Diabetic Lumbosacral Plexopathy Clinical Presentation

  • Author: Divakara Kedlaya, MBBS; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Apr 4, 2011
 

History

Several findings commonly are reported in patients with diabetic lumbosacral plexopathy. These include asymmetrical pain in the hip, buttock, or thigh and proximal weakness in the quadriceps, hip adductors, and iliopsoas muscles. Diabetic lumbosacral plexopathy often occurs in conjunction with significant recent weight loss (commonly 10-40 pounds) and is associated with poor glycemic control.[19]

Patients may have underlying distal symmetrical polyneuropathy (DSPN). Gradual onset with bilateral presentation is typical in individuals with DSPN; patients are usually insulin dependent. However, patients without DSPN most often have a sudden, unilateral onset. This symptom is sometimes the initial presenting feature of diabetes mellitus.[20]

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Physical Examination

Proximal lower limb muscle weakness and wasting are characteristic features of diabetic lumbosacral plexopathy; the patient has particular difficulty getting up from a squatting position. Minimal sensory loss is observed, and the knee-jerk reflex is absent, with commonly preserved ankle jerks; however, ankle jerks may also be absent with underlying DSPN.

Features observed in the physical examination may be localized in the lumbosacral plexus or the upper lumbar roots.

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Contributor Information and Disclosures
Author

Divakara Kedlaya, MBBS  Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine; Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, and Colorado Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Teresa L Massagli, MD  Professor of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Chief Editor

Robert H Meier III, MD  Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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