73 Views

445 - Multifocal Nerve Compression due to Unevacuated Chronic Thigh Hematoma After a Wakeboarding Injury

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

AK

Alina Kirichuk, BS

Medical Student
Touro University California, College of Osteopathic Medicine
Benicia, California, United States

Co-Author(s)

MW

Melody Wang, MS

OMS-III
Touro University California
Hacienda Heights, California, United States
KL

Kyaw Lin, DO

Assistant Professor
Touro University
Concord, California, United States

Case Diagnosis: Sciatic nerve compression due to posterior thigh hematoma

Case Description: A 59-year-old male presented to the clinic with worsening right foot pain and weakness for 7 weeks after a wakeboarding accident. Physical exam showed 0/5 strength in dorsi- and plantarflexion. Three days after the injury, the patient developed right leg pain and weakness. MRI of the right leg performed at his three-week follow-up with orthopedics showed a 10.0 x 5.9 x 4.9 cm hematoma. After discharge, the patient continued to have symptoms and developed paresthesias and numbness in the right foot. A repeat MRI at the ED showed an unresolved 11.3 x 7.9 x 4.9cm hematoma. At that time orthopedic consult was obtained and recommended no additional workup and noted the changes were stable.

Discussions: Sciatic nerve palsy produces pain, weakness, and sensation loss. While literature exists discussing sciatic nerve palsy in the context of hip arthroplasties and inferior gluteal artery ruptures, this patient had a semimembranosus tear. This patient was treated non-operatively as the hematoma appeared to be stable yet was still large enough to cause worsening symptoms and an eventual complete loss of strength of the right ankle. The literature has shown that patients who develop nerve palsy due to hematomas and pseudocompartment syndromes benefit from hematoma evacuation. Evacuating a hematoma of that size would have benefitted the patient despite his injury being muscular.

Conclusions: Patients’ with large extremity hematomas, even if stable, should be scheduled for close follow-up and provided clear instructions and precautions about nerve palsy symptoms. This case report demonstrates that despite a stable hematoma, physicians may consider evacuation as a preventative measure to help their patients avoid the pain, loss of sensation and strength that may never be restored.