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Objective:To investigate the clinical efficacy of precise real-time ultrasound-guided drug injection in the treatment of piriformis syndrome.Methods:80 patients with piriformis syndrome enrolled and were randomly divided into the treatment group ( n=40) and the control group ( n=40). The treatment group received real-time ultrasound-guided drug injection, while the control group received conventional drug injection. A visual analogue scale (VAS) was used to evaluate the degree of pain relief after the treatment. The thickness of the piriformis muscle was measured by ultrasound, and the change in thickness was used as an auxiliary evaluation index. Results:Under the guidance of real-time ultrasound, drug injection treatment for piriformis syndrome had an obvious pain relief effect, piriformis muscle thickness was significantly restored, and the effect of precise treatment was achieved. After 3 weeks of treatment, the clinical standard cure rate in the treatment group was 97.5%, and the cure rate in the ultrasonic diagnosis of the piriformis muscle was 95%. Both were higher than in the control group, and the difference was statistically significant (all P<0.05). Conclusions:Real-time ultrasound-guided drug injection for piriformis syndrome can achieve an accurate and significant therapeutic effect compared with traditional blind puncture. The real-time ultrasound-guided drug injection is safe, simple, radiation-free, and has a significant therapeutic effect. Therefore, this method for treating piriformis syndrome is worthy of being vigorously promoted in clinical practice.
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OBJECTIVE: To observe the clinical effect of elongated needle by Hui-puncture method in the treatment of piriformis syndrome. METHODS: A total of 100 piriformis syndrome patients were randomly divided into routine acupuncture group (n＝50) and elongated needle by Hui-puncture method (Hui-puncture) group (n＝50). For patients of the routine acupuncture group, Huantiao (GB30), Juliao (GB29), Zhibian (BL54), Weizhong (BL40), Yanglingquan (GB34), Juegu (GB39) and Ashi-point on the affected side of the body were punctured with filiform needles for 30 min. And for those of the Hui-puncture group, elongated needles were respectively inserted into GB30 and Ashi-point. The treatment was conducted once every other day for 10 times. The visual analog scale (VAS) pain score and the severity scores of symptoms (hip pain, lower limb pain, walking ability, straight leg elevation test, piriformis muscle tension test, piriformis muscle tenderness, 0-15 points) were measured before and after the treatment. The therapeutic effect was assessed by Criteria for Diagnosis and Assessment of Therapeutic Effect of Syndromes or Illnesses of Traditional Chinese Medicine (1994). RESULTS: After the treatment, the scores of symptoms and VAS scores of both routine acupuncture and Hui-puncture groups were significantly decreased in comparison with their own pre-treatment (P<0.05), and the scores of the two indexes of the Hui-puncture group were evidently lower than those of the routine acupuncture group (P<0.05). Of the two 50 cases in the routine acupuncture and Hui-puncture groups, 39 and 47 were effective, with the effective rate being 78.00% and 94.00%, respectively. The comprehensive therapeutic effect of the Hui-puncture group was significantly superior to that of the routine acupuncture group (P<0.05). CONCLUSION: Elongated-needle by Hui-puncture method has significant effect in treating piriformis syndrome patients and is worthy of promotion.
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Objective: The present comparative study isto find out the effectiveness between the muscle energy techniques versus stretching in patient with piriformis syndrome along with short wave diathermy. Background: Piriformis syndrome is an uncommon neuromuscular condition misdiagnosed with sciatica because sciatic nerve may be compressed by the piriformis muscle. The signs and symptoms are similar to the sciatica. This study is helpful for the diagnosis of PS and to relieve pain, increase muscle length, decrease inflammation, increase range of motion using MET and stretching along with SWD. Methodology: This comparison study setting was done in Physiotherapy Department of ACS Medical College And Hospital by Pre-Post interventional type. Female subjects aged between 30-55 who hada gluteal pain and a positive test of pace abduction test and freiburg’s test were included. From the above criteria, subjects were divided into two groups by simple convenient sampling method. Treatment duration was 10-15 min/session for 14 sessions/week for two weeks. Visual Analog Scale (VAS), Lower Extremity Functional Scale (LEFS) were used as the outcome measures. Procedure: Based on the inclusion and exclusion criteria and outcome measures, 30 female subjects were separated into two groups and Group A (15 subjects) were received MET and Group B (15 subjects) were received static stretching. Along with these, both group were received Short Wave Diathermy. Result: On comparing the Mean values of Group A & Group B on VAS Scores& LEFSgroup A showed a highly significant difference in Mean values at P ≤ 0.001.
