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

Abstract

Introduction: Quadratus 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 presentation: We 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.

Conclusion: The 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.

Figure 1

MRI performed a few days after injury. (a) The transverse fat suppressed proton density turbo spin echo (TSE) and (b) the coronal short tau inversion recovery (STIR) images, show the hematoma formation in the quadratus femoris muscle (arrows) extending to the obturator internus muscle (open arrows).

Figure 2

The follow-up MRI examination was performed six months later. (a) The transverse fat suppressed proton density (PD)-weighted TSE image, shows persistent dimensions of the hematoma-like lesion in the quadratus femoris (arrow) and the obturator internus (open arrow) muscles. The corresponding T1-weighted spin echo (SE) images show the high signal intensity on the bone-tendinous junction of the quadratus femoris (arrows in b) and obturator internus (arrow in c). These areas histologically turned out to correspond to a mixture of chronic hematoma, fibrosis, granulation tissue and fatty infiltration.

Figure 3

Intra-operative picture showing the sciatic nerve (white arrow) and the ruptured quadratus muscle (black arrow).

Figure 4

Hematoxylin and eosin stain, magnification ×400 (×400, H&E). Histopathological examination of the removed mass showing a significant quantity of fibrotic tissue and atrophy of muscles bundles.