How a valuable possession slowly damaged a young man's nerve
1. 30-year-old Sidh consulted me with severe sharp shooting #pain from right buttock to the leg & foot for 3 months. Pain was more while sitting and lesser while standing or walking. Pain increased on lying down.
1. 30-year-old Sidh consulted me with severe sharp shooting #pain from right buttock to the leg & foot for 3 months. Pain was more while sitting and lesser while standing or walking. Pain increased on lying down.
2. He was evaluated elsewhere.
MRI spine ruled out slipped disc and nerve compression in lower back region.
Nerve conduction studies had shown severe damage of right sciatic nerve (see the image below to see the location and course of sciatic nerve).
MRI spine ruled out slipped disc and nerve compression in lower back region.
Nerve conduction studies had shown severe damage of right sciatic nerve (see the image below to see the location and course of sciatic nerve).
3. No cause for sciatic nerve damage was obvious. On detailed enquiry, he informed that he always carried a "fat wallet" in his right back pocket, which remained in his pocket while he sat in office during work (10 hours a day).
Now, I could guess the cause.
(Pic from internet)
Now, I could guess the cause.
(Pic from internet)
4. The cause was "fat wallet" syndrome.
*The wallet compresses on the pyriformis muscle, through which sciatic nerve passes, thereby compressing the sciatic nerve.
*Wallet can also cause direct compression of sciatic nerve branches.
*The wallet compresses on the pyriformis muscle, through which sciatic nerve passes, thereby compressing the sciatic nerve.
*Wallet can also cause direct compression of sciatic nerve branches.
5. I did not order any investigations.
I advised him to remove wallet from back pocket while sitting.
Pyriformis muscle stretching exercises were also taught to him.
One month later, he was much better. Pain score had reduced from 7/10 to 1/10 on visual analog scale.
I advised him to remove wallet from back pocket while sitting.
Pyriformis muscle stretching exercises were also taught to him.
One month later, he was much better. Pain score had reduced from 7/10 to 1/10 on visual analog scale.
6. Wallet neuritis can occur in professionals who sit for long duration and in long distance drivers (who carry their wallets in back pockets, while sitting for long duration).
#MedTwitter #Neurotwitter
doi.org/10.2174/157339…
#MedTwitter #Neurotwitter
doi.org/10.2174/157339…
7. Credit-card-wallet sciatica was first described in 1978.
8. Wallet neuritis is associated with pyriformis syndrome, but they are not the same.
doi.org/10.7759/cureus…
doi.org/10.7759/cureus…
9. Take home message
*In a man complaining of pain, tingling, numbness in buttock, thigh, leg and foot, enquire about possession of wallet in the back pocket (for long duration while sitting)
*Symptoms can mimic those that occur due to slipped disc and pinched lumbar/sacral roots
*In a man complaining of pain, tingling, numbness in buttock, thigh, leg and foot, enquire about possession of wallet in the back pocket (for long duration while sitting)
*Symptoms can mimic those that occur due to slipped disc and pinched lumbar/sacral roots
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