ELECTROMYOGRAPHIC AND EXTENSOR DIGITORUM BREVIS EVOCKED RESPONSE EVALUATION OF SCIATIC NERVE INJECTION PALSIES FOLLOWING GLUTEAL INJECTION OF DICLOFENAC NA

Gluteal injection of diclofenac Na for children and as an ambulatory prescription was banned in Iran after observation of Sciatic nerve injuries in many cases. Ten victims during 12 months have been studied by physical examination of muscle at ankle dorsiflexors and by peroneal nerve conduction studies in associated with electromyographic evaluation of Sciatic innervated muscles at foot and leg.Sciatic nerve paralysis after diclofenac Na injection was not limited to the pediatric age group and not directly depends on misdirected injections because some injection were far from sciatic nerve passage at buttock.In four patients onset of paralysis was acute and rapidly progressed after injections but in the other cases, paralysis occurred subacute and slowly in four to eight hours. Muscle power in the first day of examination by standard muscle power measuring scale in seven patients was and improves up to during 12 months after injection. In 7 patients there were not any recordable motor action potential by peroneal nerve stimulation and pick up on extensor digitorum brevis at the first week of injection. But by spending four months there were recordable action potential in 4 of them.There was not any recordable spontaneus activity by needle examination of extensor digitorum brevis and tibialis anteior muscles at the first week of injection.However, they appeared in 8 patients by spending one month after injection time.Three out of eight patients who had recordable spontaneus activity at peroneal muscle have suffered from burning pain and increased longitudinal arch of their involved foot.By considering above findings we can conclude that presence of extensor digitorum brevis evocked response at first week after injection, is not a perfect indicator for good prognosis.