Unusual myositis ossificans and additional calcification in the gluteal region caused by intramuscular injection as a reason for sciatica?

  • Georg C Feigl Institute of Anatomy, Medical University of Graz, Austria
  • Thomas Pixner Institute of Anatomy, Medical University of Graz, Austria
  • Savo Miocinovic Department of Surgery, Hospital Bad Aussee, Austria
  • Christian Mörth Department of Radiology, Hospital Leoben, Austria
  • Walter Goessler Institute for Chemistry -Analytical Chemistry, Karl-Franzens University Graz, Austria
  • Joachim Greilberger Institute for Physiological Chemistry, Medical University of Graz, Austria
Keywords: myositis ossificans, sciatica, intramusclular injection, ischialgia, cadaver

Abstract

Treatment of sciatica can be difficult due to unknown pain origin. During a routine dissection of a left gluteal region of an 83 old male cadaver we found an unusual unique case of multiple calcifications. The tendon of the obturator internus was calcified from lesser pelvis to its insertion at the trochanteric fossa. Additionally, calcification originating from the piriformis tendon in vertical direction, parallel to the sciatic nerve course with a length of 4 cm distally tapered, was found. The proximal base had a width of 2.5cm. The sciatic nerve was located between these two calcifications. The patient mentioned left leg sciatica only once, which unfortunately was combined with a severe peripheral arterial disease (PAD) grade IV on both legs. PAD was treated including a lumbar sympathetic block. Retrospective analysis of a pelvic computerized tomography (CT) investigation, performed 3 years premortem, of the lumbar vertebral column showed the aforementioned ossifications which remained undiagnosed. Three samples (obturator internus [OI], coxal bone [CB] and vertical ossification [VO]) were taken and elements were analyzed. OI and CB were similar whereas the VO was entirely different. In case of inexplicable ischialgia, a myositis ossificans, probably caused by a dislocated intramusclular injection, has to be taken into consideration.

References

1. Pschyrembel. Klinisches Wörterbuch. de Gruyter: Berlin, 2012.
2. Gokkus K, Sagtas E, Suslu FE, Aydin AT. Myositis ossificans circumscripta, secondary to high-velocity gunshot and fragment wound that causes sciatica. BMJ Case Rep. 2013; 2013. doi: 10.1136/bcr-2013-201362.
3. Thiel W. [Supplement to the conservation of an entire cadaver according to W. Thiel]. Ann Anat Anat Anz Off Organ Anat Ges. 2002; 184(3): 267–269.
4. Meknas K, Christensen A, Johansen O. The internal obturator muscle may cause sciatic pain. Pain. 2003; 104(1–2): 375–380.
5. Darmoul M, Bouhaouala MH, Rezgui M. [Calcification following intradiscal injection, a continuing problem?]. Presse Medicale Paris Fr 1983. 2005; 34(12): 859–860.
6. Yang CC, Lin TM. Bilateral gluteal dystrophic calcification--a case report. Kaohsiung J Med Sci. 1999; 15(1): 56–61.
7. Maigne J-Y. Four cases of coccygeal disk calcification after cortivazol injection. Jt Bone Spine Rev Rhum. 2009; 76(6): 699–700. doi: 10.1016/j.jbspin.2009.10.005.
8. Fernandez-Flores A, Valerdiz S, Crespo LG, Rodriguez R. Granulomatous response due to anabolic steroid injections. Acta Dermatovenerol Croat ADC. 2011; 19(2): 103–106.
9. Fox TP, Oliver G, Wek C, Hester T. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis. BMJ Case Rep. 2013; 2013. doi: 10.1136/bcr-2013-200303.
10. Boissiere L, Valour F, Rigal J, Soderlund C. Lumbar synovial cyst calcification after facet joint steroid injection. BMJ Case Rep. 2013; 2013. doi: 10.1136/bcr-2012-008029.
11. Gilles FH, Matson DD. Sciatic nerve injury following misplaced gluteal injection. J Pediatr. 1970; 76(2): 247–254.
12. Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. J Neurosurg. 1998; 89(1): 13–23. doi: 10.3171/jns.1998.89.1.0013.
13. Schmidt R. [Intramuscular injection: anatomical study and clinical testing of the new intragluteal injection technic of von Hochstetter]. Helv Med Acta. 1957; 24(5): 561–586.
Published
2017-09-30
How to Cite
Feigl, G., Pixner, T., Miocinovic, S., Mörth, C., Goessler, W., & Greilberger, J. (2017, September 30). Unusual myositis ossificans and additional calcification in the gluteal region caused by intramuscular injection as a reason for sciatica?. BioMedicine and Surgery, 1(3), 152-155. https://doi.org/https://doi.org/10.5281/zenodo.896130
Section
Case report