Case Study: Steroid Injection-Induced Pain and Muscle Atrophy

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.


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.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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