Quadratus Femoris muscle causing deep gluteal syndrome: A rare cause of refractory sciatica of extraspinal origin in the presence of an anatomic variation

Autor:	Valerio Pipola, Eugenio Rimondi, Marco Girolami, Laura Tonetti, Alessandro Gasbarrini, Alessandro Ricci, Ugo Albisinni
Rok vydání:	2019
Předmět:	Male musculoskeletal diseases 030506 rehabilitation medicine.medical_specialty Mepivacaine Physical Therapy Sports Therapy and Rehabilitation Injections Intramuscular Quadriceps Muscle Sciatica 03 medical and health sciences 0302 clinical medicine Humans Medicine Orthopedics and Sports Medicine Muscle Skeletal Pathological Ultrasonography Hip medicine.diagnostic_test business.industry Rehabilitation Anatomic Variation Magnetic resonance imaging 030229 sport sciences Middle Aged Piriformis Muscle Syndrome medicine.disease Magnetic Resonance Imaging Low back pain Agenesis Buttocks Hip Joint Radiology medicine.symptom Differential diagnosis 0305 other medical science business Quadratus femoris muscle medicine.drug
Zdroj:	Journal of Back and Musculoskeletal Rehabilitation. 32:667-670
ISSN:	1878-6324 1053-8127
Popis:	Background Sciatica of extraspinal origin represents both a diagnostic and a therapeutic challenge for spine specialists. Among these, quadratus femoris muscle (QF) is often overlooked as a pain-generator. Reported case A 62-year old man was referred from general practitioner for isolated sciatica in the left leg, refractory to conservative treatments. Plain x-rays of the spine did not show any pathological finding nor did magnetic resonance imaging (MRI). MRI and CT showed QF with unusual morphologic features and agenesis of the contralateral QF. Ultrasonography-guided injection in the muscle was performed with mepivacaine and methylprednisolone obtaining relief of the symptoms. Discussion Leg pain can be very disabling and, when combined with a normal MRI of the spine, diagnosis can be tricky. Several causes of sciatica of extraspinal origin have been described, some of them originating from the so-called "deep gluteal space". Anecdotal communications on anatomical variations of the quadratus femoris muscle are reported in literature. Conclusions Differential diagnosis of sciatica of extraspinal origin must rule out sacroiliac and hip joint so as deep gluteal space structures. Among these, quadratus femoris muscle is often overlooked as a pain-generator. Ultrasonography-guided intramuscular injections and a program of stretching and strengthening exercises can achieve durable control on the symptoms.
Databáze:	OpenAIRE
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