Diabetic muscle infarction
- Lesley D Hordon, MD
Lesley D Hordon, MD
- Consultant in Rheumatology
- University of Leeds, United Kingdom
- Section Editors
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
Diabetic muscle infarction, which is also referred to as spontaneous diabetic myonecrosis, is the term used for spontaneous ischemic necrosis of skeletal muscle, unrelated to atheroembolism or occlusion of major arteries. It causes acute or subacute pain, swelling, and tenderness, typically in the thigh or calf.
Diabetic muscle infarction is one of many micro- and macrovascular complications of diabetes. Others include diabetic retinopathy, nephropathy, neuropathy, and atherosclerotic vascular disease affecting other circulatory beds.
The clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of diabetic muscle infarction are discussed here. Other musculoskeletal manifestations of diabetes mellitus and disorders with an increased prevalence in patients with diabetes are presented separately, as is an approach to minimizing the risk of complications arising from diabetic micro- and macrovascular disease. (See "Musculoskeletal complications in diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus".)
The pathogenesis of diabetic muscle infarction is uncertain but appears related to vasculopathic changes associated with longstanding and poorly controlled diabetes; factors responsible for the acute onset of symptoms and findings are unknown. The primary pathologic findings in muscle biopsies from affected patients are muscle necrosis and edema; occlusion of arterioles and capillaries by fibrin may also be seen [1,2].
Spontaneous infarction of muscle is a rare condition; it occurs in both type 1 and type 2 diabetes, and the majority of patients have other multiple microvascular complications, including retinopathy, nephropathy, and/or neuropathy [1,3-5]. The prevalence of this condition is difficult to determine as most information has been obtained from analyses of published case reports.
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- CLINICAL MANIFESTATIONS
- Symptoms and physical findings
- Imaging features
- - MRI
- - Ultrasonography
- - Arteriography
- Muscle biopsy
- Diagnostic evaluation
- - Testing in all patients
- - Testing in selected patients
- Differential diagnosis
- SUMMARY AND RECOMMENDATIONS