Isolated injury to the tibial division of sciatic nerve after self-massage of the gluteal muscle with massage ball A case report

Abstract

Introduction: An isolated injury to the tibial division is rare among compressive sciatic neuropathy. To date, isolated injury to the tibial division of the sciatic nerve after self-massage of the gluteal muscle has not been reported. Here, we report a case of compressive sciatic neuropathy diagnosed after self-massage of the gluteal muscle using magnetic resonance image (MRI) and ultrasound images and its associated therapeutic process. Patient concerns: A 50-year-old woman presented right lower extremity pain for the past 7 days. Diagnosis: Electrophysiological findings were consistent with right tibial neuropathy proximal to the branch to hamstring muscles. However, T2-weighted MRI showed high signal intensity and swelling in the right sciatic nerves from the superior gemellus level to the quadratus femoris level. After considering both radiologic and electrophysiological findings, the patient was diagnosed with an isolated injury to the tibial division of the right sciatic nerve. Interventions: The patient agreed to an ultrasound-guided perineural steroid injection upon receiving detailed explanation of the procedure. Outcomes: After the injection, there was significant improvement in pain. Conclusion: Therefore, in making a diagnosis of sciatic neuropathy, it may be important to find the lesion via MRI than relying solely on the patient’s history or electrophysiologic study. Abbreviations: AH = abductor halluces, Amp = amplitude, BF = biceps femoris, CV = conduction velocity, Dur = duration, EDB = extensor digitorum brevis, EMG = electromyography, Fibs = fibrillation potentials, GCM = gastrocnemius, GM = gluteus maximus, IA = insertion activity, IP = interference pattern, LMC = local medical center, LP = lumbar paraspinalis, MRI = magnetic resonance image, Normal = normal values, NRS = numeric rating scale, PL = peroneus longus, PP = polyphasic potentials, Recruit = recruitment, PSW = positive sharp waves, RF = rectus femoris, Rt = right, SH = = short head, ST = semitendinosus, TAvtibialis anterior, TFESI = transforaminal epidural steroid injection, TFL = tensor fascia latae, TP = tibialis posterior, VM = vastus medialis.