A-25F Clinical Case Slide Presentation Groin and Buttock Pain
A 35 year old female tri athlete sustained a fall in which she felt a pulling in her right buttock while running. She presented approximately one month later with difficulty sitting for prolonged periods of time. She reported pain in her buttocks right greater than left with tenderness over the ischial tuberosity with radiating electric-like pain on a regular basis into her buttocks. She also reported intermittent right greater than left posterior thigh pain radiating to her ankle during her training regimen. She denied any weakness though she was unable to run and to work in her day job as a personal trainer secondary to pain. She admitted to a previous history of right leg pain one year prior after a fall in which she had radiating pain into her lower leg after a fall on her buttocks. She denied any bladder or bowel incontinence.
In general she' was a healthy appearing female in mild distress, there was a noticeable left lumbar scoliosis with a mild right-sided pelvic shift. Seated and supine straight leg raising were positive on the right. Ankle dorsiflexion on the right worsened pain, which was exacerbated with ha neck flexion. Sensation was intact to light touch and pinprick. Reflexes were 2/4. Strength was 5/5, except 4+/5 for the EHL and ankle dorsiflexors on the right with giveway weakness for the gluteus maximus and hamstrings. Gait was heel to toe;heel walking and toe walking were within normal limits. Flexibility was normal for the hamstrings, rectus femoris, hip flexors, and ITB. Palpation revealed significant palpable discomfort over the ischial tuberosity on the right with some tenderness appreciated in the lumbar paraspinals on the right. No defect was felt at the proximal portion of the hamstring muscle origin.
Lumbosacral radiculopathy Sciatic neuropathy Hamstring strain/avulsion. Piriformis syndrome Sacroiliac joint dysfunction.
TEST AND RESULTS
MRI of lumbar spine revealed a degenerative L3-4 disc without evidence for a disc herniation of the lower lumbosacral spine. MRI of the right hip revealed findings consistent with a strain of the quadratus femoris muscle. EMG: There was electrodiagnostic evidence of an old right sciatic nerve injury with evidence for reinnervation via collateral sprouting. There was no evidence for a radiculopathy.
Acute tear of the quadratus femoris muscle Right sciatic neuropathy.
TREATMENT AND OUTCOMES
- Nonsteroidal anti-inflammatory for pain control.
- Initially, avoidance of running on land with pool running and swimming encouraged.
- Active stretching of involved musculature.
- Gradual and progressive strengthening program for lower extremity musculature.
- Gradual return to running and high impact activities