A Unique Cause Of Sciatica In A Masters Martial Arts Athlete

Abstract

HX 71-year-old male masters martial arts athlete referred for suspected “sciatica.” He had around one month of right buttocks pain with radiation to his posterior thigh. He endorsed a recent increase in his Krav Maga martial arts activity. He had pain localized over the ischial tuberosity, rated an 8/10, and described as sharp and burning. Symptoms provoked with hip movement and weight activities. He endorsed hamstring weakness and had developed a limp while walking. Denied any lower extremity numbness or low back pain. On further questioning of his personal musculoskeletal history, he did admit to a prior right proximal hamstring injury around 1 year, and a remote history of low back pain requiring a L4-L5 decompression surgery. PHYSICAL EXAM: On inspection, he had a soft tissue defect over his ischial tuberosity, but no swelling or ecchymosis. He had an antalgic gait on his right hip, extreme tenderness along his ischial tuberosity and proximal hamstring. Hip range of motion was difficult to assess due to pain. He had 5/5 strength and intact sensation throughout his bilateral lower extremities except for right knee flexion which was 4/5 and painful. Reflexes were 1+ and symmetric at the bilateral knee and ankle. Special testing was negative for a seated slump test bilateral. DIFFERENTIAL: 1. Sciatica 2. Herniated disc 3. Piriformis syndrome TEST/RESULTS: Diagnostic ultrasound of his right posterior hip region was performed in clinic. This demonstrated a high grade retracted and avulsed partial tear of the proximal hamstring tendon, involving both the conjoint and semimembranosus tendons. DIAGNOSIS: Avulsed Proximal Hamstring tear TREATMENT/ OUTCOMES: A right hip MRI was performed for surgical planning purposes. This further demonstrated a high-grade, greater than 75%, partial thickness tear involving the conjoint and semimembranosus tendon origin with 4.4 cm of retraction. He underwent an open proximal primary repair of the hamstring tendon with neuroplasty of the sciatic nerve. The patient began post-operative physical therapy around 1 month after surgery which he successfully completed. 8 months post-operative he has had near resolution of his right buttocks pain at the ischial tuberosity and his posterior thigh pain had resolved. For activity, he has been able to resume cardiovascular exercise with walking and biking.