Sunday, 13 August 2017

Dr. Sharvan Kumar Bansal, MBBS, Consulting pediatrician, ASTHA Children Hospital, SIRSA, Opposite Shri Salasar Temple, New Grain Market Road, Main Dabwali Road, Near Maruti Showroom, Sirsa – 125 055 (Haryana) Vodafone : 088139 54354

To,
The Medical Board,
Office of Chief Medical Officer,
District –Sirsa (Haryana)

This case involves Cadaveric- abbrent pathway sciatic nerve, the same is described hereinbelow as per available medical literature :
A unique case of bilateral sciatic nerve variation within the gluteal compartment and associated clinical ramifications

Abstract
1.   An abnormal course of a nerve either through or around a muscle may yield multiple or anomalous muscle innervation. Further, if nerves are inappropriately trapped within the confines of a muscle or irregular boundaries, variant emergence of a nerve could give rise to symptoms of an entrapment neuropathy. Upon routine dissection in the Department of Anatomy at the American University of Antigua College of Medicine, bilateral variants in the emergence of the sciatic nerve from the pelvis to the gluteal compartment were discovered in an elderly adult female cadaver. In the left gluteal compartment, the sciatic nerve had a high division where the peroneal division exited the pelvis superior to the piriformis muscle while the tibial division exited inferior to the piriformis. In the right gluteal compartment, the peroneal division was observed to have exited the pelvis between a split piriformis muscle before it joined the tibial division of the sciatic nerve. Knowledge of such variations in the course of the sciatic nerve may improve diagnosis and treatment of pathologies in this region.

2.   An abnormal course of a nerve either through or around a muscle may yield multiple or anomalous muscle innervation. Further, if nerves are inappropriately trapped within the confines of a muscle or irregular boundaries, variant emergence of a nerve could give rise to symptoms of an entrapment neuropathy. Upon routine dissection in the Department of Anatomy at the American University of Antigua College of Medicine, bilateral variants in the emergence of the sciatic nerve from the pelvis to the gluteal compartment were discovered in an elderly adult female cadaver. In the left gluteal compartment, the sciatic nerve had a high division where the peroneal division exited the pelvis superior to the piriformis muscle while the tibial division exited inferior to the piriformis. In the right gluteal compartment, the peroneal division was observed to have exited the pelvis between a split piriformis muscle before it joined the tibial division of the sciatic nerve. Knowledge of such variations in the course of the sciatic nerve may improve diagnosis and treatment of pathologies in this region.


Implications for Practice:
A.   What is known about this subject?
Anatomical variation of nerves and their course may confer a challenge in clinical and surgical practice for both diagnosis and intervention. This study identifies between-side variation of nerve location within the gluteal compartments of a single cadaver.
B.   What new information is offered in this study?
The presentation of the variation described shows the piriformis muscle lying between the two branches of the sciatic nerve in the left gluteal compartment, and the piriformis muscle being pierced by the common peroneal nerve in the right gluteal compartment. We also identify the statistical probability of the occurrence of both of these isolated variations in the same cadaver as approximately 1/10,000.
C.   What are the implications for research, policy, or practice?
The identification of variant sciatic nerve location in the gluteal region may contribute to improvement in diagnosis and intervention of pathologies in this area. Further prospective analyses that investigate the rate of occurrence, associated risk and any potential relationship to morphological variation could prove helpful for clinicians and surgeons.

Background
3.   Knowledge and analysis of nerve variance is clinically imperative for several reasons. In the course of a surgical procedure, it is important to be cognizant of usual morphology in addition to that of morphological variation. Nerve entrapment as a result of variant nervous pathways in the lower limb have the potential to lead to piriformis syndrome, sciatica, or coccygodynia, and may present unique clinical challenges in relation to selecting the appropriate therapy to alleviate a patient’s pain. Further, muscle power, tone, and function may be compromised with the occurrence of distal neuropathy whereby a nerve, being irritated in an abnormal location, loses its capacity to effectively innervate a distal muscle.


4.   The sciatic nerve is the largest peripheral nerve in the human body, originating from roots L4–S3. It emerges from the pelvis via the greater sciatic foramen, running inferior to the piriformis muscle, and entering the gluteal compartment. The major components of the sciatic nerve include the common fibular nerve and tibial nerve, respectively. The common fibular nerve arises from dorsal divisions of ventral rami of L4–S2 while the tibial nerve arises from ventral divisions of ventral rami of L4-S3. The sciatic nerve is responsible for the innervation of the posterior compartment of the thigh as well as all the muscles of the leg and foot.


