Inferior Gluteal Nerve Injury Due to Intramuscular Injection
Year 2020,
Volume: 22 Issue: 3, 161 - 165, 30.12.2020
Halit Fidancı
,
İlker Öztürk
,
Zülfikar Arlıer
Abstract
Aim: The purpose of this study was to determine the clinical features of the inferior gluteal nerve (IGN) injury due to intramuscular (IM) injection.
Material and Methods: Patients with clinical and electrodiagnostic features of the sciatic nerve (SN) and possible IGN injuries due to IM injection were included in this retrospective study. The presence of an IGN injury was considered in patients with weakness in the gluteus maximus (GM) muscle or in those who demonstrated needle electromyography (EMG) abnormality in the GM muscle.
Results: There were 44 (95.6%) patients with an SN injury only, 1 (2.2%) patient with both an SN and an IGN injury, and 1 (2.2%) patient with an IGN injury only. The complaints of the patient with an IGN injury only occurred within hours to days after the IM injection; this patient had no muscle weakness. The complaints of the patient with both IGN and SN injuries occurred minutes to hours after IM injection; this patient had mild weakness in the plantar flexion of the foot. In 40 of the patients with only an SN injury, complaints occurred immediately after or within a few seconds following the IM injection, while complaints occurred within minutes to hours in the remaining 4 patients.
Conclusion: Although rare when compared to SN injury, the IGN can be injured by IM injection. Therefore, the GM muscle should be examined with needle EMG in patients with complaints associated with IM injection. Muscle weakness may not occur in nerve injuries due to IM injections.
References
- Yuen EC, So YT, Olney RK. The Electrophysiologic features of sciatic neuropathy in 100 patients. Muscle Nerve. 1995;18(4):414-20.
- Obach J, Aragones JM, Ruano D. The infrapiriformis foramen syndrome resulting from intragluteal injection. J Neurol Sci. 1983;58(1):135-42.
- Jung Kim H, Hyun Park S. Sciatic nerve injection injury. J Int Med Res. 2014;42(4):887-97.
- Tak SR, Dar GN, Halwai MA, Mir MR. Post-injection nerve injuries in Kashmir: a menace overlooked. J Res Med Sci. 2008;13(5):244-47.
- Hwang K, Nam YS, Han SH, Hwang SW. The intramuscular course of the inferior gluteal nerve in the gluteus maximus muscle and augmentation gluteoplasty. Ann Plast Surg. 2009;63(4):361-5.
- Ling ZX, Kumar VP. The course of the inferior gluteal nerve in the posterior approach to the hip. J Bone Joint Surg Br. 2006;88(12):1580-3.
- de Jong PJ, van Weerden TW. Inferior and superior gluteal nerve paresis and femur neck fracture after spondylolisthesis and lysis: a case report. J Neurol. 1983;230(4):267-70.
- LaBan MM, Meerschaert JR, Taylor RS. Electromyographic evidence of inferior gluteal nerve compromise: an early representation of recurrent colorectal carcinoma. Arch Phys Med Rehabil. 1982;63(1):33-5.
- Schwarzkopf P, Rönsch B, Müller WC, Katscher S, Litz RJ, Avila González CA. Schwannoma of the inferior gluteal nerve as a rare cause of gluteal radiating chronic low back pain. Schmerz. 2019;33(4):333-6.
- Iwanaga J, Simonds E, Vetter M, Patel M, Oskouian RJ, Tubbs RS. The inferior gluteal nerve often has a cutaneous branch: a discovery with application to hip surgery and targeting gluteal pain syndromes. Clin Anat. 2018;31(6):937-41.
- Kleyweg RP, van der Meché FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve. 1991;14(1):1103-9.
- Yucel A, Senocak M, Kocasoy Orhan E, Cimen A, Ertas M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. J Pain. 2004;5(8):427-32.
- Chen S, Andary M, Buschbacher R, Del Toro D, Smith B, So Y, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve. 2016;54(3):371-7.
- Oh SJ. Clinical electromyography: nerve conduction studies. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.
- Buschbacher RM. Reference values for peroneal nerve motor conduction to the tibialis anterior and for peroneal vs. tibial latencies. Am J Phys Med Rehabil. 2003;82(4):296-301.
- Senes FM, Campus R, Becchetti F, Catena N. Sciatic nerve injection palsy in the child: early microsurgical treatment and long-term results. Microsurgery. 2009;29(6):443-8.
- Small SP. Preventing sciatic nerve injury from intramuscular injections: literature review. J Adv Nurs. 2004;47(3):287-96.
- Yeremeyeva E, Kline DG, Kim DH. Iatrogenic sciatic nerve injuries at buttock and thigh levels: the Louisiana State University experience review. Neurosurgery. 2009;65(4 Suppl):A63-6.
- Gentili F, Huson AR, Hunter D. Clinical and experimental aspects of injection injuries of peripheral nerves. Can J Neurol Sci. 1980;7(2):143-51.
- Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. J Neurosurg. 1998;89(1):13-23.
- Pham M, Wessig C, Brinkhoff J, Reiners K, Stoll G, Bendszus M. MR neurography of sciatic nerve injection injury. J Neurol. 2011;258(6):1120-5.
İntramüsküler Enjeksiyona Bağlı İnferior Gluteal Sinir Yaralanması
Year 2020,
Volume: 22 Issue: 3, 161 - 165, 30.12.2020
Halit Fidancı
,
İlker Öztürk
,
Zülfikar Arlıer
Abstract
Amaç: Bu çalışmanın amacı intramüsküler (İM) enjeksiyona bağlı gelişen inferior gluteal sinir (İGS) yaralanmasının klinik özelliklerinin belirlenmesidir.
