Injection injury of the sciatic nerve (370 cases)

Abstract

Injury to peripheral nerves due to injections of therapeutic and other agents is common. The postulated mechanisms of injury include direct needle trauma, secondary constriction by scar, and direct nerve fiber damage by neurotoxic chemicals in the injected agent. Neurological sequelae can range from minor transient sensory disturbance to severe sensory disturbance and paralysis with poor recovery. The recommended treatment has ranged from a conservative approach to immediate operative exposure and irrigation, and has also included early neurolysis or delayed exploration with neurolysis or resection and anastomosis. We present 370 cases of injection injury of the sciatic nerve in children treated during the last 20 years at the Neurosurgical Department of the Hospital La Paz in Madrid, Spain. Pathology, clinical course, treatment, and results are discussed.

An Unusual Presentation of Neurofibroma Masquerading as a Vascular Hamartoma, Post- Iatrogenic Intervention

“…in case of Sciatic Nerve it is formed between the piriformis, gemellus, quadratus and obturator muscles. Other possible mechanisms are direct needle trauma, secondary compression by scar tissue and direct nerve fibre damage caused by neurotoxic chemicals in the [ injected drug [2]. This is the case of neurofibroma that appeared as painless lump following an intramuscular injection.…”

Sciatic nerve injection injury

“…Intraneural injection appears to cause an immediate onset of symptoms, whereas delayed onset may be related to placement of the injection, either close to the nerve or into the epineurium, with central diffusion leading to damage to the fascicles, over time. 2,13,14 Patients with sciatic nerve injury present with pain, paraesthesia and causalgia along the nerve distribution. Pain is present in the majority of cases and may be described as a severe shooting or burning sensation.…”

“…Pain is present in the majority of cases and may be described as a severe shooting or burning sensation. 2,13,14 Motor function may be more severely impaired than neurosensory function. 31 Since the peroneal division is frequently involved, paralytic foot drop is a common presentation due to a deficit of dorsiflexion and eversion.…”

“…31 Since the peroneal division is frequently involved, paralytic foot drop is a common presentation due to a deficit of dorsiflexion and eversion. 2,6,13,20 Involvement of the tibial division may lead to loss of plantar flexion of the foot, loss of flexion of the toes and weakened inversion of the foot. Some patients may suffer a complete sciatic nerve lesion proximal to the hamstring, with a sciatic distribution of pain and paraesthesia, impaired knee flexion, a flail foot due to loss of dorsiflexion and plantar flexion, a loss of posterior tibialis foot invertors and peroneus longus and brevis foot evertors, and sensory loss to the posterior thigh, lower lateral leg and foot.…”

CT and MRI in the evaluation of extraspinal sciatica

“…Other possible mechanisms are direct needle trauma, secondary compression by scar tissue and direct nerve fibre damage caused by neurotoxic chemicals in the injected drug [4].…”