Numbness in thighs, hips and buttocks
Proximal diabetic neuropathy is also known as diabetic polyradiculopathy or diabetic amylotrophy.It is a complication if diabetes mellitus that affects the nerves that supply the thighs, hips, buttocks and/or lower legs. It can also affect the abdominal and chest area.It is caused by damage to nerves of lumbosacral plexus.The lumbosacral plexus is a network of nerve fibers, derived from the roots of lumbar and sacral spinal nerves that branch out to form the nerves supplying the lower limb.
Proximal diabetic neuropathy is most commonly seen people with Type II diabetics. It is less common than distal polyneuropathy that often occurs in diabetes.
Signs and symptoms:
Signs and symptoms of proximal diabetic neuropathy depend on the nerves affected. The first symptom is usually pain in the buttocks, hips, thighs or legs. This pain often starts suddenly and affects one side of the body, although may spread to both sides. This is often followed by variable weakness in the proximal muscles of the lower limbs such as the thigh and buttocks. The damage to nerves supplying specific muscles may cause muscle twitching in addition to the weakness. It is sometimes associated with weight loss.
Diabetes most commonly causes damage to the long nerves that supply the feet and lower legs, causing numbness, tingling and pain (diabetic polyneuropathy). Although these symptoms may also be present, the pain and weakness of proximal diabetic neuropathy often onset more quickly and affect nerves closer to the torso,the main part of your body, not your head, arms and legs.
Symptoms are usually on one side of the body, but may spread to the other side.Proximal Neuropathy causes pain usually on one side in the thighs, hips, or buttocks. It can also lead to weakness in the legs.
Causes of Proximal diabetic neuropathy:
This condition most commonly affects people with Type II diabetes, although sometimes presents in those without diabetes known as nondiabetic lumbosacral radiculoplexus neuropathy. The population trends suggest that hyperglycemia likely plays a role but may not be the causative factor.
The nerve damage associated with the disease was first thought to be caused by metabolic changes such as endoneurial microvessel disease, in which cells that support the endothelium (pericytes) are damaged due to high blood sugar. Pericytes regulate capillary blood flow and phagocytosis of cellular debris and ischemia of the nerves can occur if pericytes are damaged. A different potential mechanism involves an immune mechanism causing a microvasculitis which could lead to ischemia.Ischemia means an inadequate blood supply to an organ or part of the body.
Diagnosis of Proximal diabetic neuropathy:
More definitive diagnosis can be made with electrodiagnostic studies including nerve conduction studies (NCS) and
electrasomyography (EMG).Diabetic amyotrophy is often a diagnosis of exclusion in diabetic patients with evidence of lumbosacral plexopathy on NCS and EMG studies for whom no other cause of lumbosacral plexopathy can be determined.
Treatment:
Proximal diabetic neuropathy can be prevented through management of diabetes. The incidence of proximal diabetic neuropathy incidence is thought to be correlated to blood glucose control in diabetics, and is likely reversible with improved blood glucose control.
Medications can help reduce the pain involved in proximal diabetic neuropathy. Common types of medication used to treat diabetic amyotrophy target the nerve directly such as gabapentin or pregabalin.
Diabetic amyotrophy is a rare condition in which patients develop severe aching or burning pain in hips and thighs. This is followed by weakness and wasting of the muscles of proximal lower extremities, which often occur asymmetrically.
Most people with this condition need treatment, such as medication and physical therapy, for their weakness or pain.
Treatment involves exercising, maintaining a healthy weight, caring for and resting the affected joint, physical therapy, and medications for pain. Complementary treatments such as acupuncture and massage also may be helpful for managing pain.
This type of neuropathy often affects nerves in the thighs, hips, buttocks or legs. It can also affect the abdominal and chest area.
Although there is no cure for diabetic neuropathy, use of these treatments can improve painful symptoms and prevent complications.
Control blood sugar levels: An important treatment for diabetic neuropathy is to control blood sugar levels.
Walking is good for diabetic neuropathy:
In diabetic condition, aerobic exercise such as walking is commonly recommended to improve glucose control and reduce microvascular and macrovascular
complications.
Deep tissue massage can be particularly helpful for treating muscle spasms and tension that can cause this type of hip pain.Tight hip rotator muscles can also place unnecessary stress on the joint between your pelvis and sacrum, called the sacroiliac joint.
Treating thigh numbness:
In mild cases, your numbness will go away with time and no medical treatment is required. Your doctor may also recommend conservative measures to alleviate numbness and other associated symptoms. Some things you can do on your own to improve your condition include: maintain a healthy diet.
Most people improve at least partially over 6 to 12 months. This condition is often marked by symptoms including: Severe pain in the buttock, hip or thigh. Weak and shrinking thigh muscles.
While you can't reverse the damage from proximal neuropathy, there are ways to help manage the condition, including: lowering your blood sugar , treating nerve pain,regularly checking your feet to make sure they are free of injury, wounds, or infections.
Prognosis:
Prognosis meaning the chance of recovery or recurrence.
Proximal diabetic neuropathy is often monophasic and will improve after initial onset. However, the pain and weakness usually do not completely resolve and may lead to impairments in mobility and function.
Following are the questions answers on Proximal diabetic neuropathy discussed by
NIH: National Institute of Diabetes and Digestive and Kidney Disease.
•What is proximal neuropathy?
Proximal neuropathy is a rare and disabling type of nerve damage in your hip, buttock, or thigh. This type of nerve damage typically affects one side of your body and may rarely spread to the other side.Proximal neuropathy is more common in men than in women and more common in people older than age 50. Most people with this condition have Type II diabetes.
•What causes proximal neuropathy?
Over time, high blood glucose, also called blood sugar, and high levels of fats, such as triglycerides, in the blood from diabetes can damage your nerves and the small blood vessels that nourish your nerves, leading to proximal neuropathy.
•What are the symptoms of proximal neuropathy?
Symptoms may include
sudden and sometimes severe pain in your hip, buttock, or thigh
weakness in your legs that makes it difficult to stand from a sitting position
loss of reflexes such as the knee-jerk reflex—the automatic movement of your lower leg when a doctor taps the area below your knee cap
muscle wasting, or the loss of muscle tissue,weight loss
After symptoms start, they typically get worse and then gradually improve over a period of months or years. In many cases, the symptoms do not go away completely.
Man standing up from sitting with a hand on his painful hip.
Symptoms of proximal neuropathy may include sudden and sometimes severe pain in your hip, buttock, or thigh.
•How do doctors diagnose proximal neuropathy?
Doctors diagnose proximal neuropathy by asking about your symptoms and performing tests, such as nerve conduction studies NIH external link and electromyography (EMG) NIH external link. Nerve conduction studies check how fast electrical signals move through your nerves in different parts of your body. EMG shows how your muscles respond to your nerves.
•How can you help treat proximal neuropathy?
You can help treat proximal neuropathy by managing your diabetes, which means managing your blood glucose, blood pressure, and cholesterol.
•How do doctors treat proximal neuropathy?
Your doctor may treat the pain of proximal neuropathy with the same medicines used to treat peripheral neuropathy pain.
Your doctor may also recommend physical therapy to help increase your strength, and occupational therapy to help you with daily activities.
Most people recover from proximal neuropathy within a few years, even without treatment.
Information compiled by:
Dr. Bhairavsinh Raol
