Case Report An Unusual Presentation of Right-Sided Sciatica with Foot Drop Fergus J. McCabe 1 and John P. McCabe 2 1 School of Medicine, NUI Galway, Galway, Ireland 2 Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland Correspondence should be addressed to Fergus J. McCabe; f.mccabe5@nuigalway.ie Received 25 January 2016; Revised 6 April 2016; Accepted 17 April 2016 Academic Editor: Koichi Sairyo Copyright © 2016 F. J. McCabe and J. P. McCabe. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Rarely, sciatica is of extraspinal aetiology. By compressing the sciatic nerve, swelling of the short external rotators of the hip can cause sciatica. Uncommon anatomical relationships between the sciatic nerve and local muscles may potentiate this compressive efect. In this report, we describe the presentation of right sciatica and foot drop resulting from both extreme local constriction and unusual anatomical variation of the right sciatic nerve. 1. Introduction Te sciatic nerve is the major motor and sensory nerve of the lower limb [1]. In the vast majority of cases, the sciatic nerve enters the lower limb via the greater sciatic foramen, passing below piriformis [2]. Te nerve, or its constituent parts, can have uncommon anatomical relationships with the piriformis muscle [2]. Sciatica is defned by the Oxford Medical Dictionary as “pain radiating from the buttock into the thigh, calf and occasionally the foot,” occurring in the territory of the sciatic nerve [1]. Spinal disc herniation is the most common cause of sciatica, with extraspinal infrequent causes [3]. Piriformis syndrome is an extraspinal entrapment neuropathy in which the piriformis muscle compresses the sciatic nerve, causing sciatica [4]. Other gluteal muscles, including obturator internus, may constrict the sciatic nerve, producing similar efects [5]. In this case study, we present an unusual case of sciatica and foot drop, of multifactorial aetiology. 2. Case Report A 62-year-old man presented with pain and numbness in the right gluteal area which radiated down the posterior aspect of the right thigh and leg. Tis began gradually and then spread down the back of the right thigh, eventually starting to limit his ability to stand, walk, sit, and in particular drive. Tere was no specifc history of trauma to the area. Sitting aggravated the pain. Te pain and discomfort were sharp, continual, and severe, disturbing the man’s sleep pattern and hindering his quality of life. He also complained of constipation which began in the months afer a prostatectomy. Te man denied having any undue back pain and was otherwise in good health. An MRI taken 6 days previously showed intervertebral disc degeneration but no evidence of disc herniation. He had been prescribed combined 500 mg paracetamol and 30 mg codeine for pain relief. Te man was a self-employed painter and was overweight, with a BMI of 28. He rarely drank and never smoked. Examination revealed an antalgic gait afecting the right leg, indicating pain with weight bearing on the right side. Right hip range of motion was normal. Signifcantly, he was remarkably tender immediately lateral to the right ischial tuberosity, suggesting that the cause was located in the gluteal area itself. He had a grossly restricted straight leg raising test, at 25 ∘ . Te man underwent an MRI scan focusing on his hips, with particular emphasis on the path of the right sciatic nerve in the right gluteal area and around the piriformis muscle. Tis demonstrated infammation of the piriformis, obturator internus, and gemelli muscles on the right side and of the right sciatic nerve. Tere was no evidence of abscess or fracture in the area. Blood analysis showed no evidence Hindawi Publishing Corporation Case Reports in Orthopedics Volume 2016, Article ID 9024368, 3 pages http://dx.doi.org/10.1155/2016/9024368