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
The term diabetic muscle infarction is used to refer to spontaneous ischemic necrosis of skeletal muscle, unrelated to atheroembolism or occlusion of major arteries. Also referred to as spontaneous diabetic myonecrosis, it causes acute or subacute pain, swelling, and tenderness, typically in the thigh or calf. The clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of diabetic muscle infarction are discussed in this topic review.
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. An approach to minimizing the risk of complications arising from diabetic micro- and macrovascular disease is presented elsewhere. (See "Overview of medical care in adults with diabetes mellitus".)
Other musculoskeletal manifestations of diabetes mellitus and disorders with an increased prevalence in patients with diabetes are presented separately. (See "Musculoskeletal complications in diabetes mellitus".)
EPIDEMIOLOGY AND PATHOGENESIS
Spontaneous infarction of muscle is a rare condition which usually affects patients with longstanding and poorly controlled diabetes mellitus; it occurs in both type 1 and type 2 diabetes but more in type I, and the majority of patients have multiple microvascular complications including retinopathy, nephropathy, and/or neuropathy [1,2]. A systematic review of the literature through August 2001 identified a total of 116 patients . The mean age at presentation was 43 (range 19 to 81 years), the average duration of diabetes was 14 years (range 0 to 50), and vascular complications of diabetes were present in the majority of cases, particularly nephropathy (71 percent), retinopathy (57 percent) and neuropathy (55 percent). In this review, 59 percent of patients with muscle infarction had type 1 diabetes, 24 percent had type 2 diabetes, and in the remaining 17 percent the type of diabetes was 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 [1,4]. The pathogenesis is uncertain. Hyperglycemia with or without insulin resistance has many potentially adverse effects on the arterial vasculature and may also affect platelets and the levels of coagulation and thrombolytic factors. These effects are discussed elsewhere in the context of their role in predisposing to coronary heart disease. (See "Prevalence of and risk factors for coronary heart disease in diabetes mellitus".)
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