Our Patient
Our patient is a 58 year-old female with complaints of persistent pain in the sacroiliac joint, with radiating pain and paresthesia to the buttock and trochanter. She had previously received unsuccessful steroid injections for her symptoms at another clinic.
The Challenge
The patient had been previously diagnosed with a deviated coccyx and a sacral blockade was recommended based on this diagnosis. However, this approach did not fully address her symptoms. Moreover, the subsequent steroid injection appeared to cause reactions in the surrounding skin and soft tissues, as well as neuropathy that was causing her persistent paresthesia and pain. We needed to determine the underlying cause of her symptoms and identify an appropriate treatment strategy.
Our Diagnosis
We thoroughly reviewed the patient’s health history and requested documentation of the treatment she had received at her former clinic. We conducted a thorough physical exam and considered each anatomical factor, such as the superior gluteal nerve and cluneal nerve, to determine how her symptoms were related to her previous treatment.
Notable findings included atrophy of the gluteus medius muscle, an enlarged superior gluteal nerve, pain projection along the superior gluteal nerve pathway, and potential involvement of the cluneal nerve.
Our Treatment Approach
We used a multifaceted treatment approach that included:
- Targeted physical therapy to address muscular issues
- Conservative pain management strategies
- Ultrasound imaging to assess underlying anatomical factors
- Pain relief achieved through shockwave therapy and dry needling sessions
Our Results
With our treatment approach, the patient’s symptoms gradually improved. Her paresthesia decreased in intensity, and her pain became more manageable. The targeted physical therapy sessions addressed muscular imbalances in the pelvic area, which contributed significantly to her progress.
Conclusion
While a common course of treatment for musculoskeletal pain, steroid injections can lead to undesirable reactions. It’s important for medical professionals to consider all possible side effects and complications when evaluating a patient’s symptoms following any procedure. The potential for skin and soft tissue reactions, as well as neuropathy, following steroid injections warrants attention.
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