Our Patient
Our female patient came to us after unsuccessful treatment at another clinic. She presented with painful hip snapping, leg paresthesia (tingling/numbness), low back pain, sacroiliac(SI) joint pain, and gluteal pain. She had previously been treated with epidural steroid injections, piriformis steroid injections, and hip steroid injection, without long-term results.
The Challenge
Navigating the complexities of this case posed significant challenges. Distinguishing between peripheral nerve entrapment and spinal pathologies was difficult due to the diversity of symptoms. Interpreting the ultrasound images demanded a nuanced understanding of the body’s structures and systems.
Our Diagnosis
Our clinical exam revealed severe pelvic torsion and SI instability. We used high resolution diagnostic ultrasonography to examine our patient, and discovered fraying of the SI ligaments on the painful side, and thickening of the common peroneal nerve – a branch of the sciatic nerve that enables movement and sensation in the lower leg, foot and toes. Comprehensive ultrasonography enabled precise identification of multiple sites of peroneal nerve compression.
Our Conclusion
The sciatic nerve and its peroneal branch affect multiple structures along their path, from the lumbar spine to the feet and toes. Entrapment of the nerve in multiple places caused the patient to experience diverse symptoms that had previously been misdiagnosed and maltreated. In such cases, experience and expertise are crucial for identifying the underlying cause of symptoms. High resolution ultrasonography, when conducted by a skilled and knowledgeable practitioner, is an invaluable diagnostic tool.
About the Author
Dr. Lev Kalika is a world-recognized expert in musculoskeletal ultrasonography, with 20+ years of clinical experience in advanced rehabilitative medicine. In addition to operating his clinical practice in Manhattan, he regularly publishes peer-reviewed research on ultrasound-guided therapies and procedures.
Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment ((SMST), and the only clinician in New York certified by the ISMST to perform extracorporeal shockwave therapy. He is also an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to dynamic functional and fascial ultrasonography.
Request Telehealth 
