Venous Thromboembolism Manifesting as Sciatica in Two Pregnant Women

Nix, Kimberley; Curtis, Heather; Coolen, Jillian

doi:10.1016/j.jogc.2019.08.031

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…About one to three percent of women develop an obstetric palsy , a lumbosacral or lower extremity nerve injury related to labor [ 4 , 5 ]. There are several potential explanations for this condition: direct pressure from the fetal head against the lumbosacral plexus, sciatic nerve stretch related to the lithotomy position (supine with hips and knees flexed), sacroiliac joint disorders, sacral stress fracture, and deep venous thrombosis [ 5 – 8 ]. Trauma to the spinal cord due to epidural analgesia is also a rare consideration in sciatica developing after labor [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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