Diabetic myonecrosis: An easily overlooked cause of limb pain in diabetic patients

Abstract

Diabetic myonecrosis (DMN) is an underdiagnosed cause of spontaneous extremity pain and swelling in patients with diabetes. Failure to consider this diagnosis in patients with recent onset of extremity pain may lead to inappropriate testing and to treatment that worsens symptoms and delays healing. The following is a case report of recurrent diabetic myonecrosis in a 36-year-old woman that highlights several typical features of this uncommon disorder. We discuss the differential diagnosis and how to rapidly identify DMN, as well as best practices for the treatment of the disorder. We approach most types of muscular pain issues with stretching and exercise, but this approach can result in increased pain and delayed resolution in patients with DMN. Nurse practitioners and other providers should consider DMN when faced with a patient with diabetes and spontaneous extremity pain and understand how to efficiently diagnose this disorder and rule out other causes.