Diabetic myonecrosis is a rare complication of diabetes. It is caused by infarcted muscle tissue, usually in the thigh. This article is about the disease that features high blood sugar. ... A top-down view of skeletal muscle Muscle (from Latin musculus little mouse, referring to muscles like the biceps which pop up as though a mouse were scurrying about under the skin [1]) is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ...

Epidemiology

• Mean age at presentation 37yrs (reported range 19-64yrs) a
• Mean age since diagnosis of diabetes 15 years
• Female:Male ratio = 1.3:1
• Presence of diabetic complications nephropathy, neuropathy, retinopathy and hypertension are usually present.

This article is about the disease that features high blood sugar. ... Nephropathy refers to damage to or disease of the kidney. ... Neuropathy strictly speaking is any disease that affects the neurons of the nervous system. ... Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. ... For other forms of hypertension see hypertension (disambiguation). ...

Symptoms

Acute onset muscle pain usually in the thigh (62%) (in the absence of trauma)

Signs

• Exquisitely tender muscle
• Swelling

Differential Diagnosis:

 deep vein thrombosis thrombophlebitis cellulitis  fasciitis abscess haematoma myositis pseudothrombophlebitis (ruptured synovial cyst) pyomyositis parasitic myositis osteomyelitis calcific myonecrosis myositis ossificans diabetic amyotrophy muscle strain muscle rupture bursitis vasculitis arterial occlusion haemangioma lymphoedema sarcoidosis tuberculosis cat-scratch disease amyloidosis tumours: lipoma chondroma fibroma leiomyoma sarcoma 

This article is about Deep-vein thrombosis. ... It has been suggested that this article or section be merged into deep vein thrombosis. ... In medicine, fasciitis refers to an inflammation of the fascia. ... Abscess An abscess is a collection of pus collected in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e. ... A heamatoma is when boush bags become extremely inflamed and painful ush flaps become itchy and flackey just like frosted flackes :S ... Osteomyelitis is an infection of bone, usually caused by pyogenic bacteria or mycobacteria. ... Inflammation of the bursa in a male human shoulder Bursitis is the inflammation of one or more bursa, or small sacks of oil, in the body. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels. ... Hemangioma is a benign tumor, usually in the shape of a ball, but sometimes a flatter mat, formed by a collection of excess blood vessels in an area. ... Lymphedema is a condition of localized fluid retention caused by a compromised lymphatic system. ... It has been suggested that Antituberculant be merged into this article or section. ... Cat Scratch Fever is also the title of a 1977 album by Ted Nugent. ... A lipoma is a common, benign tumor composed of fatty tissue. ... A chondroma is a benign cartilaginous tumor, which is encapsulated with a lobular growing pattern. ... Soft Fibroma (fibroma molle). ... A leiomyoma (plural is leiomyomata) is a benign smooth muscle neoplasm that is not premalignant. ... A sarcoma is a cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. ...

Investigations

• Creatinine Kinase - normal
• Erythrocyte Sedimentation Rate - raised
• Planar X-ray - soft tissue swelling
• Electromyography non specific focal changes
• Bone scan - non specific uptake
• Arteriography - large & medium vessel arteriosclerosis occasionally with dye within the area of tissue infarction
• CT Muscle oedema with preserved tissue planes (non-contrast enhancing)
• MRI - increased signal on T2 weighted images within areas of muscle oedema

• Tissue biopsy is the gold standard. Macroscopically this reveals pale muscle tissue. Microscopically infarcted patches of myocytes. Necrotic muscle fibers are swollen and eosinophilic and lack striations and nuclei. Small-vessel walls are thickened and hyalinized, with luminal narrowing or complete occlusion. Biopsy cultures for bacteria, fungi, acid-fast bacilli and stains are negative in simple myonecrosis.

Electromyography (EMG) is a medical technique for measuring muscle response to nervous stimulation. ... A bone scan is a nuclear medicine study. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Look up CT, Ct, ct in Wiktionary, the free dictionary. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... This article is on the monetary principle. ... Myocyte is the technical term for a muscle cell. ... Necrosis (in Greek Νεκρός = Dead) is the name given to unprogrammed death of cells/living tissue (compare with apoptosis - programmed cell death). ... Eosinophilic is a technical term used by histologists. ... Luminal is another name for the hypnotic, anti-epileptic drug phenobarbital. ... Subgroups Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular: bacterium) are a major group of living organisms. ... Divisions Chytridiomycota Zygomycota Ascomycota Basidiomycota The Fungi (singular: fungus) are a large group of organisms ranked as a kingdom within the Domain Eukaryota. ... A bacillus is a rod-shaped bacterium: an acid-fast bacillus (or AFB) is a rod-shaped bacterium which, when stained with certain compounds, retains that stain despite treatment with an acidic solution. ...

Treatment

• Supportive with analgesics & anti-inflammatories.
• Exercise increases pain and extends the area of infarction.

For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...

Prognosis

• Symptoms usually resolve in weeks to months.
• Fifty percent will relapse in either leg.
• The majority diagnosed woth diabetic myonecrosis die within 5 years.

Pathophysiology

Arteriosclerosis obliterans has been postulated, along with errors of the clotting and fibrinolytic pathways. Coagulation is the thickening or congealing of any liquid into solid clots. ... The fibrinolytics are a class of pharmaceuticals that act as thrombolytics by activating plasminogen to form plasmin. ...

Notes:

1)CASE REPORT Detection of diabetic myonecrosis Complication is often-missed sign of underlying disease Ruth Lachar Wintz, MD; Kevin Rael Pimstone, MD; Scott Douglas Nelson, MD WEB EXCLUSIVE / JANUARY 2002 / POSTGRADUATE MEDICINE http://www.postgradmed.com/issues/2002/01_02/wintz.htm

2)Spontaneous non-traumatic muscle pain in diabetes. Endocrine Abstracts (2005) 10 DP12 AM Mousa, SF Hussein, PR Daggett & PA Coates http://www.endocrine-abstracts.org/ea/0010/ea0010dp12.htm

3) Diabetic Myonecrosis: Rare And Ominous Complication Of A Common Disease Vivek Subbiah, MD.1, Rupesh Raina, MD.1, David C. Kaelber, MD, PhD.1, Moonja Chung-Park, MD.2, De Chant Halle, MD.3, David Mansour, MD.1 and Holly B. Perzy MD.1 http://www.metrohealth.org/documents/patient%20services/MedPeds/DiabeticMyonecrosis.pdf#search=%22diabetic%20myonecrosis%22