| 제목 |
Hip pain from partial tear with hemorrhage of left gluteus medius muscle caused by IM injection |
| 소속 |
Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, Korea, Department of Rehabilitation Medicine1 |
| 저자 |
In-Sik Lee1†, Jong Won Lee1*, Soo Jin Kim1 |
Introduction: Gluteus medius tear can be a major cause of lateral hip pain. It can occur from sudden bursts of activity, any trauma, or degenerative changes. A tear in gluteus occurs less at muscular portion than at its tendinous insertion because degenerative changes are more common cause of tear than trauma. Herein, we report a case of lateral hip pain due to gluteus medius tear at muscular portion and tear of ligaments without significant trauma history, which probably caused by frequent intramuscular(IM) injections.
Case Report:
A 72-year-old man was transferred rehabilitation unit from neurology department because of left lateral hip pain and limited range of motion of left hip joint. In neurology, he was treated for Guillain-Barre syndrome (GBS) and the patient could ambulate independently after treatment. However, the patient had antalgic gait due to left hip pain. The patient complained left hip pain on ambulation and left hip joint movement. The patient denied any traumatic events or sudden burst of activity. The initial physical examination revealed no erythema, bruise or swelling on left hip, but there was mild tenderness along left lateral hip. Patrick test was positive on the left which indicates severe limited range of motion. All sensory modality was symmetric and intact. There were no abnormal findings on simple radiography of both hips. Magnetic resonance imaging (MRI) of the left hip revealed a partial tear with hemorrhage in muscular portion and ligaments tear of left gluteus muscle. Futhermor e there was also an infiltration at right gluteus medius muscle which seemed to be caused by IM injection. By reviewing previous history thoroughly, we found that the patients had frequent analgesic IM injections for previous 3 weeks before transferring to our unit on both buttocks to relief back pain after previous posterior lumbar interbody fusion (PLIF) done 2 months ago. Considering the above patient’s history and findings, frequent IM injection probably was a reason of left gluteus medius muscle tear with hematoma. Moreover this case included more severe needle injury such as ligament tear and labral tear than as usual iatrogenic injury by frequent IM injection. (Figure.1.) After the patient received ultrasonography guided injection on hematoma site and prolotheraphy was done on tear site, the hip pain and limited range of motion improved in 2 weeks. He was discharged without analgesics.
Conclusion: Tear of muscular portion of gluteus medius rarely occur without trauma or strenuous activity. However, this case shows the possibility that IM injection can cause severe injuries such as muscle tear with hematoma and ligaments tear around injection site. |
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Figure.1.2. Fat-saturated T2-weighted FSE sequences of hip MRI
Figure.1.2. Fat-saturated T2-weighted FSE sequences of hip MRI
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