Description[edit | edit source] Show
Sciatic nerve injury occurs due to trauma (pressure, stretching or cutting) to the nerve and can cause symptoms such as paresthesias, loss of muscle power and pain.[1] These symptoms are similar to those caused by sciatica, however, the term 'sciatica' is typically used to refer to conditions where the sciatic nerve is irritated or compressed, rather than being injured directly. Please read our Sciatica page for more information. Aetiology[edit | edit source]
Iatrogenic causes of Sciatic Nerve Injury.[edit | edit source]Trauma to the sciatic nerve through
[3]
Clinically Relevant Anatomy[edit | edit source]The sciatic nerve is the longest nerve in the human body (with nerve roots L4, L5, S1, S2, S3) and is 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: inferior gluteal nerve and vessels; the internal pudendal vessels; the pudendal nerve. It crosses the posterior surface of the ischium then crosses: Obturator Internus,Gemelli, Quadratus Femoris and descends on
Adductor Magnus. The sciatic nerve 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/Aetiology[edit | edit source]Injection palsy can begin suddenly or hours following damage to the Sciatic Nerve. A 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.
[4][9][2] Clinical Presentation/Characteristics[edit | edit source]The common symptoms are pain and abnormal gait pattern.[2] However, pain intensity is difficult to quantify or rate particularly in the paediatric population but facial expression is quite helpful. Other clinical signs include:
Diagnostic Procedures[edit | edit source]Sciatic neuropathy is more of a clinical diagnosis. Well, a detailed subjective and objective examination is the golden rule. Electro-diagnostic studies include;
Medical Management[edit | edit source]In most cases, symptoms of Sciatic Nerve injury does not respond to the use of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and myorelaxants.[15] However, the use of methylprednisolone via transacral block was effective to manage the neuropathic pain, motor and sensory deficits.[15] In addition, a recent study showed beneficial use of methylprednisolone via both intravenous and oral routes.[13] Surgery is opted for patients that did not improve beyond 3 months of sustaining injection palsy[16]. Common procedures include neurolysis[16][12] and grafting[14] with serial clinical and electrophysiological monitoring. Patients with foot deformity can opt for elongation of the tendon Achilles, osteotomy and capsulotomy[11]. Although, conflicting findings are comparing conservative and surgical interventions. Physical Therapy Management[edit | edit source]Conservative means is the first line approach for the management of patients with sciatic nerve injury.[16][12][14][11][10]
[20] Physiotherapists should ensure thorough evaluation through out the course of the treatment. Good clinical judgement, decision making skills and experience are important for effective rehabilitation. A 2015 paper reported that Physiotherapeutic techniques used in peripheral nerve injures lack good randomised data. It went on to outline that many physiotherapists, physicians and clinicians understand fully treatment and intervention therapy, often not comprehending the time that nerves need to regenerate.[19] Watch the youtube below to enhance your knowledge of nerve regeneration [21] References[edit | edit source]
' How do you treat nerve damage from the injection?Management of nerve injection injury includes drug treatment of pain, physiotherapy, use of assistive devices and surgical exploration. Early recognition of nerve injection injury and appropriate management are crucial in order to reduce neurological deficit and to maximize recovery.
What happens if you hit a nerve injection?When a nerve injury is caused by a needle, most patients report immediate pain at the time of injection,11 as our patient did. Neurological sequelae can range from minor transient sensory disturbances to severe sensory disturbances and paralysis.
What does nerve damage from injection feel like?The signs of nerve damage
Numbness or tingling in the hands and feet. Feeling like you're wearing a tight glove or sock. Muscle weakness, especially in your arms or legs.
What happens if you hit sciatic nerve during injection?Sciatic nerve injury from an intramuscular (IM) injection into the buttock is potentially devastating. In severe cases, the hamstrings and all the muscles below the knee are paralysed resulting in a flail numb foot.
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