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.
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