The AAO Journal, 2024/06, 34(2):10. doi: 10.53702/i2375-5717-34.2.7, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://meridian.allenpress.com/aaoj/article/34/2/7/500955/LBORC-NUFA-Poster-Abstracts-2024-Clinician-amp)

Keywords:

buttocks [3]
case report [736]
diagnosis [412]
gluteal claudication [1]
gluteus [3]
male [861]
OMT [3925]
osteopathic manipulative treatment [3946]

Abstract:

Introduction/Background: Gluteal claudication can be a diagnostic challenge as it can present with a normal Ankle-Brachial Index (ABI) and lack of ischemic leg symptoms. It is often misdiagnosed as a musculoskeletal injury. This case is important as it highlights osteopathic manipulative treatment (OMT) as part of the diagnostic process for this often-difficult diagnosis. Case: 58-year-old male with past medical history of coronary artery disease, hypertension, hyperlipidemia, and tobacco dependence presented with progressively worsening axial low-back and left buttock pain. Osteopathic assessment identified axial low back pain (LBP), left piriformis syndrome, and lower cross syndrome with significant lumbar, sacral, pelvic, and lower extremity somatic dysfunctions. Contributing lifestyle factors identified regular wallet placement in his back left pocket, sedentary desk job, lack of stretching or exercise, and tobacco use. Initial response to OMT, lifestyle changes, and exercise prescription was significant. His LBP resolved and overall mobility improved. However, he continued to have exertional left gluteal pain in the absence of somatic dysfunction or discomfort at rest. Re-review with radiology of 2018 CT abdomen/pelvis identified internal iliac calcification. Follow-up CT angiography confirmed severe stenosis of left internal iliac artery. In coordination with the vascular team this patient continued lifestyle modifications, exercise prescription, and OMT resulting in progressively improved exercise tolerance and decreased tobacco use. Results: A biopsychosocial osteopathic approach to care helped provide both therapeutic benefit and aided in the difficult diagnosis of arterial gluteal claudication. Discussion: Treatment of somatic dysfunction due to musculoskeletal compensation led to an underlying diagnosis of gluteal claudication. Overall, this case highlights the importance of using the biopsychosocial lens when approaching osteopathic care, and to consider alternative diagnoses when patients do not respond as expected to OMT.