Bano et al. Journal of Medical Case Reports 2010, 4:236 http://www.jmedicalcasereports.com/content/4/1/236 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report Artan Bano1, Apostolos Karantanas2, Dritan Pasku1*, George Datseris3, George Tzanakakis 4, Pavlos Katonis1 Abstract Introduction: Quadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative. Case presentation: We report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression. Conclusion: The correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option. Introduction Traumatic quadratus femoris muscle tear is a clinically unsuspected injury. The immediate and correct diagno- sis is a challenge because of its rarity and similarities to other disorders that cause groin pain. Only a few cases of partial and complete rupture of quadratus femoris muscle in the young active population have been reported in the literature [1,2]. In all cases, magnetic resonance imaging (MRI) was crucial both in correct diagnosis and guidance of treatment. Simultaneously, different therapeutic techniques were used including the injection of methylprednisolone acetate (Depo-Medrol), transcutaneous neurostimulation, ultrasound and physi- cal rehabilitation techniques [1]. We present a rare case of quadratus femoris muscle rupture associated with persistent sciatica, which was treated with surgical decompression. Case presentation A 22-year-old Greek woman sustained a direct injury to the right buttock following a fall down the stairs. After * Correspondence: paskudr@gmail.com 1Department of Orthopaedic and Traumatology, University Hospital of Heraklion, 71110, Crete, Greece the injury she had an antalgic gait due to pain in the right inferior gluteal area with radiation to the proximal posterior thigh. Pain was aggravated by sitting and squatting. MRI examination at that time revealed an extensive hematoma extending to both the quadratus femoris and obturator externus muscles, in keeping with strain grade II (Figure 1). She was treated with non-ster- oidal anti-inflammatory drugs (NSAID) without improvement. Six months after the injury, she was referred to our tertiary health care hospital for consultation due to per- sistent sciatica. Physical examination revealed an active young woman with healthy muscular development. There were no abnormalities on examination, such as soft tissue swelling, ecchymosis or erythema of the right gluteus and lower leg. There was tenderness upon pal- pation at the right ischial tuberosity associated with reduced muscular strength at right hip external rotators. Right straight leg rising (SLR) reproduced symptoms at 30° and her Lasegue test was positive. Passive hip inter- nal rotation also reproduced pain in the proximal pos- terior thigh, with positive Freiberg and flexion, adduction, internal rotation (FADIR) tests. Her vascular clinical tests and the lumbar spine examination were © 2010 Bano et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.