Severe limited joint mobility (LJM) involving both the hands and feet in type 1 diabetes mellitus

Objective Limited joint mobility (LJM) is one of the most common disabling musculo-skeletal complications in long-standing diabetes. Though it has been described extensively in previous pieces of literature, symmetrical involvement of both upper and lower limbs hasn’t been much reported in recent accounts. Case presentation A 25-year-old boy with type 1 diabetes mellitus (T1DM) (diagnosed at 14 months of age with poor glycemic status) had presented with progressive flexion deformity of both upper and lower limbs. It had started from the little fingers of both hands followed by the involvement of the other finger and toes. It was associated with tight and waxy skin. There was no history of trauma, pain, redness or morning stiffness. On examination, symmetrical contractures of metacarpo-phalangeal and inter-phalangeal joints of all the fingers along with the involvement of metatarso-phalangeal and inter-phalangeal joints of foot were found. These LJM findings were classified as stage III as per Brink-Starkman classification. Further examination revealed bilateral moderate nonproliferative retinopathy and proteinuria. The patient was started on palmar-stretching exercises along with reinforcement of adequate glycemic control and relative improvement was noted after 6 months. Conclusion LJM has been found to be consistently associated with microvascular complications of diabetes. Its chief pathogenesis is abnormal cross-linking of collagen fibers. The uniqueness behind this description lies in the advanced presentation of LJM involving both the hands and feet. This case also illustrates the need for regular checks for musculoskeletal involvement in T1DM, which are frequently missed.