Disclosures: Monica S. Branch, MA, MD: Nothing to disclose

Case Description: The patient was diagnosed with diabetic muscle infarction (DMI) – also called diabetic myonecrosis – of the right anterior thigh. Physical exam was remarkable for 4/5 strength in bilateral upper extremities, 1/5 strength in bilateral hip flexion and knee extension, 3/5 strength in dorsi/plantarflexion. Admission labs: Leukocytosis 17.4, glucose 260, HbA1c 7.4. MRI of the right thigh showed extensive myositis with mild necrosis of adductor brevis, adductor longus, and semitendinosis. Electrodiagnostic findings were suspicious for polyneuropathy and myopathy. Pre-admit functional status: Minimal Assist with rolling walker; Moderate Assist for wheelchair mobility and sit<>stand; Maximum Assist for lower body dressing and toileting; and Supervision for supine<>sit. Physical Therapy (PT) long term goals: Moderate Independence with wheelchair propulsion on level surfaces and up/down 3% ramp; Moderate Assist for wheelchair<>bed; Minimum/Moderate Assist with ambulating 50’ with rolling walker. Occupational Therapy (OT) long term goals: Moderate Independence with IADLs at wheelchair level, complete home exercise program for bilateral upper extremity strengthening; family to independently demonstrate safe assist/cues with toilet and shower transfers. Her rehab course was complicated by labile blood sugars with multiple episodes of symptomatic hypoglycemia, dehydration due to chronic diarrhea, and decreased activity tolerance due to pain and fatigue.

Setting: Acute Inpatient Rehabilitation Hospital

Patient: A 35-year-old female with poorly controlled type 1 diabetes mellitus complicated by multiple episodes of diabetic ketoacidosis; diabetic induced: left thigh myonecrosis, nephropathy, neuropathy, retinopathy, and gastroparesis; anemia; protein calorie malnutrition; and anxiety/depression.

Assessment/Results: Patient met 2/3 goals for PT and 1/3 goals for OT. She was discharged to home with family after 4 weeks of acute inpatient rehab.

Discussion: Optimal treatment approach for DMI is uncertain as there is no clear consensus for standard of care management.

Conclusion: Early recognition, symptomatic management, optimal glycemic control, and a comprehensive/interdisciplinary rehabilitation program are beneficial in improving functional outcomes in patients with DMI.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-rehabilitation-management-of-diabetic-muscle-infarction-a-case-report/