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Musculoskeletal and Sports Medicine

Sciatic Neuropathy in a Young Athlete with Persistent Hamstring Pain and Suspected Heterotopic Ossification: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 3

    Poster Presenter(s)

  • Huu T. Vo, MD

    Resident Physician
    University of Texas At Austin Dell Medical School PM&R Program

    • Co-Author(s)

  • Austin Peralta-Fogle, MD (he/him/his)

    PGY4 Chief Resident
    University of Texas At Austin Dell Medical School PM&R Program
    Austin, Texas

  • Ai Mukai, MD

    Physician
    Texas Orthopedics Sports and Rehabilitation Associates
    Austin, Texas

Disclosure(s):
Huu T. Vo, MD: No financial relationships to disclose
Austin Peralta-Fogle, MD: No financial relationships to disclose
Ai Mukai, MD: No financial relationships to disclose
Case Diagnosis: Heterotopic ossification with sciatic neuropathy after a hamstring avulsion injury.

Case Description or Program Description: A 21-year-old male basketball player presented with chronic posterior left leg pain that began 3-4 years ago after a hamstring avulsion injury. The sharp, aching pain ranged from 4/10 at rest to 6/10 with activity, localizing below the left buttock and occasionally radiating to the knee. Symptoms worsened with squatting, sitting, and leg stretching. There was no numbness or distal radiation.

Neurological and musculoskeletal examinations were largely non-remarkable, with full strength, intact sensation, and normal reflexes. However, electromyography (EMG) revealed mild increased insertional activity in the left medial gastrocnemius and peroneus longus, suggesting sciatic nerve irritation without clear evidence of lumbar radiculopathy or plexopathy. CT imaging reviewed demonstrated a large calcification near the ischial tuberosity, consistent with heterotopic ossification (HO).

Setting: Outpatient

Assessment/Results: The patient’s presentation and imaging findings suggested sciatic nerve compression due to HO resulting from a previous hamstring avulsion injury. Patient was referred back to an outpatient Sports Medicine physician for discussion regarding possible interventional options.

Discussion (relevance): HO following hamstring avulsion is uncommon and may contribute to sciatic nerve irritation due to compression or inflammation. Platelet-rich plasma (PRP) injections, often used for musculoskeletal injuries, are unlikely to help due to the ossified lesion. MRI of the lumbosacral plexus was recommended to further rule out compression or irritation of the sciatic nerve. Surgical excision remains a possible intervention but carries risks given the sciatic nerve's proximity.

Conclusions: This case underscores the importance of maintaining a wide differential diagnosis and considering HO in patients with persistent post-traumatic pain and neuromuscular symptoms. Advanced imaging and electrodiagnostic studies can help aid in diagnosis and treatment options, especially if the lesion is in an area with anatomical constraints. Further studies are needed to determine the benefits and risks of surgically excising HO near large neurovascular structures.