Current - long-term pain localized to the upper hamstring / ischial tuberosity. Pain is aggravated by walking, sitting, or prolonged driving and has persisted despite:
• Physical therapy
• Massage
• Shockwave / softwave therapy
• Injections (various)
• Scrambler therapy

April 11, 2024, ultrasound-guided right quadratus femoris muscle corticosteroid
injection which helped about 20% to 30%, but then the symptoms returned back to
baseline.

November MRI

Significant findings include
there is no significant disk herniation or central canal stenosis. There are changes consistent with right L4-5
laminectomy/partial facetectomy. There are edematous degenerative endplate changes demonstrated left at L4-L5 as
well as a new Schmorl's node at L4 and inferiorly at L2. There is mild-to-moderate left and mild right L5-S1 and
mild-to-moderate left L4-L5 facet arthrosis in addition as well as ongoing synovitis at the left L4-L5 facet joint.

Late 2025 - Twin Cities Pain Clinic and had an ischial bursa or potential trochanteric
bursa corticosteroid injection performed.
helped somewhat but overall did not make a huge difference with respect to pain
difference with respect to his pain.

Current symptoms are very similar to those in the past -
primarily gluteal pain, right greater the left. This is directly at the "hip bones."
Not having any significant low back pain

Symptoms radiate distally into the posterior thigh on the right and into the posterior leg at times and also can experience numbness in the dorsum of the foot on the right greater than the left.

In morning, not having any discomfort. The pain will then intensify throughout the
day. Typically around noon take Ativan and Aleve which has been helpful,
and if he lies down meditates for a period of time that does help his symptoms as well.

ASSESSMENT
#1 Right greater than left inferior gluteal pain
#2 MRI evidence of bilateral ischial femoral impingement, right greater than left
#3 History of right L4-L5 diskectomy and synovial cyst resection on March 7, 2018

Diagnosis: Sciatic nerve tethering / entrapment at the ischial tuberosity WITH proximal hamstring tendinopathy

Currently considering :

Sciatic Nerve Hydrodissection at the Ischial Tuberosity (ultrasound-guided)

What it does:
• Gently separates the sciatic nerve from the hamstring tendon
• Breaks adhesions that formed over years
• Reduces nerve “burning” almost immediately
• Restores sliding of the nerve during walking and sitting
• Often improves car sitting and forward bending the same day or within a few days

Hydrodissection targets:
• Burning (nerve)
• Deep ache (tendon)
• Radiation down thigh (nerve)
• Pain bending forward (nerve tension)
• Pain getting out of car (nerve adhered)
• Localized pain at sit bone (tendon origin)