Patients with diabetes may suffer general tiredness, soreness, and muscle aches, associated with loss of energy. Could this be Fibromyalgia? How do you tell the difference.
Diabetes and Fibromyalgia
A. Lee Dellon, MD, Professor of Plastic Surgery
and Neurosurgery, Johns Hopkins University, Director of the Dellon Institutes for Peripheral Nerve Surgery http://www.dellonipns.comPatients with diabetes may suffer general tiredness, soreness, and muscle aches, associated with loss of energy. Could this be Fibromyalgia? How do you tell the difference.The American College of Rheumatology recognizes Fibromyalgia as a chronic condition with widespread and changing degrees of multifocal tenderness, involving the limbs and trunk. Many diabetics with nerve compression have symptoms in the arms and legs that could be confused with Fibromyalgia.
A. Lee Dellon, MD, Director of the Dellon Institutes for Peripheral Nerve Surgery http://www.dellonipns.com
A recent article in the Journal of the American Podiatric Medical Association addresses the physical examination techniques to differentiate Fibromyalgia from nerve entrapment in a manner that is valuable for the patient with diabetes (Fibromyalgia and Tinel’s Sign in the Foot, by Shookster, L, Falke, G.I., Ducic, I, Maloney, C.T., and Dellon, A.L., volume 94:400-403, 2004.)
This group of authors has also written about this technique of examination when applied to the upper extremity (Dellon AL, Shookster L, Maloney CT, Ducic I.: Diagnosis of compressive neuropathies in patients with fibromyalgia. J Hand Surg, 28A: 894-897, 2003.) Doctor Shookster is a Rheumatologist. Dr. Falke is a Podiatrist. The other authors are members of the Dellon Institutes for Peripheral Nerve Surgery? (dellonins.com).
There is no laboratory test that can be used to make the diagnosis of Fibromyalgia. However, the American College of Rheumatology recognizes the existence of 18 “fibro points”. If 11 of these 18 are tender, and the symptoms and history of pain are compatible with the syndrome, the Fibromyalgia may be considered as the diagnosis.
The main point made in the two articles described above is that the diabetic who has a nerve entrapment will have a localized point of tenderness over the known site of anatomic narrowing in which the nerve is entrapped.
The commonest one of these in the upper extremity would be the median nerve in the carpal tunnel at the wrist. The commonest of these in the lower extremity would be the tibial nerve in the tarsal tunnel at the inside of the ankle.
None of the known sites of nerve entrapments is the same as the fibro points.
Therefore, the doctor can determine whether the diabetic with symptoms of pain and aching in the arms has either tender fibro points of signs of nerve entrapment with a reliable physical examination technique.
Based on this data the physician can then refer to the proper specialist.
A. Lee Dellon, M.D. is the founder of The Dellon Institutes for Peripheral Nerve Surgery®. He is an accomplished Plastic Surgeon as well as a Professor of Plastic Surgery and Neurosurgery at the prestigious Johns Hopkins University School of Medicine, at the University of Maryland in Baltimore, Maryland and at the University of Arizona, Tucson, Arizona.
He specializes in the treatment of diabetic neuropathy as well as other painful peripheral nerve disorders and has trained many surgeons worldwide in the procedures he has developed to relieve pain.
Dr. Dellon completed his BS at John Hopkins University and received hi Medical Degree from Johns Hopkins University School of Medicine in 1970. He Completed General Surgery, Plastic Surgery and Hand Surgery Residencies at Columbia Presbyterian Hospital, John Hopkins Hospital and Union Memorial Hospital respectively. He has been in practice since 1978 and has been on the faculty of Johns Hopkins since that time.