perspective 5) or HAND LINES (= hand perspective 4).

- ADDITIONAL REQUIREMENT C: The person requires to have at least one hand marker in the palm (or back of the hand) + at least one hand marker in the fingers.




IMPORTANT: Even when all above REQUIREMENTS are fullfilled, then one can still NOT speak of a 'confirmed' hand diagnosis for Diabetes Mellitus: an additional health assessment beyond the hand is still requirement!

Some of the 35 significant hand markers for Diabetes Mellitus that are listed below became known in medical science as a 'physical minor anomaly' (such as the simian crease & the Sydney line).
But in general most of these individual hand markers can usually be described as harmless body characteristics - except for the markers described for perspectives 2, 6 and 7.







- List of 35 hand markers for Diabetes Type 1 & 2 -


• Hand perspective 1 - HAND SHAPE:
- 1-1: Appearent hand shape asymmetry.

• Hand perspective 2 - FINGERNAILS:
- 2-1: Fungal infection of the nail (onychomycosis);
- 2-2: Redness in proximal nail fold (chronic paronychia);
- 2-3: Half white, half pink nails (Terry's nails);
- 2-4: Blue lunula;
- 2-5: Yellow nails + yellow skin;
- 2-6: Spoon nail (koilonychia).

• Hand perspective 3 - FINGER MORPHOLOGY:
- 3-1: High finger length asymmetry: e.g. 2D:4D asymmetry.

• Hand perspective 4 - MAJOR LINES:
- 4-1: Simian crease;
- 4-2: Sydney line.

• Hand perspective 5 - DERMATOGLYPHICS:
- 5-1: Fingers: radial loop on ringfinger;
- 5-2: Fingers: radial loop on pinky;
- 5-3: Fingers: high thumb minus pinky ridge count (high MD15);
- 5-4: Palm: triradius c below ring finger is missing;
- 5-5: Palm: ridge line C ends below ring finger (abbortive ridge line C);
- 5-6: Palm: a-b ridge count summarized for both hands < 70 (ridge count between triradius below index finger & triradius below middle finger);
- 5-7: Palm: 2 or 3 triradii on hypothenar;
- 5-8: Palm: high positioned axial triradius;
- 5-9: Palm: triradius t is missing;
- 5-10: Palm: ulnar loop on hypothenar;
- 5-11: Palm: radial arch on hypothenar;
- 5-12: Palm: pattern in the hypothenar OR thenar of just one hand;
- 5-13: Palm: high density on thenar.

• Hand perspective 6 - SKIN QUALITY:
- 6-1: Thick, waxy/thickening skin on back of the hand (sclerodactyly);
- 6-2: Infections;
- 6-3: Pink patches on back of the hand / fingers (granuloma annulare lesions);
- 6-4: Little skin pebbles on back of the hand / fingers (Huntley's papules);
- 6-5: Blisters (bullosis diabeticorum);
- 6-6: Shiny patches, first: red-brown & painless, later: yellow & ulceration (necrobiosis lipoidica);
- 6-7: Dramatic appearing hand infections (e.g. Tropical Diabetic Hand Syndrome).
- 6-8: Dry scally palms.

• Hand perspective 7 - MOTORICS:
- 7-1: Neuropathy: loss of function, loss of movement / sensation (Tinel's sign, Phalen's test, preacher sign / prayer sign, limited joint mobility);
- 7-2: Contracture of pinky and/or ring finger (Dupuytren's contracture);
- 7-3: Locked finger, a.k.a. 'trigger finger' (stenosing tenosynovitis);
- 7-4: Numbness, tingling and/or pain (Carpal Tunnel Syndrome);



NOTICE: About 3% of the world population has diabetes mellitus, of which about 2.7% concerns Type 2 and 0.3% concerns Type 1. But in Down syndrome the occurence of diabetes type 1 is much higher (estimates indicate at least 4x times higher to up to 10%), therefore it is interesting to notice that 8 of the 26 hand markers in Down syndrome are also seen in the summary of hand markers for Diabetes Mellitus!

- MORE MULTI-PERSPECTIVE PALM READING -

The hand in RHEUMATOID ARTHRITIS
The hand in PSORIASIS
The hand in DOWN SYNDROME
The hand in FRAGILE-X SYNDROME

Fingernails problems in Diabetes Mellitus



THE FAMOUS 'SIMIAN LINE' (SINGLE PALMAR CREASE) IS ONLY A MINOR KEY-ELEMENT FOR THE HAND IN DIABETES MELLITUS (TYPE 2)


Hand Diagnostics:
the Simian Line & Diabetes Mellitus!

