Spontaneous Diabetic Myonecrosis Presenting as Acute Carpal Tunnel Syndrome

A 57-year-old man with diabetes mellitus presented with a 4-day history of left palm pain out of proportion, with swelling, erythema, and dense median and ulnar nerve distribution sensory changes. Magnetic resonance imaging with and without contrast revealed diffuse hand edema and myonecrosis. The patient was treated surgically because the examination was concerning for acute carpal tunnel syndrome and ulnar nerve compression. Spontaneous diabetic myonecrosis is a complication of diabetes mellitus that can be confused with several other conditions. It presents as acute-onset painful swelling in any muscle, and in the hand, may cause compressive neuropathies that necessitate surgical intervention.