Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report

Abstract

Background While most cases of sciatica result from degenerative conditions of the low back, some cases result from conditions of the hip and pelvic region. Sciatica developing in relation to pregnancy or labor also presents unique considerations. Case presentation A 37-year-old African American woman with a history of hypertension and polycystic ovary syndrome presented to a chiropractor at a hospital-based outpatient clinic with a seven-week history of low back pain with radiation into the right lower extremity which began during labor. The chiropractor performed a brief trial of care, yet when the patient’s symptoms worsened, ordered lumbar spine radiographs, followed by lumbar magnetic resonance imaging (MRI), which were both normal. The chiropractor then ordered hip radiographs, which were suggestive of ischial osteochondroma, and referred the patient to an orthopedic oncologist. MRI findings were compatible with an osteochondroma with associated adventitial bursitis and mass effect on the sciatic nerve. The patient initially chose conservative management with bursa aspiration and therapeutic injection. Despite initial relief, there was eventual return of symptoms. The patient elected to undergo surgical removal, with a positive outcome. Conclusion The key distinguishing features that led to a diagnosis of osteochondroma in this case included attention to the patient-reported symptoms and history, worsening of symptoms despite conservative care, and lack of explanatory findings on lumbar imaging. This case highlights the benefit of evaluating the hip and pelvis when the clinical features of sciatica cannot be ascribed to a lumbar etiology. This case also illustrates the role of a chiropractor working in an integrative health system to facilitate timely imaging and referrals to resolve a challenging diagnosis.

Peroneal Nerve Decompression in Patients with Multiple Hereditary Exostoses

“…It is important to assess patients with MHE for multiple sites of compression and not just the proximal fibula. This includes the spine, ischium, proximal femur, distal femur, and proximal tibia 5,6 . Sixty percent of cases in this series also had an osteochondroma removed from a location other than the proximal fibula, which might have compressed the nerve (Fig.…”

“…There are multiple musculoskeletal manifestations including injury to neurovascular structures 2 . Compression of the peripheral nerves by osteochondromas has been described [3][4][5][6][7][8][9] (Fig. 1).…”

Dorsal Scapular Osteochondroma in the Chiropractic Clinic: A Case Report and Literature Review

“…Osteochondromas are benign bone tumors originating from growth plates that predominantly occur in long bones [ 1 ]. Although they account for 4% of all tumors occurring in the scapula, making them the most common tumor type at this location [ 2 ], they mostly occur in individuals under 20 years of age, as tumor growth is typically prevented by closure of the physis [ 2 ].…”

Sporadic Desmoid Tumor Mimicking Myofascial Pain Syndrome in a Chiropractic Clinic

“…As primary healthcare providers, chiropractors play a significant role in diagnosing and managing various health conditions [1]. Their comprehensive approach to patient care extends beyond musculoskeletal disorders and encompasses a wide range of conditions, including oncological cases [2][3][4][5][6][7]. Chiropractors utilize a unique set of skills and techniques, combining detailed physical examinations with clinical acumen to detect abnormalities that may otherwise go unnoticed [8].…”