SCIATIC NERVE INJURY

By: John Omole

Physiotherapy Department
OAUTHC
 DEFINITION

Trauma to a nerve specifically the

sciatic nerve by an injection
(needle) resulting usually from
either a direct injury or irritating
effects of the injected drugs.
 OTHER NAMES
• POST INJECTION PALSY
• SCIATIC NERVE PASLY
• POST INJECTION SCIATIC NEUROPATHY
• INJECTION INDUCED SCIATIC NERVE INJURY
• TRAUMATIC INJECTION NEUROPATHY
• POST INJECTION SCIATIC NERVE INJURY
 PREVALENCE
• CHILDREN IN DEVELOPING COUNTRIES
• MALES MORE AFFECTED THAN FEMALES
• UNDER FIVES MORE PREDISPOSED
 AETIOLOGY
• POOR TECHNIQUE BY TRAINED OR UNTRAINED
INDIVIDUALS
• WRONG PLACEMENT OF THE NEEDLE
• ANATOMICAL VARIATION
• MALARIA / FEVER THE MAIN REASON FOR IM
INJECTION
 QUESTION
• WHICH IS MORE LIKELY TO CAUSE INJURY TO
THE SCIATIC NERVE?
A. Direct trauma to the sciatic nerve via needle
B. Caustic agents in the syringe
 SITES OF
INTRAMUSCULAR
INJECTION
 SYMPTOMS
The initial symptoms are as follows;
• Pain especially in back thigh or buttocks
• Altered sensation i.e. excruciating sensitivity
and burning
• Difficulty sleeping
• Swelling of the injection site
• injection site may be warm to touch
• Unable to stand or walk
 SYMPTOMS CONTINUES
Later, if there is no medical intervention within a
month or two then other symptoms may include;
• Atrophy of the Tibialis Anterior
• Foot drop of the affected foot
• Pain at the ankle or calf
• Trophic changes i.e. decreased sweat/sensation
• Development of club foot deformity
 Differential diagnosis b/w SNI and Polio
SNI POLIO
1. No Polio virus seen Polio virus seen
in stool sample
2. Skin sensation may Not impaired at
impaired. All
3. AFP: May not be seen Present > 24hrs
but if present < 24 hrs
4. Meningeal sign absent Present.
5. Trophic changes Absent
present
 CONTINUES
SNI POLIO
6. Nil difficulty in Present : In clinical
breathing/swallowing Polio type.
7. Protein levels in CSF High
Normal
8. Tibialis anterior Majorly Quards.
majorly affected.
9. Pathological gait Hand to knee or
High steppage gait weak Quard. gait
 What is Meningeal Sign?
A clinical sign of meningeal irritation.
Tests:
• BRUDZINSKI SIGN
• KERNIG SIGN
• NUCAHL RIGIDITY
 What is Trophic changes
Trophic changes results from interruption of
nerve supply.
 ON SET OF PARALYSIS
POLIO : 8 – 17 DAYS POST PROVOCATIVE POLIO
(AVERAGE OF 10)
SNI : 0 – 48HRS AFTER INJECTION

PROVOCATIVE POLIO:
Phenomenon where skeletal muscles injury
predisposes an individual to neurological
complication following a polio infection.
 PLAN
• TO RELIEVE / ELIMINATE PAIN
• TO STRENGTHEN WEAK MUSCLES
• TO PROMOTE FUNCTION
• TO CORRECT (IF ANY) DEFORMITIES
• TO EDUCATE PROPER GAIT (IF NEED BE)
• TO RECOMMEND OR PROVIDE ORTHOTIC
DEVICES
 MEANS
• CRYOTHERAPY (WITH DISCRETION)
• ULTRASOUND (WITH SERIOUS DISCRETION)
• IRR
• TENS
• EMS
• FES
• MASSAGE
• EXERCISES; STIR CASE CLIMBING, SQUATTING,
INCLINATION BOARD, WOBBLE BOARD ETC.