Diabetic muscle infarction: a systematic review

Abstract

Context: Diabetic muscle infarction (DMI) is a rare complication associated with poorly controlled diabetes mellitus. Less than 200 cases have been reported in the literature since it was first described over 45 years ago. There is no clear 'standard of care' for managing these patients.

Evidence acquisition: PubMed searches were conducted for 'diabetic muscle infarction' and 'diabetic myonecrosis' from database inception through July 2014. All articles identified by these searches were reviewed in detail if the article text was available in English.

Evidence synthesis: The current literature exists as case reports or small case series, with no prospective or higher-order treatment studies available. Thus, an evidence-based approach to data synthesis was difficult. The available literature is presented objectively with an attempt to describe clinically relevant trends and findings in the diagnosis and management of DMI.

Conclusions: Early recognition of DMI is key, so appropriate treatment can be initiated. MRI is the radiological study of choice. A combination of bed rest, glycemic control, and non-steroidal anti-inflammatory drug therapy appears to yield the shortest time to symptom resolution and the lowest risk of recurrence.

Keywords: Clinical Complications; NSAIDs.

Figure 1

Flow diagram of the review and selection of cases (DMI, diabetic muscle infarction).

Figure 2

Diabetic muscle infarction affected regions by percentages. The most commonly affected region is the front thigh, followed by the calf and back thigh. Affected muscle groups: vastus medialis (25; 17.9%), vastus lateralis (21; 15%), vastus intermedius (10; 7.1%), rectus femoris (9; 6.4%), soleus (8; 5.7%), gastrocnemius (7; 5%), adductor magnus (6; 4.3%), biceps femoris (6; 4.3%), sartorius (5; 3.6%), gracilis (4; 2.9%), tibialis anterior (4; 2.9%), gluteus maximus (3; 2.1%), peroneus brevis (3; 2.1%), semimembranosus (3; 2.1%), deltoid (2; 1.4%), brachioradialis (2; 1.4%), tibialis posterior (2; 1.4%), pectineus (1; 0.7%), external obturator (1; 0.7%), flexor digitorum longus (1; 0.7%), flexor hallucis longus (1; 0.7%), tensor fasciae latae (1; 0.7%), triceps (1; 0.7%), biceps (1; 0.7%), brachialis (1; 0.7%), coracobrachialis (1; 0.7%), pronator teres (1; 0.7%), pectoralis major (1; 0.7%), supraspinatus (1; 0.7%), subscapularis (1; 0.7%), adductor hallucis (1; 0.7%), extensor hallucis longus (1; 0.7%), plantaris (1; 0.7%), obturator (1; 0.7%), gluteus medius (1; 0.7%), gluteus minimus (1; 0.7%), semitendinosus (1; 0.7%).

Figure 3

Imaging studies. Proton density fat-saturated MRI sequence demonstrates an increased signal within the semimembranosus and biceps femoris musculature (large arrows) and the adductor magnus muscle (thin arrow) consistent with edema due to early muscle infarction. MRI was performed in the 103 cases included. The findings identified included T2 hyperintensity (86; 76.8%), T1 hypointensity (7; 6.3%), T1 isointensity (8; 7.1%), and T1 hyperintensity (2; 1.8%). No MRI was performed in 23 cases (18.3%).