Objective: To assess the role of high resolution sonography and interventional sonography in diagnosis and management of diabetic hand tendinopathy.Methods: One hundred and two consecutive diabetic patients, along with 40 normal controls without a known history of diabetes were examined in the study. Of the diabetic patients, (76) females & (26) males, mean age years = 53.83+9.6yrs, 91 had NIDDM and 11 had IDDM. All patients were subjected to clinical examination to assess the presence of diabetic cheiroarthropathy(DCA) by measuring the angle of extension at the PIPJ using a goniometer, examined for trigger fingers(TF), tendon nodules, thickened indurated skin over the dorsum of the hand & for Tinel's sign. High-resolution ultrasonography was used to examine the digital flexor tendons, as well as, their synovial & fibrous sheaths, median nerve and skin thickness. In this study, 34 patients with DCA and/or TF were subjected to injection of their flexor tendon sheaths, using a mixture of corticosteroid & local anesthetic; 17 patients were injected blindly while the other 17 patients were injected under ultrasound guidance. A time series design was employed in which individual patients served as their own control before and after injection. Results: Our patients were classified into three groups; group A with DCA, group B with TF and group C with neither DCA nor TF. Cheiroarthropathy was found in 24/102 patients (24%). Diabetic patients with cheiroarthropathy had significantly increased frequency of retinopathy (58% versus 0%), nephropathy (58% vs 4%), and peripheral neuropathy (42% vs 12%) and were more often on insulin treatment (25% vs 17%). They showed significantly increased synovial sheath thickness on ultrasonography (1.1+0.19mm vs 0.72 +0.12mm in the diabetic patients without DCA, versus 0.28 +0.1mm in the control group). Trigger finger was found in 71/102 patients (70%);. Diabetic patients with TF had significantly increased frequency of retinopathy (37% vs 0%), nephropathy (32% vs 4%), and peripheral neuropathy(41% vs 12%) and were more often on insulin treatment(44% vs 17%). They showed significantly increased A1 pulley thickness on ultrasonography (1.17+0.19mm vs 0.76 +0.11mm in the diabetic patients without trigger finger). No differences in the tendon itself could be detected between the different groups (A, B & C groups). Diabetic patients with DCA and/or TF (group A & B) had increased frequency of CTS, sclerodactyly & lower extremity ischemia, compared with group C but these differences were also statistically insignificant. In patients with clinical evidences of carpal tunnel syndrome (CTS), the mean median nerve cross-sectional area was 18+3.84 mm2, compared to 9.4+2.2 mm2 in patients without clinical evidences of CTS. Ultrasonography of the median nerve showed significant caliber change across the carpal tunnel and/or cross-sectional area >15 mm2 in 92% (57/62) of these patients with clinical evidences of CTS. Response rate to corticosteroid injection, defined as complete resolution of the abnormal diabetic finger after injection were 34/37 (92%) at one month post-injection, which is significantly different from pre-injection (P value <0.001). Response rate for trigger finger injection alone was 29/32 (91%) & response rate for DCA injection alone was 5/5 (100%). Response rate for ultrasound-guided injection was 94% (16/17) while response rate for blind injection was 90% (18/20). Conclusion: Diabetes-associated hand conditions including diabetic cheiroarthropathy, trigger finger, diabetic sclerodactyly & carpal tunnel syndrome are common in Egyptian diabetic patients and commonly associated with diabetic microvascular complications (namely; retinopathy, nephropathy and peripheral neuropathy) as well as, lower extremity ischemia. High resolution ultrasonography is the modality of first choice for assessment of DCA, TF, CTS and sclerodactyly, being easy, rapid, inexpensive, widely available and accurate. Corticosteroid injection is an effective safe underused therapy for diabetic hand conditions and should be considered in all patients with DCA and/or TF while surgery should be considered only after repeated failure of corticosteroid injection.