ARRS 2022 Abstracts

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E2029. More than Infection: Musculoskeletal Complications of Diabetes Mellitus
Authors
  1. Thomas Cowan; Wake Forest School of Medicine
  2. Bahram Kiani; Wake Forest School of Medicine
  3. Scott Wuertzer; Wake Forest School of Medicine
Background
Diabetes mellitus (DM), a chronic endocrine disorder, affects millions of people worldwide with a wide range of musculoskeletal complications. These complications can lead to significant morbidity for patients, and imaging often plays an essential role in the diagnosis. This educational exhibit will review the spectrum of diabetic complications based on their location within the bones, joints, and soft tissues.

Educational Goals / Teaching Points
The goals of this exhibit are to review the pathophysiology of diabetes mellitus organized by location in bones, joints, or soft tissues; correlate the pathophysiology with expected imaging findings; and review these findings in multimodality case examples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In bone, DM leads to osteoporosis, osteoporosis-related fractures, and delayed fracture healing through a combination of low bone mineral density, decreased bone strength, and osteoblast dysfunction. Osteomyelitis occurs from the direct spread at pressure points in the feet, and diffuse idiopathic skeletal hyperostosis (DISH) occurs more frequently due to chronically increased levels of serum insulin and insulin-like growth factor (IGF-1). In joints, DM leads to neuropathic osteoarthropathy through blunting of the sensory feedback loop. Septic arthritis is more common in DM due to the direct spread of infection from adjacent soft tissue ulcers into the joint. A “loose” association between gout, osteoarthritis, and DM exists, likely due to their connection with obesity. In soft tissues, DM leads to many fibroproliferative disorders, including adhesive capsulitis, Dupuytren’s contracture, diabetic cheiroarthropathy, flexor tenosynovitis (trigger finger), and carpal tunnel syndrome, likely due to chronic hyperglycemia that contributes to glycosylation of collagen, decreased collagen degradation, and diabetic microangiopathy. Muscle infarction (myonecrosis) tends to occur from microangiopathy in patients with poorly controlled diabetes. Vascular calcifications occur with greater frequency due to dysregulated calcium and phosphate homeostasis.

Conclusion
DM can lead to a wide range of musculoskeletal manifestations with characteristic imaging findings. Knowing these findings and their association with DM can aid the radiologist in image interpretation and recommendations.