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Piriformis syndrome as a result of intramuscular haematoma mimicking cauda equina effectively treated with piriformis tendon release
  1. Thomas Robert William Ward,
  2. Kanai Garala,
  3. Ian Dos Remedios and
  4. Justin Lim
  1. Trauma and Orthopaedics, Department of Orthopaedics, Royal Stoke University Hospital, Stoke-on-trent, UK
  1. Correspondence to Mr Thomas Robert William Ward; thomasrwward{at}doctors.org.uk

Abstract

We present a case of piriformis syndrome in a woman in her 30’s following low energy trauma, presenting with unilateral lower limb weakness, altered sensation and urinary retention. CT imaging revealed a bulky piriformis muscle which was further clarified on MRI as an intramuscular haematoma within the left piriformis causing compression of the left lumbosacral plexus. Haematoma formation was exacerbated due to use of an antiplatelet medication the patient was taking for Moyamoya disease, which carries an increased risk of cerebrovascular accident. Surgical exploration of the piriformis and sciatic nerve was undertaken and confirmed a haematoma within the piriformis. A full release of the piriformis tendon was undertaken, and the sciatic nerve was inspected, no further abnormality was found. After review in clinic post-discharge, the patient reported normal sensation and normal muscle power in her feet.

  • Moyamoya
  • trauma CNS /PNS
  • orthopaedics
  • radiology

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Footnotes

  • Contributors All the authors cited have been involved in patients care and treatment and have been involved in the production of case report in equal measures. TRWW contributed to Peri op care, post op care, writing of summary, discussion, learning points, imaging analysis and review of whole document. KG contributed to initial patient assessment, peri op care, post op care, writing of summary, case presentation, investigations, learning points, imaging analysis and review of whole document. IDR contributed to Peri op care, surgical intervention post op care, writing of treatment and outcome, learning points and review of whole document. JL contributed to initial patient assessment, peri op care, post op care, writing of background, differential diagnosis, learning points and review of whole document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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