The Piriformis Syndrome: Evaluation of Seven Cases
Abstract
Low back pain is one of the causes of Piriformis syndrome. Low back pain is the second most common medical complaints encountered by physicians. More than 50% of the population will complain of low back pain at the same time. Piriformis syndrome may constitute up to 5% of cases of low back pain, buttock pain, and lower limb pain. This is a prospective and case–control study. In this study, we study 268 cases with low back pain; in 268 cases, seven cases had Piriformis syndrome. We studied pain, severity pain, radicular pain, limping, and painful sitting. Evaluation of musculoskeletal, BMI, and physical examination of Piriformis sign, Freiberg sign, and pace sign. Neurological evaluation was taken by paraclinical examination elevated through X-ray, computed tomography scan, magnetic resonance imaging, and electromyography. Data as mean + standard deviation. And SPSS software for analysis. In 268 cases with conservative method, 100% of cases were cure treatment after 4 months, in contrast to surgery methods after 1 month. The result illustrated the significantly improved between two methods of treatment (P < 0.0025). In seven cases, four cases had a history of blunt trauma and one case had a history of surgery that after 6 months had complication of surgery and scare tissue that with the second surgery release of scare was done with 100% cure. Anomaly of Piriformis muscle was seen in one case that surgery was done. Tumor was seen in one case that had pressure effect on sciatic nerve that surgery was done. Heterotopic ossification was seen in two cases. BMI of all cases was in normal range. All cases with diagnosis of disc herniation were excluded from the study. They were need to surgical operation for herniated disc. Piriformis syndrome is differentiated primary from secondary type, in which it is done according to history and physical examination. According to the etiology of Piriformis syndrome, the treatments are different. If you see mass that compressed the sciatic nerve, you must remove it. If the patient had sacroiliitis, it must be treated in early phase. Surgery of Piriformis is not accepted by all surgeons. It is limited to release Piriformis tendon and insertion to femur.
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References
K. Hopayian and A. Danielyan. “Four symptoms define the piriformis syndrome: An updated systematic review of its clinical features”. European Journal of Orthopaedic Surgery and Traumatology, vol. 28, no. 2, pp. 155-164, 2018.
L. M. Fishman and M. P. Schaefer. “The piriformis syndrome is underdiagnosed”. Muscle and Nerve, vol. 28, no. 5, pp. 646-649, 2003.
K. Meknas, A. Christensen and O. Johansen. “The internal obturator muscle may cause sciatic pain”. Pain, vol. 104, no 1-2, pp. 375-80, 2003.
A. G. Filler, J. Haynes, S. E. Jordan and J. Prager. “Sciatica of nondisc origin and piriformis syndrome: Diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment”. Journal of Neurosurgery Spine, vol. 2, no. 2, pp. 99-115, 2005.
M. R. Foster. “Piriformis syndrome”. Orthopedics, vol. 25, no. 8, pp. 821-825, 2002.
L. M. Fishman, G. W. Dombi and C. Michaelsen. “Piriformis syndrome: Diagnosis, treatment, and outcome-a 10-year study”. Archives of Physical Medicine and Rehabilitation, vol. 83, no. 3, pp. 295-301, 2002.
H. T. Benzon, J. A. Katz, H. A. Benzon and M. S. Iqbal. “Piriformis syndrome: Anatomic considerations, a new injection technique, and a review of the literature”. Anesthesiology, vol. 98, no. 6, pp. 1442-1448, 2003.
S. K. Han, Y. S. Kim, T. H. Kim and S. H. Kang. “Surgical treatment of piriformis syndrome”. Clinics in Orthopedic Surgery, vol. 9, no. 2, pp. 136-144, 2017.
P. M. Barton. “Piriformis syndrome: A rational approach to management”. Pain, vol. 47, no. 3, pp. 345-352, 1991.
R. A. Beatty. “The piriformis muscle syndrome: A simple diagnostic maneuver”. Neurosurgery, vol. 34, pp. 512-514, 1994.
R. P. Beauchesne and S. F. Schutzer. “Myositis ossificans of the piriformis muscle: An unusual cause of piriformis syndrome. A case report”. Journal of Bone and Joint Surgery American, vol. 79, no. 6, pp. 906-910, 1997.
J. A. Brown, M. A. Braun and T. C. Namey. “Pyriformis syndrome in a 10-year-old boy as a complication of operation with the patient in the sitting position”. Neurosurgery, vol. 23, no. 1, pp. 117-119, 1998.
Z. Durrani and A. P. Winnie. “Piriformis muscle syndrome: An underdiagnosed cause of sciatica”. Journal of Pain and Symptom Management, vol. 6, no. 6, pp. 374-379, 1991.
K. Hopayian and A. Danielyan. “Four symptoms define the piriformis syndrome: An updated systematic review of its clinical features”. European Journal of Orthopaedic Surgery and Traumatology, vol. 28, no. 2, pp. 155-164, 2018.
A. H. Freidberg. “Sciatic pain and its relief by operation on muscle and fascia”. Archives of Surgery, vol. 34, pp. 337-349, 1937.
J. W. Frymoyer. “Back pain and sciatica”. The New England Journal of Medicine, vol. 318, no. 5, pp. 291-300, 1988.
J. J. Jankiewicz, W. L. Hennrikus and J. A. Houkom. “The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature”. Clinical Orthopaedics, vol. 262, pp. 205-209, 1991.
S. P. Cass. “Piriformis syndrome: A cause of nondiscogenic sciatica”. Current Sports Medicine Reports, vol. 14, no. 1, pp. 41-44, 2015.
C. Steiner, C. Staubs, M. Ganon and C. Buhlinger. “Piriformis syndrome: Pathogenesis, diagnosis, and treatment”. The Journal of the American Osteopathic Association, vol. 87, no. 4, pp. 318323, 1978.
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