Iatrogenic Injury to the Sciatic Nerve due to Intramuscular Injection: A Case Report

Abstract

Iatrogenic injuries due to intramuscular (IM) injection, although less frequently reported than before, are still common. The sciatic nerve is the most commonly injured nerve because of an IM injection owing to its large size and the buttock being a common injection site. Iatrogenic injury to the sciatic nerve resulting from a misplaced gluteal IM injection is a persistent problem worldwide affecting patients in economically rich and poor countries alike. The consequences of sciatic nerve injection injury (SNII) are potentially devastating and may result in serious neurological and medico-legal problems. A 68-year-old male presented with intractable neuropathic pain from SNII that occurred during gluteal IM injection of an analgesic for post-appendectomy pain. This chronic SNII pain did not improve despite his gradual recovery from weakness in the left foot. Partial improvement was seen following an external neurolysis, performed three months post-appendectomy. SNII is a preventable complication of gluteal IM injection. While the complete avoidance of gluteal IM injection is desirable, should need arise, the use of an appropriate administrative technique is recommended.

Keywords: Iatrogenic nerve injury; Intramuscular injections; Neurolysis; Neuropathic pain; Sciatic nerve.

FIGURE 1. (A) Anterior-posterior photographs of patient with left sciatic nerve injection injury. His left foot shows calcaneal position (arrows) indicating more severe involvement of the tibial division. Atrophy of the gluteal muscles in the buttock is evident due to previous total hip atrophy. The arrowhead indicates the site of injection. The dotted area shows the area of aching and electrical shock-like pain, hypesthesia, and dysesthesia. (B) X-ray film showing bilateral total hip arthroplasty.

FIGURE 2. (A) An axial T2-weighted image of the pelvis showing the right and left sciatic nerves. Compared to the right sciatic nerve (black arrow), the left sciatic nerve is atrophic and does not show a normal reticular pattern. (B) An intraoperative photograph showing the adhesion and scarring around the left sciatic nerve (arrowheads). The left sciatic nerve was pale and swollen. The arrow indicates the site of the misplaced IM injection. (C) An intraoperative photograph after decompression and external neurolysis of the left sciatic nerve (arrowheads). The arrow indicates the site of the misplaced IM injection.

Is: ischial spine, L: left, R: right, IM: intramuscular.