Unusual myositis ossificans and additional calcification in the gluteal region caused by intramuscular injection as a reason for sciatica?
Keywords:myositis ossificans, sciatica, intramusclular injection, ischialgia, cadaver
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.
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