Beetus 4 Flashcards
Associated pathologies with DM
- peripheral neuropathy
- atherosclerosis
- infection
- retinopathy
- nephropathy
- MSK problems
- skin ulcerations
DM: peripheral neuropathy
Cause
diminished peripheral vascular perfusion
DM: peripheral neuropathy onset
Diffuse polyneuropathy progressing distal to proximal
DM: atherosclerosis
- increased fat metabolism
- hypoglycemic damage to vessel walls
- poor healing of damage along vessels
DM: infection
- impaired wound healing » infection risk
- impaired immune response
DM: infection
Why is infection even more likely in this population?
Rapid multiplication of infectious organisms in glucose rich environment
DM: retinopathy
What causes it?
Blockage of microvascular perfusion with retinal ischemia and necrosis
DM: retinopathy (% of population)
After 20 years, all type I and 60% of type II have some degree of retinopathy
DM: nephropathy
DM is the most common cause of this
End stage renal disease
DM: nephropathy
What accelerates the damage?
Smoking
DM: MSK problems
- Dec ROM/strength
- flexor tenosynovitis
- Dupuytren’s contracture
- CTS
- adhesive capsulitis
- CRPS
- DISH
- OP
- Charcot’s arthropathy
- subluxation of tarsal and metatarsal joints
Flexor tenosynovitis
Inflammation and fibrotic changes of flexor tendons of the hand
Dupuytren’s contracture
- flexion contracture with thickening of the palmar fascia
- most commonly involved in 3rd and 4th digits in diabetic population
Dupuytren’s contracture: how is it different in the diabetic population?
Diabetic: 3rd and 4th digits
Other causes: 4th and 5th digits
How is CTS different in the diabetic pt?
More neuropathic than entrapment
DM: adhesive capsulitis
Thickening and stiffening of the GH capsule
CRPS =
Complex regional pain syndrome
RSD =
Reflex sympathetic dystrophy (former name for CRPS)
DISH =
Diffuse idiopathic skeletal hyperostosis
What is DISH?
- Osteophytes grow and fuse from adjacent vertebrae
- most common in t-spine, but seen in other joints/areas
DM: When does OP occur?
- generalized OP within 5 years of DM I onset
- less pronounced in DM II (get microfractures and decreased bone repair)
Charcot’s arthropathy
Loss of sensation with repeated trauma to joints
DM: skin ulceration
Shear forces increased due to
- orthopedic changes
- previous scarring
- subcutaneous stiffness
- loss of local fat pads
What leads to skin ulceration in a diabetic pt?
- neuropathy
- decreased vascular perfusion
- increased shear forces
- lack of normal sweating
- dry and elastic skin
- decreased healing (lack of vascularization)
