Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Limited joint mobility in diabetes mellitus

Lesley D Hordon, MD
Section Editors
David M Nathan, MD
John S Axford, DSc, MD, FRCP, FRCPCH
Deputy Editor
Jean E Mulder, MD


Limited joint mobility (previously known as cheiroarthropathy) is common in patients with diabetes mellitus. It is characterized by limitation of joint movement that is most marked in the small joints of the hands [1,2]. Thickening and waxiness of the skin are also common, particularly on the dorsal surface of the fingers, but these skin changes may occur in the absence of limited joint mobility [3].


The prevalence of limited joint mobility in diabetes mellitus has ranged from 8 to 58 percent [1,4,5]. This variability depends largely upon the population studied and the way in which joint mobility is measured. Care must also be taken to avoid confusion with other diabetic hand problems, such as Dupuytren's contracture, flexor tenosynovitis, trigger finger, and reflex sympathetic dystrophy, which may coexist [5] (see "Musculoskeletal complications in diabetes mellitus"). Limited joint mobility also occurs in the absence of diabetes, with prevalence figures varying between 12 and 25 percent in nondiabetic subjects of three studies [4,6,7].

Limited joint mobility occurs in both type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes [4,6,7]. The risk increases with increasing glycated hemoglobin (A1C) values [8] and the duration of diabetes [4,9-11], although it can occur early in the course of the disease [6]. The prevalence also increases with age and cigarette smoking in both diabetics and nondiabetics [7,12]. (See 'Associations with other diabetic complications' below.)

Two cross-sectional studies have investigated the prevalence of limited joint mobility in patients with diabetes over time:

In children and adolescents between the ages of 7 to 18 years, the prevalence of limited joint mobility fell significantly from 31 to 7 percent, between 1976 to 1978 and 1988 [13].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 10, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Jelinek JE. The skin in diabetes. Diabet Med 1993; 10:201.
  2. Kapoor A, Sibbitt WL Jr. Contractures in diabetes mellitus: the syndrome of limited joint mobility. Semin Arthritis Rheum 1989; 18:168.
  3. Seibold JR. Digital sclerosis in children with insulin-dependent diabetes mellitus. Arthritis Rheum 1982; 25:1357.
  4. Arkkila PE, Kantola IM, Viikari JS. Limited joint mobility in type 1 diabetic patients: correlation to other diabetic complications. J Intern Med 1994; 236:215.
  5. Ramchurn N, Mashamba C, Leitch E, et al. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med 2009; 20:718.
  6. Clarke CF, Piesowicz AT, Spathis GS. Limited joint mobility in children and adolescents with insulin dependent diabetes mellitus. Ann Rheum Dis 1990; 49:236.
  7. Eadington DW, Patrick AW, Frier BM. Association between connective tissue changes and smoking habit in type 2 diabetes and in non-diabetic humans. Diabetes Res Clin Pract 1991; 11:121.
  8. Silverstein JH, Gordon G, Pollock BH, Rosenbloom AL. Long-term glycemic control influences the onset of limited joint mobility in type 1 diabetes. J Pediatr 1998; 132:944.
  9. Gamstedt A, Holm-Glad J, Ohlson CG, Sundström M. Hand abnormalities are strongly associated with the duration of diabetes mellitus. J Intern Med 1993; 234:189.
  10. Garg SK, Chase HP, Marshall G, et al. Limited joint mobility in subjects with insulin dependent diabetes mellitus: relationship with eye and kidney complications. Arch Dis Child 1992; 67:96.
  11. Larkin ME, Barnie A, Braffett BH, et al. Musculoskeletal complications in type 1 diabetes. Diabetes Care 2014; 37:1863.
  12. Schulte L, Roberts MS, Zimmerman C, et al. A quantitative assessment of limited joint mobility in patients with diabetes. Goniometric analysis of upper extremity passive range of motion. Arthritis Rheum 1993; 36:1429.
  13. Infante JR, Rosenbloom AL, Silverstein JH, et al. Changes in frequency and severity of limited joint mobility in children with type 1 diabetes mellitus between 1976-78 and 1998. J Pediatr 2001; 138:33.
  14. Lindsay JR, Kennedy L, Atkinson AB, et al. Reduced prevalence of limited joint mobility in type 1 diabetes in a U.K. clinic population over a 20-year period. Diabetes Care 2005; 28:658.
  15. Brownlee M, Cerami A, Vlassara H. Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. N Engl J Med 1988; 318:1315.
  16. Buckingham B, Reiser KM. Relationship between the content of lysyl oxidase-dependent cross-links in skin collagen, nonenzymatic glycosylation, and long-term complications in type I diabetes mellitus. J Clin Invest 1990; 86:1046.
  17. Lyons TJ, Bailie KE, Dyer DG, et al. Decrease in skin collagen glycation with improved glycemic control in patients with insulin-dependent diabetes mellitus. J Clin Invest 1991; 87:1910.
  18. Hider SL, Roy DK, Augustine T, et al. Resolution of diabetic cheiroarthropathy after pancreatic transplantation. Diabetes Care 2004; 27:2279.
  19. Shah AK, Clatworthy MR, Watson CJ. Diabetic cheiroarthropathy following simultaneous pancreas-kidney transplantation. Transpl Int 2009; 22:670.
  20. Shah KM, Ruth Clark B, McGill JB, et al. Shoulder limited joint mobility in people with diabetes mellitus. Clin Biomech (Bristol, Avon) 2015; 30:308.
  21. Kameyama M, Meguro S, Funae O, et al. The presence of limited joint mobility is significantly associated with multiple digit involvement by stenosing flexor tenosynovitis in diabetics. J Rheumatol 2009; 36:1686.
  22. Ismail AA, Dasgupta B, Tanqueray AB, Hamblin JJ. Ultrasonographic features of diabetic cheiroarthropathy. Br J Rheumatol 1996; 35:676.
  23. Khanna G, Ferguson P. MRI of diabetic cheiroarthropathy. AJR Am J Roentgenol 2007; 188:W94.
  24. Frost D, Beischer W. Limited joint mobility in type 1 diabetic patients: associations with microangiopathy and subclinical macroangiopathy are different in men and women. Diabetes Care 2001; 24:95.
  25. McCance DR, Crowe G, Quinn MJ, et al. Incidence of microvascular complications in type 1 diabetic subjects with limited joint mobility: a 10-year prospective study. Diabet Med 1993; 10:807.
  26. Akanji AO, Bella AF, Osotimehin BO. Cheiroarthropathy and long term diabetic complications in Nigerians. Ann Rheum Dis 1990; 49:28.
  27. Amin R, Bahu TK, Widmer B, et al. Longitudinal relation between limited joint mobility, height, insulin-like growth factor 1 levels, and risk of developing microalbuminuria: the Oxford Regional Prospective Study. Arch Dis Child 2005; 90:1039.
  28. Turner DE, Helliwell PS, Burton AK, Woodburn J. The relationship between passive range of motion and range of motion during gait and plantar pressure measurements. Diabet Med 2007; 24:1240.
  29. Delbridge L, Perry P, Marr S, et al. Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration. Diabet Med 1988; 5:333.
  30. Fernando DJ, Masson EA, Veves A, Boulton AJ. Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care 1991; 14:8.
  31. Duffin AC, Donaghue KC, Potter M, et al. Limited joint mobility in the hands and feet of adolescents with Type 1 diabetes mellitus. Diabet Med 1999; 16:125.
  32. Sibbitt WL Jr, Eaton RP. Corticosteroid responsive tenosynovitis is a common pathway for limited joint mobility in the diabetic hand. J Rheumatol 1997; 24:931.