Diabetic amyotrophy, also termed diabetic lumbosacral radiculoplexus neuropathy or proximal diabetic neuropathy, is a distinct and relatively uncommon form of diabetic neuropathy characterised by subacute, often asymmetric pain followed by progressive weakness and wasting of the proximal lower-limb muscles. It typic…
Diabetic amyotrophy, also termed diabetic lumbosacral radiculoplexus neuropathy or proximal diabetic neuropathy, is a distinct and relatively uncommon form of diabetic neuropathy characterised by subacute, often asymmetric pain followed by progressive weakness and wasting of the proximal lower-limb muscles. It typically affects the muscles of the hip, thigh, and buttock, usually beginning on one side before sometimes extending to the contralateral limb, and is frequently accompanied by severe neuropathic pain and significant weight loss. The condition occurs more often in older adults with type 2 diabetes and can arise even when glycaemic control is reasonable. Its pathophysiology is thought to involve a microvasculitis and immune-mediated ischaemic injury to nerve roots and the lumbosacral plexus, distinguishing it from the length-dependent distal symmetric polyneuropathy that more commonly complicates diabetes. Diagnosis is largely clinical, supported by electrodiagnostic studies showing axonal involvement of the affected plexus and by exclusion of structural and other causes of proximal weakness. The course is typically monophasic, with pain often preceding weakness and gradual, though sometimes incomplete, recovery over months to years. Management centres on neuropathic pain control, optimisation of glycaemic and metabolic status, and intensive physical rehabilitation to preserve strength and function; the role of immunomodulatory therapy remains an area of ongoing investigation.
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