Sciatic Nerve Injury: Difference between revisions

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== Definition/Description ==
== Definition/Description ==
It is characterized by trauma to the sciatic nerve via intramuscular injection at gluteal region (dorsogluteal site), nerve compression and stretch during sugery.<ref name=":0">Cornwall, J. Are nursing students safe when choosing gluteal intramuscular injection locations? AMJ 2011, 4, 6, 315-­‐321</ref><ref name=":1">Mishra P, Stringer MD. Sciatic nerve injury from intramuscular injection: a persistent and global problem. Int J Clin Pract, October 2010, 64, 11, 1573–1579</ref><ref>Altıntaş A, Gündüz A, Kantarcı F,  Gözübatık Çelik G, Koçer N, Kızıltan ME. Sciatic neuropathy developed after injection during curettage. A Case Report. Agri 2016;28(1):46–48</ref>
It is characterized by trauma to the sciatic nerve via intramuscular injection at gluteal region (dorsogluteal site), nerve compression and stretch during sugery.<ref name=":0">Cornwall, J. Are nursing students safe when choosing gluteal intramuscular injection locations? AMJ 2011, 4, 6, 315-­‐321</ref><ref name=":1">Mishra P, Stringer MD. Sciatic nerve injury from intramuscular injection: a persistent and global problem. Int J Clin Pract, October 2010, 64, 11, 1573–1579</ref><ref name=":5">Altıntaş A, Gündüz A, Kantarcı F,  Gözübatık Çelik G, Koçer N, Kızıltan ME. Sciatic neuropathy developed after injection during curettage. A Case Report. Agri 2016;28(1):46–48</ref>


Sciatic Nerve Injury is otherwise known as Sciatic neuropathy or injection palsy.<ref name=":2">Toopchizadeh V, Barzegar M, Habibzadeh A. Sciatic Nerve Injection Palsy in Children, Electrophysiologic Pattern and Outcome: A Case Series Study. Iran J Child Neurol. Summer 2015;9(3):69-72.</ref><ref>Evren Eker H, Yalcin Cok O,  Aribogan A. A Treatment Option for Post-Injection Sciatic Neuropathy: Transsacral Block with Methylprednisolone. A Case Report. Pain Physician 2010; 13:451-456</ref> It describes a situation where there is a loss of movement and or lack of sensation at the affected lower extremity with or without pain. Stress or damage to the sciatic nerve that serves majority of muscle groups in the lower limb, result to this dysfunction.
Sciatic Nerve Injury is otherwise known as Sciatic neuropathy or injection palsy.<ref name=":2">Toopchizadeh V, Barzegar M, Habibzadeh A. Sciatic Nerve Injection Palsy in Children, Electrophysiologic Pattern and Outcome: A Case Series Study. Iran J Child Neurol. Summer 2015;9(3):69-72.</ref><ref>Evren Eker H, Yalcin Cok O,  Aribogan A. A Treatment Option for Post-Injection Sciatic Neuropathy: Transsacral Block with Methylprednisolone. A Case Report. Pain Physician 2010; 13:451-456</ref> It describes a situation where there is a loss of movement and or lack of sensation at the affected lower extremity with or without pain. Stress or damage to the sciatic nerve that serves majority of muscle groups in the lower limb, result to this dysfunction.
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== Clinical Presentation/Characteristics  ==
== Clinical Presentation/Characteristics  ==


The persistent and most reported symptoms are pain and abnormal gait pattern<ref name=":2" />. This is particular difficult to rate or quantify in the Pediatric population. However, facial expression is quite helpful. Others include;
The persistent and most reported symptoms are pain and abnormal gait pattern.<ref name=":2" /> However, pain intensity is difficult to quantity or rate particularly in the Pediatric population but facial expression is quite helpful. Others include;
* Foot drop<ref name=":3">Napiontek M, Ruszkowski K. Paralytic drop foot and Gluteal fibrosis after intramuscular injection. ''J Bone Joint Surg'' ''[Br]'' 1993; 75-B: 83-5</ref><ref name=":4">Brown BA: Sciatic injection neuropathy. Calif Med 116: 13-15, May 1972</ref>
* Foot drop<ref name=":3">Napiontek M, Ruszkowski K. Paralytic drop foot and Gluteal fibrosis after intramuscular injection. ''J Bone Joint Surg'' ''[Br]'' 1993; 75-B: 83-5</ref><ref name=":4">Brown BA: Sciatic injection neuropathy. Calif Med 116: 13-15, May 1972</ref>
* External rotation and abduction contracture of the hip<ref name=":3" />
* External rotation and abduction contracture of the hip<ref name=":3" />
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== Diagnostic Procedures  ==
== Diagnostic Procedures  ==


add text here relating to diagnostic tests for the condition<br>  
Sciatic neuropathy is more of a clinical diagnosis. Well detailed subjective and objective examination is the golden rule. In recent times, debate on the use of imaging modalities is on the  fast pace. Electro-diagnostic studies are;<br>
* Electromyography<ref name=":2" /><ref name=":5" />
* Magnetic Resonance Imaging<ref>Ong MJF, Lim GHT, Kei PL. Clinics in diagnostic imaging (140). ''Singapore Med J 2012; 53(8): 551–555''</ref><ref name=":5" />


== Outcome Measures  ==
== Outcome Measures  ==

Revision as of 17:51, 14 August 2017

Original Editor : Fasuba Ayobami D

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Keywords[edit | edit source]

Sciatic Nerve Injury, Injection Palsy, Intramuscular Injection

Definition/Description[edit | edit source]

It is characterized by trauma to the sciatic nerve via intramuscular injection at gluteal region (dorsogluteal site), nerve compression and stretch during sugery.[1][2][3]

Sciatic Nerve Injury is otherwise known as Sciatic neuropathy or injection palsy.[4][5] It describes a situation where there is a loss of movement and or lack of sensation at the affected lower extremity with or without pain. Stress or damage to the sciatic nerve that serves majority of muscle groups in the lower limb, result to this dysfunction.

