Disclosures: Yingrong Zhu, MD: No financial relationships or conflicts of interest

Case Diagnosis: 64-year-old woman with history of uterine cancer status post radiation presents with radiating right buttock pain due to sciatic neuropathy secondary to radiation fibrosis syndrome (RFS) years after initial radiation treatment.

Case Description: 64-year-old woman with uterine cancer in 2016 status post total abdominal hysterectomy, bilateral salpingo-oophorectomy and radiation, presents with pain located in right buttocks. The pain is persistent, 8/10, shooting, accompanied by paresthesias, radiating to the dorsal foot, worsened by flexion and twisting movements of the spine. She denies weakness or changes in bowel or bladder function.

Setting: Outpatient physiatry clinicAssessment/

Results: Magnetic resonance (MRI) neurogram showed a prominent T2 hyperintense signal in the right sciatic nerve below the right ischium indicating local sciatic nerve neuritis with surrounding thickening of soft tissues on T1-weighted imaging, suggesting scar entrapment of the sciatic nerve. Given the patient’s history of prior pelvic radiation, the cause of sciatic neuritis was likely compression from radiation induced fibrosis. The patient was treated with sciatic nerve perineural block under ultrasound guidance with good pain relief.

Discussion: The term RFS describes various clinical conditions associated with radiation treatment, typically caused by an abnormal accumulation of thrombin in tissue causing progressive fibrotic tissue sclerosis. RFS can present during radiation treatment or years after treatment and can affect any tissue type which can result in significant functional implications including pain, loss of sensation, weakness. Radiation induced injury at the nerve root and plexus is well described; however, radiation mononeuritis is a rare phenomenon.

Conclusion: In patients with a history of malignancy and radiation treatment, the differential for pain should include direct effects of malignancy (recurrence or metastasis) along with complications of cancer treatment, such as RFS. Late mononeuropathy is a relatively rare complication but should be considered in patients presenting with mononeuropathy after radiation therapy. Imaging modalities such as MRI help make the diagnoses.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sciatic-neuropathy-after-radiation-treatment-a-case-report/