Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report

Abstract

IntroductionQuadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative.Case presentationWe report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression.ConclusionThe correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option.

An Algorithmic Approach to Mechanical Hip Pain

“…The quadratus femoris muscle may be compressed directly between the lesser trochanter and ischium. Clinically, the symptoms of impingementpain in the groin and/or buttock which may radiate distally [5,80,84]-can be reproduced by a combination of hip extension, adduction, and ER [44]. The insertion of psoas into the lesser trochanter and the origin of the hamstrings may also be affected [84,110].…”

Clinical significance of signal changes in the quadratus femoris muscle on MR

“…A narrower intertuberous diameter was significantly associated with greater degenerative changes of the QFM. This narrow intertuberous diameter may allow greater motion of the hip and may put the QFM under excessive stress with subsequent degeneration ular impingement lesion (CAM) have also been described (6,7,10,14). The greater trochanter insertion of the gluteus muscles is located lateral to the QFM femoral insertion on the quadrate tubercle.…”

“…Internal or external rotation, sitting, prolonged hip flexion and adduction were also reported to provoke symptoms (1,7,10,14).…”

“…In a case report a QFM tear resulted in a massive hematoma compressing the sciatic nerve. This had to be treated by surgical decompression due to persistent sciatica (14). Associated morbidity would be too high if resection of the lesser trochanter was to be used as the routine treatment resulting in weakness of hip flexion (22).…”

“…Periarticular endoscopic decompression around the hip joint is a more recent treatment technique used in snapping psoas, gluteus medius and minimus tears and sciatic nerve compression. Decompression of the QFM is an option in case of MRI proven ischiofemoral impingement not responding to conservative therapy (14,15,23).…”