JBJS Case Connections—Peculiar Sciatic Nerve Problems

Most insults to the sciatic nerve arise from intervertebral disc conditions or spinal stenosis. However, beyond these common etiologies for sciatic-nerve problems are a host of other, rarer causes. This month’s “Case Connections” explores 4 such peculiar examples.

The springboard case report, from the October 12, 2016 edition of JBJS Case Connector, describes 3 instances of sciatica caused by nerve compression from a perineural cyst arising from a paralabral cyst. All 3 patients were successfully treated with arthroscopic decompression. Three additional JBJS Case Connector case reports summarized in the article focus on:

• A 70-year-old woman with a history of thromboembolism who experienced sciatic nerve palsy from an anticoagulant-induced hematoma
• A 31-year-old woman with sciatic endometriosis who was successfully treated by a team of gynecologists, orthopaedists, and microsurgeons
• A 66-year-old woman in whom sciatic nerve injury occurred after repeated attempts at closed reduction of a dislocated hip prosthesis

Orthopaedists evaluating patients with symptoms characteristic of sciatic-nerve pathology should recognize that these symptoms may arise from a variety of etiological pathways. These patients require a complete history-taking, a thorough physical exam, and an attempt to rule out all possible lumbar causes.