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Piriformis syndrome caused by an accessory belly of the piriformis muscle is very rare. Only a few cases have been reported. Here, we report a case of piriformis syndrome resulting from an extremely rare type of accessory belly of the piriformis muscle originated at the proximal third portion of the main piriformis muscle and attached separately to the greater trochanter inferior to the insertion of the main piriformis muscle. A definitive diagnosis of piriformis syndrome was made based on magnetic resonance imaging and magnetic resonance neurography findings that were consistent with results of nerve conduction study and needle electromyography.
Subject(s)
Diagnosis , Electromyography , Femur , Magnetic Resonance Imaging , Needles , Neural Conduction , Piriformis Muscle SyndromeABSTRACT
BACKGROUND: Motor weakness occurs frequently after piriformis injection and it could put patients at risk of falls. We investigated the appropriate concentration and volume of ropivacaine required to minimize motor dysfunction. METHODS: A total of 120 patients who received piriformis injection were included in this study. Piriformis injections of triamcinolone 10 mg in various concentrations (0.1%, 0.075%) and volumes (8, 10, 12 ml) of ropivacaine were administered in 20 patients, respectively. One hour after the injection, we compared motor function according to the concentrations and volumes of ropivacaine. RESULTS: There were significant differences (P < 0.05) in the occurrence of motor dysfunction according to body mass index (BMI) and the concentration of ropivacaine. No significant differences were found in terms of gender, age, weight, height, or the volume of ropivacaine. Logistic regression analysis showed that the likelihood of motor dysfunction with administration of 0.1% ropivacaine was 58.249 times greater than that with administration of 0.075% concentration (P < 0.001), while BMI did not have a significant effect on motor dysfunction. CONCLUSIONS: According to the results of this study, 0.075% ropivacaine rather than 0.1% ropivacaine is appropriate in terms of reducing motor dysfunction after piriformis injection.
Subject(s)
Humans , Accidental Falls , Body Mass Index , Logistic Models , Piriformis Muscle Syndrome , TriamcinoloneABSTRACT
Background and Aims: The Sciatic nerve is the widest nerve of the body, consists of two components namely tibial and common peroneal components, derived from the lumbosacral plexus from the ventral rami of L4 to S3 spinal nerves. The Sciatic nerve usually enters the gluteal region under the piriformis muscle. The purpose of this study is to identify the variations in the course and branching pattern of the sciatic nerve and its relation to the piriformis muscle which may lead to various clinical manifestations like non-discogenic sciatica. Materials and Methods: 50 gluteal regions and posterior compartment of thigh from 25 formalin fixed adult cadavers are used for this study, of which one is a female cadaver. Gluteal regions and the posterior aspect of thigh on both sides are dissected to expose the sciatic nerve. Variations in the sciatic nerve and their relationship to piriformis muscle are observed. Results: 41 gluteal regions and posterior compartments of thigh (82%) showed normal anatomy of sciatic nerve and also piriformis muscle. 9 regions (18%) showed variations in the sciatic nerve, of which 5 regions (10%) showed variation of sciatic nerve in relation to piriformis muscle. Other details are explained further in the article. Conclusion: A proper knowledge about the variations of sciatic nerve, its relation to piriformis muscle is must for medical professionals during posterior hip surgeries, sciatic nerve decompression, total hip replacement, sciatic nerve injury during deep intramuscular gluteal injections, failed sciatic nerve block during anaesthetic procedures etc.
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As the expertise of the surgeon improves in arthroscopic surgery of the hip, the number of conditions treated by it also increases. In this case, an arthroscopic treatment was performed on a patient with piriformis syndrome due to schwannoma on the sciatic nerve. Meticulous excision of the cystic lesion on the sciatic nerve was completely performed and neither recurrence nor complication of the surgery was observed. Endoscopic excision using arthroscopy is useful for reducing postoperative pain and achieving early return to activities for the patient.
Subject(s)
Humans , Arthroscopy , Hip , Neurilemmoma , Pain, Postoperative , Piriformis Muscle Syndrome , Recurrence , Sciatic NerveABSTRACT
During routine dissection on 50 years old male cadaver, an accessory belly of piriformis was observed. This accessory belly was superior and parallel to the main piriformis muscle. This was associated with emergence of superior gluteal nerve and superior gluteal artery between the two bellies. Piriformis muscle and its relation to sciatic nerve has been suggested as a cause of piriformis syndrome. But interestingly in the present case, superior gluteal nerve was interposed between two bellies that may help the clinicians to establish a rare yet important cause of piriformis syndrome and a rare cause of undiagnosed chronic pain in gluteal region. As superior gluteal artery was also interposed, so this rare variation holds interest to surgeons especially in isolated buttock claudication despite otherwise normal vascular investigations.
