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Musculoskeletal and Sports Medicine

Sciatic Nerve Mononeuropathy After Post-Surgical Ultrasound-Guided Nerve Block in a 22-year-old College Football Player: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Primary Author(s)

  • Austin Sturdivant, MD

    Resident Doctor
    Vanderbilt University Medical Center PM&R Program
    Nashville, Tennessee

    • Co-Author(s)

  • JE

    Julia Evans, MD

    Medical Resident
    Vanderbilt University Medical Center PM&R Program
    Nashville, Ohio

    • Poster Presenter(s)

  • William M. Jones, MD (he/him/his)

    Assistant Professor
    Vanderbilt University Medical Center PM&R Program
    Nashville, Tennessee

Disclosure(s):
Austin Sturdivant, MD: No financial relationships to disclose
William M. Jones, MD: No financial relationships to disclose
Case Diagnosis: Patient is a 22-year-old male college football player with persistent right foot numbness and weakness after post-operative ultrasound-guided (USG) popliteal sciatic nerve block, subsequently diagnosed with sciatic nerve mononeuropathy.

Case Description or Program Description: Patient is a 22-year-old college football player who underwent a right ankle syndesmosis repair and tightrope procedure for a high ankle sprain.  Post-operatively, he had an USG right popliteal distal sciatic nerve block for pain control.   The athlete noted new-onset right foot paresthesias and weakness immediately after the nerve block.  He was referred for electrodiagnostic (EDX) testing due to his having a 4-month history of persistent, post-nerve block, right lateral foot sensory abnormalities and significant right foot weakness with push-off when running.

Setting: Outpatient EMG Lab

Assessment/Results: Physical examination revealed muscle atrophy in the right gastrocnemius, EDB, and AH muscles, altered sensation along the lateral right foot, and weakness with right EHL muscle testing. EDX studies revealed a right sciatic mononeuropathy at the popliteal space. Early re-innervation in the sciatic-innervated muscles was observed on needle EMG.  No EDX evidence of lumbar radiculopathy or lumbosacral plexopathy was observed. Right knee MRI revealed no focal sciatic nerve compression or inflammation.  The athlete’s symptoms improved over 7 months, and he was able to return to play without restrictions.

Discussion (relevance): Sciatic mononeuropathy is a potential complication of a sciatic nerve block with studies showing an incidence as high as 5%. Potential etiologies include direct trauma to the nerve during the block, external compression, chemical neuritis from the anesthetic, or a microvascular/ ischemic injury. Fortunately, fewer than 1% of affected patients have continued symptoms at 12 months.

Conclusions: Although rare, sciatic neuropathy after USG sciatic nerve block for anesthesia/ post-operative pain control is a complication that can occur. This potential complication should be considered when doing this procedure in high-level athletes.