The greater trochanteric bursa and contiguous structures were noted to be normal. After decompressing the sciatic nerve from the fibrotic and granulation tissue, the newly formed mass was evacuated. An associated solid mass (5 cm × 2 cm × 3 cm), representing chronic hematoma and fibrosis, was attached to and compressed the sciatic nerve. Intra-operatively, an atrophic quadratus femoris muscle was found, with complete detachment at the tendon-bone junction from the quadrate tubercle of the femur (grade III strain) (Figure (Figure3). A surgical exploration of our patient was then performed through a posterolateral approach of the right hip. The lack of obvious fluid effusion did not allow computed tomography (CT)-guided drainage. A conservative approach, by means of strengthening of our patient's external rotators muscles, did not show any improvement for one month. Thus, hematoma formation was thought to be responsible for her persistent sciatica. This showed that the previous muscular strain showed only a minor degree of hematoma absorption compared to the previous study (Figure (Figure2).

A new MRI examination of our patient was requested for confirmation.

Based on the above, the initial clinical impression was piriformis syndrome. The complete laboratory work-up did not reveal any indication for infection or coagulopathy. Standard hip, lumbar spine and pelvis radiographs were unremarkable. Her vascular clinical tests and the lumbar spine examination were normal. Passive hip internal rotation also reproduced pain in the proximal posterior thigh, with positive Freiberg and flexion, adduction, internal rotation (FADIR) tests. Right straight leg rising (SLR) reproduced symptoms at 30° and her Lasegue test was positive. There was tenderness upon palpation at the right ischial tuberosity associated with reduced muscular strength at right hip external rotators. There were no abnormalities on examination, such as soft tissue swelling, ecchymosis or erythema of the right gluteus and lower leg. Physical examination revealed an active young woman with healthy muscular development. Six months after the injury, she was referred to our tertiary health care hospital for consultation due to persistent sciatica.

VIP Marathi muve duniyadari online