Various studies around the world have proven that the simian line is more often seen among diabetics than in the general population (about 3% of the healthy population has a simian line in at least one hand). This implicates that the simian line is much more important in the genetic syndromes (e.g. Down syndrome & Fragile-X syndrome) than in Diabetes Mellitus - but still, combined with other relevant hand markers the simian line can play a role in a hand diagnosis for Diabetes Mellitus.

This raises the question: 'how can the simian line serve as a diagnostic marker specific for Diabetes Mellitus?'

'Phantom picture' of the hand in Diabetes type 2.

Phantom picture for Diabetes Mellitus - type 2: including the simian line.

NOTICE: Later the author will present a comprehensive 'phantom picture' for the most typical hand-characteristics in Diabetes Mellitus.


HAND SHAPE & Diabetes Mellitus:

• 1-1 - Apparent hand shape asymmetry
Prevalence:
- Diabetic patients: ? %; controls: ? %

LOG ODDS RATIO: ? (unknown)



FINGERNAILS & Diabetes Mellitus:

• 2-1 - Fungal infection of the nail (onychomycosis)
Prevalence:
- Diabetic patients: 17-36 %; controls: 6.8-7.0 % 1

LOG ODDS RATIO: +1.57 (average)


• 2-2 - Redness in proximal nail fold (chronic paronychia)
Prevalence:
- Diabetic patients: 10.0 %; controls: +3.0 % 2

LOG ODDS RATIO: 1.28 (average)


• 2-3 - Half white, half pink nails (Terry's nails)
Prevalence:
- Diabetic type 2 patients: 10.0 %; controls: 0.5 % (rare in young people) 3

LOG ODDS RATIO type 2: +3.09 (average)


• 2-4 - Blue lunulae
Prevalence:
- Diabetic patients: ? %; controls: ? % 4

LOG ODDS RATIO: ? (unknown)


• 2-5 - Yellow nails + yellow skin
Prevalence:
- Diabetic patients: ? %; controls: ? %

LOG ODDS RATIO: ? (unknown)


• 2-6 - Spoon nail (koilonychia)
Prevalence:
- Diabetic patients: ? %; controls: ? %

LOG ODDS RATIO: ? (unknown)



FINGER LENGTH & Diabetes Mellitus:

• 3-1 - High finger length asymmetry: e.g. 2D:4D asymmetry
Prevalence:
- Diabetic patients: ? %; controls: ? %

LOG ODDS RATIO: ? (unknown)



HAND LINES & Diabetes Mellitus:

• 4-1 - Simian crease
Prevalence:
- Diabetic type 1 patients: males: 2.3-12.93 %, females: 1.0-12.0 %; controls: 0.3-2.0 % & 0.4-1.0 % 5-7
- Diabetic type 2 patients: males: 3.8-13.33 %, females: 0-14.23 %; controls: 0.3-2.0 % & 0.4-1.0 % 5-8,21


LOG ODDS RATIO type 1: +2.12 (average)
LOG ODDS RATIO type 2: +2.24 (average)


• 4-2 - Sydney line
Prevalence:
- Diabetic type 1 patients: males: 0.8, females: 4.0 %; controls: 3.8 % & 1.7 % 6
- Diabetic type 2 patients: males: 0, females: 7.6 %; controls: 3.8 % & 1.7 % 6


LOG ODDS RATIO type 1 (females only): +0.87
LOG ODDS RATIO type 2: +0.34 (average)


DERMATOGLYPHICS & Diabetes Mellitus:

• 5-1 - Fingerprints: radial loop on ringfinger
Prevalence:
- Diabetic patients (confirmed by glucose tolerance test): 6.2 %; controls: 0.3 % 7

LOG ODDS RATIO: +3.09


• 5-2 - Fingerprints: radial loop on pinky
Prevalence:
- Diabetic patients (confirmed by glucose tolerance test): 2.3 %; controls: 0 % 7

LOG ODDS RATIO: +3.16


• 5-3 - Fingerprints: high thumb minus pinky ridge count (high MD15)
Prevalence:
- Diabetic type 2 patients: ? %; controls: ? %

LOG ODDS RATIO: ? (unknown)


• 5-4 - Palm: triradius c below ring finger is missing
Prevalence:
- Diabetic type 1 patients: 3.0-8.7 %; controls: 3.1-3.0 % 5-7
- Diabetic type 2 patients: 4.5-15.9 %; controls: 3.1-3.0 % 5-7

LOG ODDS RATIO type 1: +0.69 (average)
LOG ODDS RATIO type 2: +1.28 (average)