Gereç ve Yöntemler: Klinik ve elektrodiagnostik özellikleri İM enjeksiyona bağlı gelişen siyatik sinir (SS) ve olası İGS yaralanmaları ile uyumlu olan hastalar bu geriye dönük çalışmaya dahil edildi. Gluteus maksimus (GM) kasında güçsüzlük ya da GM kasında iğne elektromiyografi (EMG) anormalliği olan hastalarda İGS yaralanması olduğu kabul edildi.
Bulgular: Sadece SS yaralanması olan 44 (%95,6) hasta, hem SS hem İGS yaralanması olan 1 (%2,2) hasta ve sadece İGS yaralanması olan 1 (%2,2) hasta mevcuttu. Sadece İGS yaralanması olan hastanın şikayetleri İM enjeksiyondan sonra saatler ile günler içinde oluşmuştu ve bu hastanın kas güçsüzlüğü yoktu. Hem İGN hem SS yaralanması olan hastanın şikayetleri İM enjeksiyondan sonra dakikalar ile saatler içinde oluşmuştu ve bu hastanın ayak plantar fleksiyonunda hafif derecede güçsüzlük mevcuttu. Sadece SS yaralanması olan hastaların 40’ında şikayetler İM enjeksiyonu takiben hemen ya da saniyeler içinde ortaya çıkarken geri kalan 4 hastada ise şikayetler IM enjeksiyonu takiben dakikalar ya da saatler içinde oluşmuştu.
Sonuç: SS yaralanması ile karşılaştırıldığında nadir olsa da, İM enjeksiyon ile İGS yaralanabilir. Bu nedenle İM enjeksiyon ile ilişkili şikayetleri olan hastalarda GM kası iğne EMG ile değerlendirilmelidir. İM enjeksiyonlara bağlı gelişen sinir yaralanmalarında kas güçsüzlüğü oluşmayabilir.
References
- Yuen EC, So YT, Olney RK. The Electrophysiologic features of sciatic neuropathy in 100 patients. Muscle Nerve. 1995;18(4):414-20.
- Obach J, Aragones JM, Ruano D. The infrapiriformis foramen syndrome resulting from intragluteal injection. J Neurol Sci. 1983;58(1):135-42.
- Jung Kim H, Hyun Park S. Sciatic nerve injection injury. J Int Med Res. 2014;42(4):887-97.
- Tak SR, Dar GN, Halwai MA, Mir MR. Post-injection nerve injuries in Kashmir: a menace overlooked. J Res Med Sci. 2008;13(5):244-47.
- Hwang K, Nam YS, Han SH, Hwang SW. The intramuscular course of the inferior gluteal nerve in the gluteus maximus muscle and augmentation gluteoplasty. Ann Plast Surg. 2009;63(4):361-5.
- Ling ZX, Kumar VP. The course of the inferior gluteal nerve in the posterior approach to the hip. J Bone Joint Surg Br. 2006;88(12):1580-3.
- de Jong PJ, van Weerden TW. Inferior and superior gluteal nerve paresis and femur neck fracture after spondylolisthesis and lysis: a case report. J Neurol. 1983;230(4):267-70.
- LaBan MM, Meerschaert JR, Taylor RS. Electromyographic evidence of inferior gluteal nerve compromise: an early representation of recurrent colorectal carcinoma. Arch Phys Med Rehabil. 1982;63(1):33-5.
- Schwarzkopf P, Rönsch B, Müller WC, Katscher S, Litz RJ, Avila González CA. Schwannoma of the inferior gluteal nerve as a rare cause of gluteal radiating chronic low back pain. Schmerz. 2019;33(4):333-6.
- Iwanaga J, Simonds E, Vetter M, Patel M, Oskouian RJ, Tubbs RS. The inferior gluteal nerve often has a cutaneous branch: a discovery with application to hip surgery and targeting gluteal pain syndromes. Clin Anat. 2018;31(6):937-41.
- Kleyweg RP, van der Meché FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve. 1991;14(1):1103-9.
- Yucel A, Senocak M, Kocasoy Orhan E, Cimen A, Ertas M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. J Pain. 2004;5(8):427-32.
- Chen S, Andary M, Buschbacher R, Del Toro D, Smith B, So Y, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve. 2016;54(3):371-7.
- Oh SJ. Clinical electromyography: nerve conduction studies. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.
- Buschbacher RM. Reference values for peroneal nerve motor conduction to the tibialis anterior and for peroneal vs. tibial latencies. Am J Phys Med Rehabil. 2003;82(4):296-301.
- Senes FM, Campus R, Becchetti F, Catena N. Sciatic nerve injection palsy in the child: early microsurgical treatment and long-term results. Microsurgery. 2009;29(6):443-8.
- Small SP. Preventing sciatic nerve injury from intramuscular injections: literature review. J Adv Nurs. 2004;47(3):287-96.
- Yeremeyeva E, Kline DG, Kim DH. Iatrogenic sciatic nerve injuries at buttock and thigh levels: the Louisiana State University experience review. Neurosurgery. 2009;65(4 Suppl):A63-6.
- Gentili F, Huson AR, Hunter D. Clinical and experimental aspects of injection injuries of peripheral nerves. Can J Neurol Sci. 1980;7(2):143-51.
- Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. J Neurosurg. 1998;89(1):13-23.
- Pham M, Wessig C, Brinkhoff J, Reiners K, Stoll G, Bendszus M. MR neurography of sciatic nerve injection injury. J Neurol. 2011;258(6):1120-5.