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A Real Pain in the Butt

Author: Swami Rajaram, MD
Peer-Reviewer and Final Editor: Alex Tomesch, MD, CAQ-SM 

A 26-year-old golfer presents with left gluteal pain and paresthesias to the lower leg. Symptoms have been ongoing for the 2 weeks but acutely worsened after a ground level fall while trail running. He has a positive straight leg and crossed straight leg test, as well as weakness with dorsiflexion of the big toe and ankle.

Image 1. Plain radiograph of the lumbar spine. Case courtesy of Craig Hacking,, rID: 37918

Image 2. Magnetic resonance imaging of the lumbar spine. Author’s own imaging.


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