Diabetic Lumbosacral Plexopathy Clinical Presentation

Updated: Mar 07, 2019
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Milton J Klein, DO, MBA  more...
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Presentation

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. [26]

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. [27]

Gupta et al reported on the occurrence of cervical-radiculoplexus neuropathy in a man aged 53 years with type 2 diabetes, in whom the cranial and phrenic nerves were concomitantly involved and in whom the neuropathy developed in a stepwise, monophasic course. [28]

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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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