5.   The piriformis muscle assists in forming the posterolateral wall of the pelvis, attached medially to the sacrum and laterally to the greater trochanter of the femur. Functionally, the piriformis contracts to provide external rotation, abduction and extension of the hip, depending on the initial thigh position. It also assists with hip stabilisation by assisting the maintenance of the position of the head of the femur in the acetabulum. The muscle bridges the pelvis, from its attachment at the sacrum, through the greater sciatic notch, and in doing so is located posterosuperiorly to the sciatic nerve. The piriformis is innervated by direct branches from the sacral plexus, specifically arising from S1–S2 nerve roots. It is relatively uncommon to observe deviation from this schema.


6.   Piriformis syndrome occurs when the sciatic nerve is entrapped by the piriformis muscle as it exits the sciatic notch in the gluteal region. This can potentially occur when the piriformis muscle is hypertrophied and mechanically compromises the adjacent sciatic nerve. Piriformis syndrome is considered as a differential diagnosis with variations of the sciatic nerve where the sciatic nerve pierces the piriformis muscle. Pharmacologic interventions used in the treatment of piriformis syndrome may include intramuscular injections of steroids, anesthetics, or botulinum toxin.


7.   Peripheral neuropathy involving the sciatic nerve presents with pain, tingling or numbness in the buttocks, and weakness of muscles innervated by this nerve. This can sometimes be triggered by activities such as climbing stairs or running. Most commonly this occurs iatrogenically but may also be due to other causes. Surgical decompression of the sciatic nerve may provide variable relief in some cases.


Case details
8.   In the course of routine dissection of an elderly female Caucasian cadaver, bilateral variants were discovered in the gluteal compartment. In the right gluteal compartment, the piriformis muscle was found to be bifid (Figure 1). The common peroneal nerve was found to emerge into the gluteal compartment by piercing the piriformis muscle, effectively separating it into superior and inferior muscle slips (Figure 1). The tibial nerve was found emerging from the lower border of the inferior muscle slip of the piriformis.

Figure 1
Right gluteal compartment

9.   On the left side the common peroneal nerve exited the pelvis superior to the piriformis muscle, while the tibial nerve coursed inferior to the piriformis muscle. The two divisions subsequently joined distal to their emergence around the piriformis


Figure 2

Left gluteal compartment


10.                The nerve supply to the posterior compartment of the thigh, the flexor compartment of the leg, and the extensor compartment of the leg appeared to have a regular path and distribution, bilaterally

Figure 3
Right and left gluteal compartments


Discussion
11.                Bilateral variants in the gluteal compartment appear uncommonly in most anatomical studies. However, various clinical manifestations may potentially be associated with altered morphological relations between the piriformis muscle and the sciatic nerve. Given the asymmetric presentation of the sciatic nerve’s emergence from the pelvis in this case, variation of the innervation between the gluteal compartments’ muscles should be considered. We did not investigate this specifically.


12.                Sciatica, described as lower back, gluteal, and thigh pain, is experienced as a result of compression or irritation of the sciatic nerve or its roots. Given the anatomical variation observed and the variable passage of the sciatic nerve through and around the piriformis muscle, sciatica may have been present in this individual.


13.                Another clinical ailment in the posterior gluteal region is coccygodynia, defined as pain in and around the coccyx, typically worsening when sitting and upon rising from a seated position. Aberrant formation or presentation of accessory muscle slips of the piriformis muscle, or normal muscle being split into multiple slips, have been considered to provide a likely morphological basis for coccygodynia as a result of the unusual relation between the variant muscle slip and sciatic nerve, or branch thereof. As it applies to this case study, there was the potential for coccygodynia to have been present bilaterally in this individual based on the anatomical variations observed.


14.                The rarity of this case is due to the variation between opposite gluteal compartments in the same cadaver. Smoll suggested the probability of observing the presentation in the right gluteal compartment, where the peroneal division pierced the piriformis, to be 13.8 per cent (829 cases/5,987 total limb dissections = 0.138). Smoll also indicated the probability of observing the presentation in the left gluteal compartment, where a split sciatic nerve encompassed the piriformis, to only be 0.0835 per cent (5 cases/5,987 total limb dissections = 0.000835). Therefore, the probability of identifying both of these variations within the same cadaver, as is presented in this case study, is 0.011 per cent or 1 in 10,000 individuals.