• 5-5 - Palm: ridge line C ends below ring finger (abortive ridge line C)
Prevalence:
- Diabetic type 1 patients: 0.5-36.6 %; controls: 0.4-8.0 % 5-7
- Diabetic type 2 patients: 1.3-34.6 %; controls: 0.4-8.0 % 5-7

LOG ODDS RATIO type 1: +1.65 (average)
LOG ODDS RATIO type 2: +1.61 (average)


• 5-6 - Palm: a-b ridge count summarized for both hands < 70 (ridge count between triradius below index finger & triradius below middle finger)
Prevalence:
- Diabetic type 1 patients: ? %; controls: ? % 5,6,10
- Diabetic type 2 patients: ? %; controls: ? % 5,6,10

LOG ODDS RATIO type 1: ? (unknown)
LOG ODDS RATIO type 2: ? (unknown)


• 5-7 - Palm: 2 or 3 triradii on hypothenar
Prevalence:
- Diabetic type 1 patients: ? %; controls: ? % 5,6,10
- Diabetic type 2 patients: ? %; controls: ? % 5,6,10

LOG ODDS RATIO type 1: ? (unknown)
LOG ODDS RATIO type 2: ? (unknown)


• 5-8 - Palm: high positioned axial triradius
Prevalence:
- Diabetic type 1 patients: ? %; controls: ? % 5,6,10
- Diabetic type 2 patients: ? %; controls: ? % 5,6,10

LOG ODDS RATIO type 1: ? (unknown)
LOG ODDS RATIO type 2: ? (unknown)


• 5-9 - Palm: triradius t is missing
Prevalence:
- Diabetic type 1 patients: 0.75 %; controls: 0.5 % 5
- Diabetic type 2 patients: 3.95 %; controls: 0.5 % 5

LOG ODDS RATIO type 1: +0.41
LOG ODDS RATIO type 2: +2.10


• 5-10 - Palm: ulnar loop on hypothenar
Prevalence:
- Diabetic type 1 patients: 13.5 %; controls: 1.8 % 5
- Diabetic type 2 patients: 11.6 %; controls: 1.8 % 5

LOG ODDS RATIO type 1: +2.14
LOG ODDS RATIO type 2: +1.97


• 5-11 - Palm: radial arch on hypothenar
Prevalence:
- Diabetic type 1 patients: 5.6 %; controls: 0.5 % 5
- Diabetic type 2 patients: 4.7 %; controls: 0.5 % 5

LOG ODDS RATIO type 1: +2.47
LOG ODDS RATIO type 2: +2.28


• 5-12 - Palm: pattern in the hypothenar OR thenar of just one hand
Prevalence:
- Diabetic patients (confirmed by glucose tolerance test): 36.7 %; controls: 9.9 % 7

LOG ODDS RATIO: +1.67


• 5-13 - Palm: high density on thenar
Prevalence:
- Diabetic type 1 patients: 39.1 %; controls: 5.0 % 5
- Diabetic type 2 patients: 31.8 %; controls: 5.0 % 5

LOG ODDS RATIO type 1: +2.50
LOG ODDS RATIO type 2: +2.19



SKIN QUALITY & Diabetes Mellitus:

• 6-1 - Thick, waxy/hardening skin on back of the hand (sclerodactyly)
Prevalence:
- Diabetic type 1 patients: 33 %; controls: 0.5 % (rare) 16,17

LOG ODDS RATIO type 1: +4.58


• 6-2 - Infections
Prevalence:
- Diabetic patients: ? %; controls: ? %

LOG ODDS RATIO: ? (unknown)


• 6-3 - Pink patches on back of the hand / fingers (granuloma annulare lesions)
Prevalence:
- Diabetic patients: 3 %; controls: 0.2 % 18

LOG ODDS RATIO: +2.73


• 6-4 - Little skin pebbles on back of the hand / fingers (Huntley's papules)
Prevalence:
- Diabetic patients: 72-75 %; controls: 12-21 % 15

LOG ODDS RATIO: +2.64


• 6-5 - Blisters (bullosis diabeticorum)
Prevalence:
- Diabetic patients: ? %; controls: ? % 14,18

LOG ODDS RATIO: ? (unknown)


• 6-6 - Shiny patches, first: red-brown & painless, later: yellow & ulceration (necrobiosis lipoidica)
Prevalence:
- Diabetic patients: 7 %; controls: 0.5 % (rare)

LOG ODDS RATIO: +2.71


• 6-7 - Dramatic appearing hand infections (e.g. Tropical Diabetic Hand Syndrome)
Prevalence:
- Diabetic patients: ? %; controls: ? %

LOG ODDS RATIO: ? (unknown)


• 6-8 - Dry scally palms
Prevalence:
- Diabetic patients type 1: 21 %; controls: 0.8 % 19

