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Question:

Numbness in left buttock and back of left thigh after repeated falls

Dear Ask The Doctor:
My left buttock and back of my left thigh is all numb? It all started with just playing catch with a rugby ball and me falling over maybe three times but it didn't hurt at all. Later on that day at night, there was pain on my left thigh and buttock and the pain kind of shot down to my whole left leg and the very next day i couldn't get out of bed because of the pain. I managed to get out of bed but later on that day and go out and as i mentioned above, the area started to get numb and now its entirely numb since yesterday, what is it?


Answer:

According to your description, your symptoms may correspond to a Piriformis Syndrome, this condition can simulate diskogenic sciatica (radicular compression by a bulging disc), usually is caused by neuritis of the proximal sciatic nerve. The piriformis muscle can either irritate or compress the proximal sciatic nerve due to spasm and/or contracture. The Piriformis Syndrome is also referred to as pseudosciatica, wallet sciatica, and hip socket neuropathy. The pain, numbness or tingling originates in the base of the buttock and may radiate to the hip. You mentioned you fell over many times playing rugby, possibly on a very hard surface; this may have produce a trauma or blunt injury that could have caused hematoma formation and subsequent scarring between the sciatic nerve and short external rotators muscles. Nerve injury can occur with prolonged pressure on the nerve. It has been described bilateral Piriformis Syndrome due to prolonged sitting on a hard surface. Piriformis syndrome remains controversial because, in most cases, the diagnosis is clinical, and no confirmatory tests exist to support the clinical findings. Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome. Approximately 50% of patients with piriformis syndrome have a history of trauma, with either a direct buttock contusion or a hip/lower back torsional injury. The remaining 50% of cases are of spontaneous onset. Diagnostic imaging of the lumbar spine (MRI) is mandatory to rule out associated diskogenic (bulging disk) and/or osteoarthritis. Usually the treatment is aimed to correct the following: tight piriformis muscle, tight hip rotator muscles, hip muscles weakness, and sacroiliac problems. The use of ultrasound previously the physical therapy session may be beneficial, and the proceed with a stretching routine for the piriformis and hip muscles, you should be provided with a home stretching program because the stretches every 2-3 hours (while awake) are critical for the treatment success
 



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