Prayer sign.

A 50-year-old male with poorly controlled type 2 diabetes of 10 years duration presented with history of inability to straighten his fingers. Microvascular complications in the form of retinopathy, neuropathy and nephropathy were present. Examination of hands revealed presence of “Prayer sign,” a feature of diabetic cheiroarthropathy [Figure 1]. It is also known as diabetic stiff hand syndrome or limited joint mobility syndrome. It is found in both type 1 and type 2 diabetic patients. The prevalence increases with duration of diabetes.[1] This condition is associated with and predictive of diabetic microvascular complications. Increased glycosylation of collagen in the skin and periarticular tissue, increased collagen degradation, microangiopathy and neuropathy are postulated to be the multiple factors responsible for it. Biopsy specimens of involved skin show pronounced thickening of periarticular collagen. Treatment consists of achieving gIycemic control and an individualized hand therapy programme.[2]

Figure 1

The “prayer sign” is shown by inability to completely close gaps between the opposed palms and fingers on pressing them together