Upper-limb complications of diabetes, including osteoarticular, musculoskeletal, and neurologic disorders, are often underdiagnosed and inadequately managed (read more). These conditions can cause substantial pain and disability, making early diagnosis and appropriate treatment important.

During the European Association for the Study of Diabetes (EASD) 2026 Annual Meeting, Lars B. Dahlin, MD, PhD, professor emeritus of hand surgery at Lund University and hand surgeon at the Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital in Malmö, Sweden, discussed the management of these complications.

He is also a co-author of the review Upper-Limb Complications in Diabetes.

Complications affecting the upper extremities include chronic inflammation, older age, longer diabetes duration, poor glycemic control, smoking, and obesity. Upper-limb complications often resolve more slowly and recur more frequently in patients with diabetes than in those without diabetes. Routine screening and optimization of glycemic control may help reduce complications and improve outcomes.

Treatment generally begins with symptom management and rehabilitation, including stretching and early physical therapy to preserve joint mobility. Analgesics and nonsteroidal anti-inflammatory drugs should be used cautiously because of their potential for causing renal and cardiovascular complications in this population.

Corticosteroid injections and surgery may also be appropriate depending on the condition. However, “corticosteroid injections can cause transient hyperglycemia in patients with diabetes, requiring close blood glucose monitoring and, in some cases, temporary adjustment of insulin therapy,” cautioned Dahlin.

Additionally, surgery is associated with a higher risk for infection and slower wound healing in patients with diabetes than in the general population.

Tailored Treatment and Multidisciplinary Care

Treatment depends on the specific upper-limb complication and its severity:

• Adhesive capsulitis of the shoulder. This may be treated with corticosteroid injections during stage I with physical therapy. If symptoms persist, mobilization under anesthesia or arthroscopic capsulotomy may be considered.
• Dupuytren disease. This may be treated with corticosteroid injections for painful nodules or collagenase injections available in the US. Surgical options include needle aponeurotomy and partial fasciectomy when restricted finger extension causes functional impairment, particularly in the proximal interphalangeal joints.
• Trigger finger. This may be treated with corticosteroid injections or surgical release of the A1 pulley. “In patients with diabetes, injections have a high failure rate, reaching up to 75% in those with type 1 diabetes, particularly when HbA1c levels are high. Surgical release may therefore be a more favorable first-line option in this population,” Dahlin said.
• Carpal tunnel syndrome. This may initially be managed with ergonomic measures and orthoses when symptoms are intermittent. However, in cases of persistent symptoms, surgical decompression of the median nerve may be warranted. “In patients with diabetes, corticosteroid injections into the carpal tunnel are not recommended,” Dahlin said.
• Ulnar nerve entrapment. This may initially be managed with ergonomic measures and a brace that limits maximal elbow flexion. However, in cases of persistent or severe symptoms, in situ decompression or ulnar nerve transposition should be performed. “In patients with diabetes, postoperative outcomes are generally similar or slightly less favorable, with concomitant carpal tunnel decompression performed more often,” Dahlin said.
• Rhizarthrosis. This is initially managed conservatively with self-rehabilitation, a pain-relieving orthosis, and corticosteroid injections. When pain at rest is severe, trapeziectomy with or without interposition arthroplasty or prosthetic arthroplasty may be indicated. “In patients with diabetes, surgery is associated with a slightly increased risk for complications and wound infections as well as more readmissions and repeat surgeries for certain arthroplasties,” Dahlin said.

Regardless of the upper-limb complications being treated, multidisciplinary follow-up involving a diabetologist, rheumatologist, surgeon, and rehabilitation specialist is recommended.

Dahlin reported having no relevant conflicts of interest. 

This story was translated from Medscape’s French edition.