Conclusion
15.                Anatomical variants in the pelvic and gluteal regions are of interest to clinicians to guide accurate diagnosis and intervention. Visual screening of this zone (such as using ultrasound) could be of assistance with posterior gluteal pathology, and suspected piriformis syndrome, to prevent iatrogenic surgical damage, and knowledge of within-individual variations such as those described are therefore important for clinical practice.


Summry of Treatment
16.                Patient’s USG report was of 3rd sept. 2016 at Dhaliwal Hospital Mandi Dabwali. So Patient had taken treatment from other doctor. Patient came to my hospital on 4thSeptember 2016 at 7:15 p.m with complaints of (1) Pain Abdomen, (2) Vomiting, and (3) Weakness. Patient Admitted in 1st Notice that he came with pain in Rt. Leg as notice given to us. After prescribing inj. Diclo by me I/M, Patient Refuse due to pain in his rt.Leg. These things are in written in the documents.


Chronological events
1.    USG at dhaliwal Hospital by Self on 3rd September, 2016
2.    Patient came to Aastha Hospital on 4th September, 2016 at 7:15P.M. Patient Left After 2Hours.
3.    Patient went to Bikaner Hospital on 5th September, 2016 at 1:00a.m.
4.   Patient went to Janta Hospital (Quack) By self Decisen
5.    Patient went to Life line Hospital on 10th September, 2016.
6.    Patient went to Medical College Faridkot
7.    Patient went to Singla Neuro Hospital on 16th September, 2016.
8.    Patient went to PGI Chd. On 10th October, 2016.


17.                The liability of a doctor arises not when the patient has suffered any injury, but when the injury has resulted due to the conduct of the doctor, which has fallen below that of reasonable care. In other words, the doctor is not liable for every injury suffered by a patient. He is liable for only those that are a consequence of a breach of his duty. Hence, once the existence of a duty has been established, the plaintiff must still prove the breach of duty and the causation. In case there is no breach or the breach did not cause the damage, the doctor will not be liable. In order to show the breach of duty, the burden on the plaintiff would be to first show what is considered as reasonable under those circumstances and then that the conduct of the doctor was below this degree. It must be noted that it is not sufficient to prove a breach, to merely show that there exists a body of opinion which goes against the practice/conduct of the doctor.

18.                The law, like medicine, is an inexact science. One cannot predict with certainty an outcome in many cases. It depends on the particular facts and circumstances of the case, and also the personal notions of the Judge who is hearing the case. However, the broad and general legal principles relating to medical negligence need to be understood. Before dealing with these principles two things have to be kept in mind:
    I.        Judges are not experts in medical science, rather they are laymen. This itself often makes it somewhat difficult for them to decide cases relating to medical negligence. Moreover, Judges usually have to rely on the testimonies of other doctors, which may not be objective in all cases. Since like in all professions and services, doctors too sometimes have a tendency to support their own colleagues who are charged with medical negligence. The testimony may also be difficult to understand for a Judge, particularly in complicated medical matters and

  II.        A balance has to be struck in such cases. While doctors who cause death or agony due to medical negligence should certainly be penalized, it must also be remembered that like all professionals doctors too can make errors of judgment but if they are punished for this no doctor can practice his vocation with equanimity. Indiscriminate proceedings and decisions against doctors are counter productive and are no good for society. They inhibit the free exercise of judgment by a professional in a particular situation.

ADDITIONAL SUBMISSION

Sciatic Nerve Injury Following Intramuscular Injection: A Case Report and Review of the Literature

Discussion
19.                When giving gluteal injections, it is safest to use the upper outer quadrant. The choice of site for injection must be based on good clinical judgment, using the best evidence available and individualized client assessment. There is wide agreement in the literature that the ventrogluteal site is preferable (Small, 2004). Review of the literature on relevant injection procedure found that injury to the sciatic nerve is associated with use of the dorsogluteal site for injection, because the sciatic nerve commonly courses this site (Fig. 1).

Click to zoom

Anatomy of the sciatic nerve in the gluteal region

20.                Ndiaye, Sakho, Fall, Dia, and Sow (2004) performed sciatic nerve gluteal dissection on 10 fresh adult African cadavers, on both sides. The nerve pathway was 19 times out of 20 in the subpiriformis canal. In all cases the pathway was identical, with an oblique and vertical portion running down through the ischio-trochanteric channel. The cutaneous projection of the sciatic nerve was distant from the upper lateral quadrant of the buttock.

