Thursday, December 8, 2011

An Uncommon Cause of Sciatic Nerve Entrapment

An Uncommon Cause of Sciatic Nerve Entrapment

                This report documents the case of a forty four year old woman who lost control while water skiing, and injured herself when both “hips were hyper flexed and hyper abducted with the knees fully extended.” Although she felt immediate pain, she continued to ski. “Shortly thereafter, she was unable to walk or bear weight on the left lower limb secondary to painful hamstring spasms.”

                The woman was treated with NSAIDs, walked on crutches for a few days, and then began a program of stretching and deep tissue massage. She was pain free in two weeks.

                Two and a half months later, the woman began to experience “numbness in the lateral aspect of the left calf that extended onto the lateral and dorsal aspects of the left foot. Two weeks later, dropfoot developed.” After extensive testing, surgical exploration uncovered, “A portion of the origin of the hamstring muscles that was common to the semitendinosis and the long head of the biceps femoris had been avulsed from the ischial tuberosity and had been retracted about seven centimeters. The avulsed end of the tendon was surrounded by an exuberant fibroblastic response that had encased the sciatic nerve.” After dissecting the nerve free, the patient showed gradual improvement, and at one year was free of numbness, weakness, pain, or paresthesia. She was, however, 50% weaker in the left leg than in the right.

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