Piriformis Syndrome.pdf

Piriformis Syndrome.pdf

• 1.
  Piriformis Syndrome Presented By:Rutvi Raualji (MPT)
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  Contents • Anatomy ofPiriformis muscle • Introduction • Clinical picture • Aetiology • Pathophysiology • History and Evaluation • Management
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  Anatomy of Piriformismuscle ❑ Piriformis muscle is flat, oblique, and pyramidal-shaped. ❑ Origin: Anterior to the vertebrae (S2-S4), superior margin of greater sciatic foramen, and Sacro tuberous ligament. ❑ Crosses greater sciatic notch ❑ Insertion: Attaches to greater trochanter of hip bone. ❑ Nerve supply: L5, S1, and S2. ❑ Action: Extension of hip, prime mover for external rotation when flexed hip, hip adductor.
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  Introduction ❑ Piriformis Syndromeis a clinical condition of sciatic nerve entrapment at the level of ischial tuberosity. ❑ Thereby, resulting in inflammation. ❑ This condition is not seen very commonly. It’s prevalence ranges from 0.3% to 6% in lower back pain cases. ❑ Usually occurs in middle aged individuals and the ratio for female : male is 1:6.
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  Clinical Picture ❑ Isfairly consistent, with patients reporting pain in gluteal/ buttock region that may “shoot”, burn, or ache down the back of the leg (similar to sciatic pain). ❑ Numbness in buttocks and tingling sensations along the distribution of sciatic nerve ( Reason: The nerve runs adjacent to the muscle; and when inflamed or irritated, it also affects sciatic nerve)
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  Difference between Sciaticaand Piriformis Syndrome Sciatica ➢ It is caused by herniated disk or spinal canal stenosis. ➢ It affects lower back and can travel down through buttocks and leg. Piriformis Syndrome ➢ Piriformis muscle is compression one area of sciatic nerve in the buttock.
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  Types Primary Piriformis Syndrome •It has an anatomical cause, with variations such as a split piriformis muscle, split sciatic nerve, or anomalous sciatic nerve path. Secondary Piriformis Syndrome • Usually occurs as a result of a precipitating cause, including microtrauma, ischemic mass effect, or local ischemia.
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  Aetiology 1. Trauma tothe hip or buttock area 2. Piriformis muscle hypertrophy (especially in athletes) 3. Sitting for prolong period 4. Anatomic anomalies
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  Pathophysiology Piriformis muscle isoverused, irritated, inflamed, stressed due to poor body posture chronically or sudden acute injury Irritates the adjacent sciatic nerve Entrapped anteriorly to muscle or posteriorly to gemelli- obturator internus complex.
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  History and Evaluation •Patient may present with: 1) Chronic pain in buttock and hip area 2) Pain when getting out of bed 3) Inability to sit for prolonged time 4) Pain in the buttocks that is worsened by hip movements • Patients will often present with sciatica symptoms- radiating into the back of the thigh, but can occur in lower leg at dermatomes L5-S1. • Complain for buttock pain • ON PALPATION- Mild to moderate tenderness at sciatic notch
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  Special test: Piriformistest ✓Patient position- Side lying with the leg uppermost. Patient flexes the test hip to 60 degrees with knee flexion. Examiner stabilises the hip and gives downward pressure to the knee. Tight piriformis- pain elicited in the muscle; if it pinches sciatic nerve- buttock pain and sciatica may be experienced.
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  Diagnostic Tests i. Ultrasound ii.CT iii. EMG iv. To rule out facet arthropathy, herniated nucleus pulposus, lumbar muscle strain, and spinal stenosis.
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  Management I. Short-term rest(not more than hours) II. Muscle relaxants III. NSAIDS IV. Physical therapy- Stretching of piriformis muscle, range of motion exercises, and deep tissue massage)