21.                The site of injection is the crucial factor in determining the degree of nerve fiber injury. The degree of injury varies significantly, depending upon the specific agent injected. The most severe injuries have been associated with widespread axonal and myelin degeneration (Gentili, Hudson, and Hunter, 1980a). Pathological alterations in the nerve were evident as early as 30 minutes following injection injury (Gentili et al., 1980b).

22.                Although postinjection injury can occur in both adults and children, children appear to be at higher risk (Krasnikova, 1986). Fatunde and Familusi (2001) did a retrospective study of all children with a diagnosis of sciatic nerve injury during a 12-year period. They examined 27 children, 5 months-12 years of age, with a diagnosis of postinjection sciatic nerve injury. The drugs administered to 17 patients included chloroquine, novalgin, paraldehyde, procaine penicillin, and sulfadoxine-pyrimethamine. However, the most neurotoxic agents tested in a previous study appear to be penicillin G, diazepam, and chlorpromazine (Yaffe, Pri-Chen, Lin, Engel, & Modan, 1986). The postulated mechanisms of injury include direct needle trauma, secondary constriction by scar, and direct nerve fiber damage, due to both axon and Schwann cell, with a breakdown in the blood-nerve barrier by neurotoxic chemicals in the injected agent (Gentili et al., 1980b; Villarejo & Pascual, 1993)

23.                Neurological sequelae can range from minor transient sensory disturbance to severe sensory disturbance and paralysis, with poor recovery (Villarejo & Pascual, 1993). In one study, seven patients (26%) presenting with foot drop had had recent IM injections in the buttock. An additional 20 patients (74%) presented much later (Fatunde & Familusi, 2001). In fact, gluteal IM injection that led to sciatic nerve injury most often presented as paralytic drop foot (Mayer & Romain, 2001; Sobel, Huang, & Wieting, 1997).

24.                Children who present with drop foot may later develop gluteal fibrosis (diagnosed 5.1 years after the injections). In contrast, sciatic nerve palsy, presenting as equinovarus or equinus deformity, was diagnosed on average 3.8 months after the intragluteal injections (Napiontek & Ruszkowski, 1993). Cavovarus and calcaneocavus foot deformities have also been reported (Bigos & Coleman, 1984).

25.                Medical treatments including administration of vitamins and alphachymotrypsine have been tried with varying results, depending on the extent of the lesion. Early (within 2 months) physiotherapy may provide a better chance of recovery (Bourrel & Souvestre, 1982). Our patient presented 12 months after nerve injury and, thus, his chances of recovery were small.

26.                The recommended treatment ranges from a conservative approach to immediate operative exposure and irrigation and has included early neurolysis or delayed exploration with neurolysis or resection and anastomosis (Villarejo & Pascual, 1993). Of 190 patients with gluteal sciatic nerve injuries in one retrospective study, the injuries were caused by injection in 164 patients (86.32%). Fifteen were treated by conservative means, and the other 175 had surgical intervention. Neurolysis was performed in 160 cases, epineural neurorrhaphy in 12 cases, nerve grafting in 2 cases, and nerve exploration but no repair in 1 case. Late-stage functional reconstruction of the foot and ankle was performed in 23 cases. Follow-up of 151 patients for an average 8.5 years revealed excellent to good nerve recovery (i.e., 57% and 78% in the early and late stage, respectively). We believe that neurolysis should be performed as soon as possible in cases of injection injury (Huang, Yan, & Lei, 2000).

27.                Epineural neurorrhaphy should be performed in cases of nerve rupture. Functional reconstruction of the foot and ankle should be carried out in the late stage for the improvement of the limb function, if a surgical team is available for this purpose (Huang et al., 2000). If performed within 24 hours after injury, neurolysis may prevent the occurrence of paralysis (Mayer & Romain 2001; Yaffe et al., 1986). Our patient was offered physiotherapy rather than surgical treatment because of his late presentation. To date, his improvement has been minimal.

28.                The implications for nurses include the need to learn and practice safe injection technique. Nurses must also assess for complications (both immediate and long term), and educate patients.


From the facts and circumstances, it is clear like light of the day that no case is made out prima facie on account of medical negligence, therefore the complaint filed, may please rejected in the larger interest of Justice.

Dr. Sharvan Kumar Bansal,
MBBS,
Consulting pediatrician,
Opposite Shri Salasar Temple,
New Grain Market Road,
Main Dabwali Road,
Near Maruti Showroom,
Sirsa – 125 055 (Haryana)
Vodafone : 088139 54354


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