The insult affect just a single nerve, hence, it is also referred to a Peripheral neuropathy called mononeuropathy. And occurs more in children[2] and young adults.

Clinically Relevant Anatomy[edit | edit source]

Sciatic nerve is the largest nerve in the human body (with nerve root L4,L5,S1,S2,S3) and the continuation of the sacral plexus. The sciatic nerve is the most lateral structure emerging through the greater sciatic foramen inferior to the piriformis. Medial to it are the inferior gluteal nerve and vessels, the internal pudendal vessels, and the pudendal nerve. It crosses the posterior surface of the ischium, crosses obturator internus, with its gemelli, quadratus femoris and descends on adductor magnus.The sciatic divides into its terminal branches, the tibial and common peroneal nerves, usually just below the mid-thigh, although a higher division is not uncommon.[6][7]

Epidemiology/Etiology[edit | edit source]

Injection palsy can begin suddenly or hours following damage to the sciatic nerve. Misplaced intramuscular injection at the gluteal region is the most common cause of injury and it is attributed to either frequent injections or poor techniques as a result of inadequately trained staff or unqualified staff. [1][2][4]
It affects more males than females with a ratio of 2.7:1.[8] Within a period of two years, Pakistan recorded annual incidence of six (6) million chldren.[1] For overview of nerve injury

Clinical Presentation/Characteristics[edit | edit source]

The persistent and most reported symptoms are pain and abnormal gait pattern.[4] However, pain intensity is difficult to quantity or rate particularly in the Pediatric population but facial expression is quite helpful. Others include;

  • Foot drop[9][10]
  • External rotation and abduction contracture of the hip[9]
  • Equinovarus or Equinus deformity[9]
  • Muscular weakness/atrophy[10]
  • Motor and sensory deficit such as paresthesia and numbness[4][2]

Diagnostic Procedures[edit | edit source]

Sciatic neuropathy is more of a clinical diagnosis. Well detailed subjective and objective examination is the golden rule. In recent times, debate on the use of imaging modalities is on the fast pace. Electro-diagnostic studies are;

Outcome Measures[edit | edit source]

add links to outcome measures here (see Outcome Measures Database)

Management / Interventions
[edit | edit source]

add text here relating to management approaches to the condition

Differential Diagnosis
[edit | edit source]

add text here relating to the differential diagnosis of this condition

Key Evidence[edit | edit source]

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Resources
[edit | edit source]

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Case Studies[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Cornwall, J. Are nursing students safe when choosing gluteal intramuscular injection locations? AMJ 2011, 4, 6, 315-­‐321
  2. ↑ 2.0 2.1 2.2 2.3 Mishra P, Stringer MD. Sciatic nerve injury from intramuscular injection: a persistent and global problem. Int J Clin Pract, October 2010, 64, 11, 1573–1579
  3. ↑ 3.0 3.1 3.2 Altıntaş A, Gündüz A, Kantarcı F,  Gözübatık Çelik G, Koçer N, Kızıltan ME. Sciatic neuropathy developed after injection during curettage. A Case Report. Agri 2016;28(1):46–48
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Toopchizadeh V, Barzegar M, Habibzadeh A. Sciatic Nerve Injection Palsy in Children, Electrophysiologic Pattern and Outcome: A Case Series Study. Iran J Child Neurol. Summer 2015;9(3):69-72.
  5. ↑ Evren Eker H, Yalcin Cok O,  Aribogan A. A Treatment Option for Post-Injection Sciatic Neuropathy: Transsacral Block with Methylprednisolone. A Case Report. Pain Physician 2010; 13:451-456
  6. ↑ Moore KL, Dalley AF. Clinically Oriented Anatomy, 5th Edition. 2006 Pg 621
  7. ↑ Ellis H. Clinical Anatomy: A revision and applied anatomy for clinical students. 11th Edition. 2006 Pg 253-254
  8. ↑ Geyik S, Geyik M, Yigiter R, Kuzudisli S, Saglam S, Elci MA, Yilmaz M. Preventing Sciatic Nerve Injury due to Intramuscular Injection: Ten-Year Single-Center Experience and Literature Review. Turk Neurosurg 27(4):636-640, 2017
  9. ↑ 9.0 9.1 9.2 Napiontek M, Ruszkowski K. Paralytic drop foot and Gluteal fibrosis after intramuscular injection. J Bone Joint Surg [Br] 1993; 75-B: 83-5
  10. ↑ 10.0 10.1 Brown BA: Sciatic injection neuropathy. Calif Med 116: 13-15, May 1972
  11. ↑ Ong MJF, Lim GHT, Kei PL. Clinics in diagnostic imaging (140). Singapore Med J 2012; 53(8): 551–555

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