Pointing Out the Facts: Diabetes Stiff Hand Syndrome (DSHS)

Diabetic stiff hand syndrome (DSHS) is a painless disorder that can limit hand function in patients with diabetes. Patients who develop DSHS suffer from an increased stiffness of the hands, which can limit mobility and make it harder to complete daily tasks. DSHS occurs in up to 58% of patients with type 1 diabetes and occurs up to 76%of patients with type 2 diabetes. DSHS is most common in those who have uncontrolled diabetes, have a long history of diabetes (greater than 30 years) and have diabetic nerve damage (neuropathy).
Causes of DSHS

Scientists are still unsure why diabetes increases the risk for hand complications. Possible theories for this condition appear to be related to problems with your body’s collagen. Collagen is a protein that makes up tendons, joints, ligaments and other connective tissue in the body. Increased collagen production, decreased collagen break down, and changes to the composition of collagen can lead to abnormal gathering of proteins in your hands, which makes them more stiff.

Signs and Symptoms

Symptoms include thick, tight, waxy skin that is often found on the back of the hand. Stiffness usually begins at the little finger and spreads to the thumb.Inability to flex or extend the fingers and severely limited hand function is also described. A test for DSHS is the “prayer sign” test: try pressing your hands together completely without gaps between the palms and fingers. If your hands cannot press together, and there are significant gaps, this may be indicative of diabetic stiff hand syndrome.


Tight blood sugar control is the best way to prevent or slow the development of DSHS.In the images above, a patient is shown attempting the “prayer sign” test, and in the second image improvement is seen in the patient after four months of good blood glucose control.Experts recommend keeping your hands strong and flexible, massaging the hands, and utilizing hand exercises like throwing and catching a ball.Never force a stretch and stop if you feel any pain right away. Physical therapy may be recommended by your doctor if your symptoms and limited joint mobility are causing you distress.


DSHS is a common disorder that can limit the ability of patients with diabetes to complete daily tasks with their hands.  DSHS can also be a sign that your blood sugar levels are uncontrolled. It is important to report hand stiffness or other signs and symptoms of DSHS to your health care provider as well as to maintain good control of your diabetes.

This Article is Brought to you By Our Guest Staff Writers:
Hannah Kim, PharmD Candidate 2016 ‎MCPHS University
Damian Bialonczyk, PharmD, MBA Fellow, MCPHS University
Jennifer Goldman, PharmD, CDE, BC-ADM, FCCP Professor of Pharmacy Practice, MCPHS University Clinical Pharmacist, Well Life Medical, Peabody