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Piriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by the piriformis muscle or other local structures. We report a case of sciatic and gluteal nerve lesions with infarction of the piriformis muscle following internal iliac artery embolization of the bilateral uterine vascular malformation. The surgical intervention revealed anatomical variation of the right sciatic nerve. To our knowledge, this is the first case of piriformis syndrome following endovascular treatment of uterine vascular malformation in Korea.
Subject(s)
Arteriovenous Malformations , Iliac Artery , Infarction , Korea , Muscles , Nerve Compression Syndromes , Piriformis Muscle Syndrome , Sciatic Nerve , Vascular MalformationsABSTRACT
BACKGROUND: Rocker bottom shoes (RBS) are popular among patients with different foot, leg, or back problems in Korea. Patients with knee osteoarthritis concurrent weakness in the quadriceps femoris muscle, who wear these shoes, are often assumed to develop piriformis syndrome (PS). This study was performed to improve the understanding about the effect of wearing such shoes on duration of the syndrome in knee osteoarthritis. METHODS: We randomly assigned 150 patients with PS, who had used RBS daily for at least 6 months, to 2 groups, the S (stopped wearing) and K (kept wearing) groups. Both the groups were subdivided into the O and N groups, comprising patients with and without knee osteoarthritis, respectively. The effects of the treatment, including piriformis muscle injections and a home exercise program, were compared between the 2 groups by using a flexion-adduction-internal rotation (FAIR) test, a numeric rating scale (NRS), and the revised Oswestry disability index (ODI) during the 12-week follow-up. RESULTS: The positive FAIR test ratios, mean NRS scores, and revised ODIs were higher in the KO group than the SN group from 4?12 weeks after treatment. CONCLUSIONS: RBS may extend duration of the PS in osteoarthritis patients.
Subject(s)
Humans , Back Pain , Foot , Knee , Korea , Leg , Muscles , Osteoarthritis , Osteoarthritis, Knee , Piriformis Muscle Syndrome , Quadriceps Muscle , ShoesABSTRACT
The piriformis syndrome is a condition allegedly attributable to compression of the sciatic nerve by the piriformis muscle. Recently, magnetic resonance neurography and electrophysiologic study have helped to diagnose piriformis syndrome. High dose radiotherapy could induce acute and delayed muscle damage. We had experienced piriformis syndrome with fatty atrophy of piriformis muscle after radiotherapy for recurrent cervical cancer.
Subject(s)
Atrophy , Magnetic Resonance Spectroscopy , Muscles , Piriformis Muscle Syndrome , Sciatic Nerve , Sciatic Neuropathy , Uterine Cervical NeoplasmsABSTRACT
The traditional treatment of piriformis syndrome includes heat modality, deep muscle massage, slow stretch exercise, injection of local anesthetics, and surgical division of piriformis muscles in some selected cases. More recently, the use of botulinum toxin (BTX) for the treatment of piriformis syndrome has been suggested. We experienced two cases of piriformis syndrome with distinctive clinical feature. The symptoms of these two cases were not controlled by conservative managements including physical therapy, direct injection of lidocaine or steroid, or caudal block. So we injected Type A BTX in the piriformis muscle with the guidance of CT scan. 8 weeks after the botulinum injection, symptoms had almost completely disappeared, and follow up CT scan showed sufficient atrophy of piriformis muscles. The CT guided BTX injection in the piriformis muscle might emerge as a feasible technique to obtain a good local therapeutic effect without risk of imprecise inoculation.
Subject(s)
Anesthetics, Local , Atrophy , Botulinum Toxins , Botulinum Toxins, Type A , Follow-Up Studies , Hot Temperature , Lidocaine , Massage , Muscles , Piriformis Muscle SyndromeABSTRACT
Secondary piriformis syndrome may develop under several conditions. We report on the method and usefulness of arthroscopic treatment of the piriformis muscle and benign perineural cyst of the sciatic nerve. Arthroscopic assessment was performed to a perineural cyst on the sciatic nerve seen through EMG and hip MRI. Through the posterior and posteroinferior portal, the lesion below the piriformis muscle was confirmed following release of the tendon. The incision and drainage of the perineural cyst was done so as to achieve decompression. The excision of the lesion was not carried out so as to avoid injury to the sciatic nerve. Symptoms did not recur during 10 months of follow up appointments.
