Sciatic nerve injury following intramuscular injection: a case report and review of the literature.

Abstract: A 25-year-old male patient presented with foot drop indicative of a sciatic nerve injury following gluteal intramuscular (IM) injections. Blood tests and magnetic resonance imaging of his spine were within normal limits, but electrophysiological studies confirmed a partial sciatic

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Intramuscular (IM) injection is an important means of administering medication. Sound knowledge of the anatomy of the area to be injected is essential. This article describes a case of sciatic nerve injury after gluteal IM injections. Related literature is reviewed with the goal of improving practice.

Case Report

A 25-year-old male migrated to the United Kingdom from the Congo after an imprisonment of 2 years. While in prison, he had received several left gluteal IM injections (the indications and drugs are unknown). Approximately 12 months before presenting, he developed a painful, swollen left leg that improved during several weeks. He then noticed that his left leg "started to shrink." He provided no history of polio infection and did not have any weakness in other limbs or associated sensory disturbance.

He was currently being treated for pulmonary tuberculosis that was diagnosed after migration. He was taking isoniazid, rifampicin, ethambutol, and pyridoxine. He was hepatitis-C positive but had tested negative for HIM. He had no significant surgical, social, or family history.

Neurological examination data were normal, apart from positive findings in his left lower limb. Inspection of his lower leg revealed marked muscle wasting with prominent fasciculations in the L4-S1 distribution. Power was markedly reduced to grade I out of 5 for dorsiflexion, inversion, and eversion. He had an absent left ankle jerk, although his sensory examination was normal. He had the typical high-steppage gait indicating left foot drop.

Blood tests revealed normal full blood count, urea and electrolytes, liver function, C-reactive protein and erythrocyte sedimentation rate, thyroid function, and vitamin B12 and folate levels. Polio and Coxsackie serology were negative. Two separate stool samples were also negative for the polio virus. Spinal magnetic resonance imaging excluded any structural cause, including disseminated tuberculosis (Pott's disease).