LOG ODDS RATIO type 1: +3.47



MOTORICS & Diabetes Mellitus:

• 7-1 - Limited joint mobility (LJM): neuropathy, loss of function: movement / sensation; a.k.a. diabetic hand syndrome or cherioarthropathy (e.g. associated with: Tinel's sign, Phalen's test, preacher sign / prayer sign)
Prevalence:
- Diabetic type 1 patients: 20-66 %; controls: 4 % 11,12,13 (+22)
- Diabetic type 2 patients: 33-76 %; controls: 4 % 11,12,13 (+22)

LOG ODDS RATIO type 1: +2.98 (average)
LOG ODDS RATIO type 2: +3.36 (average)


• 7-2 - Contracture of pinky and/or ring finger (Dupuytren's contracture)
Prevalence:
- Diabetic patients: 3-32 %; controls: 1-7 % 14,22

LOG ODDS RATIO: +1.31 (average)


• 7-3 - Locked finger, a.k.a. 'trigger finger' (stenosing tenosynovitis)
Prevalence:
- Diabetic patients: 10-20 %; controls: 1-2 % 14,22

LOG ODDS RATIO: +2.50


• 7-4 - Numbness, tingling and/or pain (Carpal Tunnel Syndrome)
Prevalence:
- Diabetic patients: 11-21 %; controls: 5 % 14

LOG ODDS RATIO: +1.28 (average)


(More details about prevalence of other significant hand markers for diabetes - plus the relates sources - will become available later)


SOURCES:

1)
The prevalence and management of onychomycosis in diabetic patients. A.K. Gupta et al., 2000

2) Infections and Diabetes: Mechanisms and Prospects for Prevention. P. Pozzilli & R.G.D. Leslie., 1994

3) Comparative study on secondary structural changes in diabetic and non-diabetic human finger nail specimen by using FTIR spectra. K.M. Farhan, 2010

4) Abnormalities of the lunula. M.E. Williams, 2009

5) Dermatoglyphics in diabetes mellitus of type 2 (T2DM) or non-insulindependent. A. Tarca, 2006

6) Digital and palmar dermatoglyphics in diabetes mellitus, multiple sclerosis and essential hypertension. G.F. Floris, et al., 2000

7) Association between diabetes mellitus and dermatoglyphics. M.R. Chakravartti, 1967 (in: Hautleisten und Krankheiten - Hirsch, 1967 / Hautleistenfibel - A. Rodewald & H. Zankl, 1981)

8) Dermatoglphics study of 210 patients with diabetes mellitus. Li Yanhua Wu Shoushan Han Li Guo Qingmei He Liping, 1990

9) A fingerprint marker from early gestation associated with diabetes in middle age: The Dutch Hunger Winter Families Study. H.S. Kahn et al., 2008

10) Dermatoglyphics in Type 1 diabetes mellitus. A.G. Ziegler et al., 2009

11) Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. M. Chammas et al., 1995

12) Reduced Prevalence of Limited Joint Mobility in Type 1 Diabetes in a U.K. Clinic Population Over a 20-Year Period. J.R. Lindsay et al., 2005

13) Limited joint mobility (LJM) of the hand in patients with diabetes mellitus: relation to chronic complications. H.S. Starkman et al, 1986

14) Hand manifestations of diabetes mellitus. P.G. Fitzgibbons & A-P C. Weiss, 1995

15) Finger pebbles: a dermatologic sign of diabetes mellitus. D.S. Hollister et al., 2000

16) Updates in the Management of Cutaneous Manifestations of Diabetes Mellitus. A.S. Hayat et al., 2010

17) Scleredema and diabetic sclerodactyly. Lisa Moed Gruson & Andrew Franks, 2005

18) Localized granuloma annulare is associated with insulin-dependent diabetes mellitus. M.F. Muhlemann & D.R.R. Williams, 2006

19) The Prevalence of Cutaneous Manifestations in IDDM Patients and Their Association With Diabetes Risk Factors and Microvascular Complications G. YOSIPOVITCH et al, 1998

20) pattern in connective autoimmune diseases. A comparison with microvascular changes in diseases of social importance: arterial hypertension and diabetes mellitus S.N. Lambova & U. Müller-Ladner, 2009

21) Study of Dermatoglyphics in Patients with Type II Diabetes Mellitus Essential Hypertension in the Age Group between 35-55 Years. S. Sumathi & S.D. Desai, 2007

22) Hand disorders associated with diabetes : a review. A. Zyluk & P. Puchalski, 2015

Martijn van Mensvoort - Hand Research

© COPYRIGHT 2002-2016:
Martijn van Mensvoort | Contact | Privacy Policy