Korean J Neurotrauma.  2019 Apr;15(1):61-66. 10.13004/kjnt.2019.15.e4.

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

• Park CW
• Cho WC
• Son BC

• KMID: 2444208
• DOI: http://doi.org/10.13004/kjnt.2019.15.e4

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.

Keyword

Intramuscular injections; Iatrogenic nerve injury; Neurolysis; Neuropathic pain; Sciatic nerve

MeSH Terms

Aged
Buttocks
Foot
Humans
Injections, Intramuscular*
Male
Neuralgia
Organization and Administration
Sciatic Nerve*

Figure

• 

  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.

Reference

1. Turner GG. The site for intramuscular injections. Lancet. 1920; 196:819.

2. Miller MA, Pisani E. The cost of unsafe injections. Bull World Health Organ. 1999; 77:808–811. PMID: 10593028.

3. Pandian JD, Bose S, Daniel V, Singh Y, Abraham AP. Nerve injuries following intramuscular injections: a clinical and neurophysiological study from Northwest India. J Peripher Nerv Syst. 2006; 11:165–171. PMID: 16787515.

4. Mishra P, Stringer MD. Sciatic nerve injury from intramuscular injection: a persistent and global problem. Int J Clin Pract. 2010; 64:1573–1579. PMID: 20670272.

5. Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. J Neurosurg. 1998; 89:13–23. PMID: 9647167.

6. Small SP. Preventing sciatic nerve injury from intramuscular injections: literature review. J Adv Nurs. 2004; 47:287–296. PMID: 15238123.

7. Kim HJ, Park SH. Sciatic nerve injection injury. J Int Med Res. 2014; 42:887–897. PMID: 24920643.

8. Streib EW, Sun SF. Injection injury of the sciatic nerve: unusual anatomic distribution of nerve damage. Eur Neurol. 1981; 20:481–484. PMID: 7308248.

9. Hadzic A, Dilberovic F, Shah S, Kulenovic A, Kapur E, Zaciragic A, et al. Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med. 2004; 29:417–423. PMID: 15372385.

10. Senes FM, Campus R, Becchetti F, Catena N. Sciatic nerve injection palsy in the child: early microsurgical treatment and long-term results. Microsurgery. 2009; 29:443–448. PMID: 19306387.

11. Topuz K, Kutlay M, Simşek H, Atabey C, Demircan M, Senol Güney M. Early surgical treatment protocol for sciatic nerve injury due to injection--a retrospective study. Br J Neurosurg. 2011; 25:509–515. PMID: 21513449.

12. Kim DH, Murovic JA, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg. 2004; 101:8–17. PMID: 15255245.

13. Villarejo FJ, Pascual AM. Injection injury of the sciatic nerve (370 cases). Childs Nerv Syst. 1993; 9:229–232. PMID: 8402705.

14. Yeremeyeva E, Kline DG, Kim DH. Iatrogenic sciatic nerve injuries at buttock and thigh levels: the Louisiana State University experience review. Neurosurgery. 2009; 65:A63–A66. PMID: 19927080.

15. Spinner RJ, Kline DG. Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions. Muscle Nerve. 2000; 23:680–695. PMID: 10797390.

16. Gentili F, Hudson AR, Midha R. Peripheral nerve injuries: types, causes, and grading. In : Wilkins RH, Rengachary SS, editors. Neurosurgery. New York, NY: McGraw-Hill;1997. Vol. 3:p. 3105–3114.

17. Midha R. Peripheral nerve: approach to the patient. In : Winn HR, editor. Youmans neurological surgery. Philadelphia, PA: Saunders;2003. Vol. 4:p. 3819–3830.

18. Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol. 2008; 119:1951–1965. PMID: 18482862.

19. Khan R, Birch R. Latropathic injuries of peripheral nerves. J Bone Joint Surg Br. 2001; 83:1145–1148. PMID: 11764429.