Subject(s)
Appointments and Schedules , Decompression , Drainage , Follow-Up Studies , Hip , Muscles , Piriformis Muscle Syndrome , Sciatic Nerve , Tarlov CystsABSTRACT
OBJECTIVE: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. METHOD: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. RESULTS: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7+/-3.4 (12~22) mm laterally and 16.5+/-4.1 (10~25) mm caudally. The mean width of the sciatic nerve at that point was 15.4+/-3.7 (12~22) mm. Ultrasonographic findings revealed the mean distance as 4.48+/-0.49 cm from the skin to the surface of the piriformis muscle and as 5.68+/-0.62 from the skin to the surface of the sciatic nerve. CONCLUSION: The most optimal injection site for piriformis syndrome was located 15.6+/-3.4 (12~22) mm laterally and 16.5+/-4.1 (10~25) mm caudally from the inferior margin of the sacroiliac joint.
Subject(s)
Buttocks , Cadaver , Muscles , Piriformis Muscle Syndrome , Sacroiliac Joint , Sciatic Nerve , SkinABSTRACT
Sixty patients with piriformis syndrome were treated mainly by electroacupunture, Tuina plus TDP irradiation. After 10 treatments, among 60 patients, 41 cases were cured and 19 cases were improved.
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Fourty-five Cases of piriformis syndrome were treated by acupuncturing Huantiao(GB 30),Yanglingquan (GB 34) and Kuanlun (BL 60). After 20 treatments,36 individuals were well cured and 9 were effective.
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PURPOSE: Sciatic pain rarely develops from piriformis syndrome; thus, its differential diagnosis from other diseases associated with sciatic pain is essential. We analysed the clinical symptoms and radiological findings for the differential diagnosis of piriformis syndrome, and assessed the results of its treatment. MATERIALS AND METHODS: We analysed five patients diagnosed with piriformis syndrome. Four patients were treated with a tenotomy. Of these, three had a history of misdiagnosis. The hypertrophied piriformis muscle was revealed with a compressed sciatic nerve in the operative field. We performed a tenotomy of the piriformis at the site of the tendinous insertion to decompress the sciatic nerve. RESULTS: At the average follow up was 23.5 months, at which time no patients had any problems relating to tenderness and sciatic pain, and were able to return to normal activity one month postoperatively. All patients evaluated their postoperative clinical state as being better. CONCLUSION: Multiple approaches are essential for the diagnosis of piriformis syndrome. We can obtain the satisfactory results through a tenotomy of the piriformis for the decompression of the sciatic nerve in intractable cases as a conservative treatment.
Subject(s)
Humans , Decompression , Diagnosis , Diagnosis, Differential , Diagnostic Errors , Follow-Up Studies , Piriformis Muscle Syndrome , Sciatic Nerve , TenotomyABSTRACT
The piriformis syndome is a rare condition characterized by pain and paresthesia in the buttock, often radiating to the posterior thigh. Symptoms are made worse by hip adduction and internal rotation of the hip joint. We report two cases of piriformis syndrome caused by an atypical sciatic nerve pathway combined with hamstring hypertrophy.
Subject(s)
Buttocks , Hip , Hip Joint , Hypertrophy , Paresthesia , Piriformis Muscle Syndrome , Sciatic Nerve , ThighABSTRACT
In the present study, acupuncture treatment has performed in a patient with spondylosis deformans combined piriformis syndrome, and applied to relief the hypertonus of the piriformis in the right buttock. As a result, the mitigation of right buttock pain and subsequent improvement in the range of the hip joint motion were observed from the early stage of treatment. These acupuncture effects are probably due to pain relief that resulted from increased local muscle blood flow following acupuncture stimulation. In addition, the present patient was suspected of double lesion neuropathy consisting of spondylosis deformans complicated by piriformis syndrome. From the present study, acupuncture therapy is thought to be useful method of enhancing the decompression of an entrapped nerve and vessels by increasing blood flow in the affected muscle in entrapment neuropathy such as thoracic outlet syndrome or piriformis syndrome.
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The most common cause of pain in the distribution of sciatic nerve is a herniated lumbar disc, Spinal stenosis, intrapelvic masses, and diabetic neuropathy may also produce scitica-like symptom. Infrequently, Piriformis syndrome is a rare disease causing sciatica produced by entrapment of sciatic nerve by the piriformis muscle as it passes through the sciatic notch. Recently we experienced a case of piriformis syndrome to be successfully treated by exploration of sciatic nerve and sectioning of fibrous band between piriformis muscle and gluteus maximus muscle. We would describe the clinical feature of a piriformis syndrome, and review other literatures.