| 제목 |
Sciatic nerve injury involving only tibial division by post-traumatic cyst: A case report |
| 소속 |
Eulji University Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Yong Sung Jeong1*, Jong Keun Kim1, Jin Seok Bae1, Hyo Sik Park1, DaWa Jung1, Jong Youb Lim1, Kang Jae Jung1† |
Introduction
The sciatic nerve is composed of L4 – S3 spinal nerves and is the thickest nerve in the body. It begins in the lower back and runs through the buttock and down to the lower limb. Regarding injuries to the sciatic nerve in the gluteal region, the peroneal division can be damaged much more frequently than the tibial division. The funicular arrangement of the two divisions and the tethering of the two divisions contribute to this result. Here we report a case of sciatic nerve injury involving only tibial division, the cause of which was later diagnosed as a post-traumatic cyst by electromyography and ultrasonography.
Case report
A 60-year-old woman visited the outpatient department of the orthopedic surgery in April 2019. The patient could not do toe walking after a falling from a bike in October 2018. The patient was referred to the department of rehabilitation medicine to rule out nerve injury. The patient did not complain of any pain and could do heel walking. Neurological examination demonstrated 3/5 Medical Research Council grade muscle power on the left plantar flexion. Electrophysiologic study was performed, and the incomplete lesion of the left sciatic nerve above the knee level was found, and it involved only tibial division. Ultrasound revealed left gluteal capsular cyst about 2.5 × 3.1 cm. The mass lesion in the left piriformis area was found on computed tomography. About 7 cc of yellow gelatinous liquid was aspirated ultrasonographically. However, muscle strength unchanged after the aspiration, and she was undergoing ankle plantarflexion strengthening rehabilitation.
Conclusion
An isolated injury to the tibial division is rare among sciatic neuropathy. We report a case of sciatic neuropathy isolated to the tibial division only caused by a post-traumatic cyst, and it was diagnosed by using electromyography, ultrasound, and computed tomography. Even with a history of trauma, the tibial division can be injured in isolation by a formation of a cyst.
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Fig. 1. Computed tomography showed left gluteal mass.
Fig. 2. Ultrasound-guided aspiration.
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