A few weeks ago a 73 year old man was referred to me by his MD for management of “sciatic nerve pain” that had been going on for the past 20 years after suffering a spinal compression fracture in a snowmobiling accident.
This gentleman described the pain as “shock-like” and localized to only a small area, pointing to the midpoint of the bottom of his right butt cheek.
Never any numbness, tingling or weakness. Never any radiating pain, no low back pain, no opposite side hip or leg pain and no knee pain. Just this one spot that would “grab him and make him “drop” 2-5 times a day and only last seconds before resolving.
First thing I noticed on examination was that he had a 3 inch thick wallet in his back pocket of his jeans. “Do you sit on that wallet often?” I asked (I knew the answer, I could tell from the wear pattern of his right back pocket.)
“All the time, why?” He asked.
Long story short, not a single orthopaedic test, or nerve test would re-create the pain. His range of motion was normal with no pain. I did some muscle work around the right hip and gluteal muscles, then showed him some stretches and told him not to sit on that wallet.
It was the wallet folks. 20 years of daily pain, visits to MD’s, orthopedic surgeons, neurologists, MRI’s, nerve conduction tests, Physical Therapy, electrotherapy, acupuncture, you name it.
It was the wallet!
Patient is pain free!
Not all heroes wear capes.