tests for piriformis syndrome
The typical symptoms of lumbar disc herniation is one for the sciatica, but some scholars have statistics about 6% of sciatica caused by piriformis syndrome is, therefore, the diagnosis of lumbar disc herniation to piriformis syndrome as a important differential diagnosis.
1, the anatomical location of piriformis
Piriformis is a deep hip muscles, starting at the side 2-4 in front of sacrum, the next outward through the hole and to the greater sciatic piriformis into the hole and the next hole, the tendon ends within the upper part of the greater trochanter side, is the hip abductor one. The location of sciatic nerve and piriformis relationship shown in Figure 1, Figure 2, different types can produce different degrees of clinical symptoms.Figure 1,2 anatomical relationship between piriformis and the sciatic nerve
2, the definition of piriformis syndrome
Piriformis piriformis syndrome is the anatomical variation, trauma, fatigue, infection and other factors have led to piriformis congestion, edema, hypertrophy, spasm, contracture, modified so as to stimulate and oppression of the sciatic nerve and its nutrient vessels
Caused by a series of symptoms.Symptoms: hip, greater trochanter and posterior thigh pain, numbness, when supine at night, long-term sitting, or standing by the rose, lifting heavy objects, bending over when the pain worsened, some patients may appear limp, and some patients with the thigh outside the side pain radiating to the ankle and the sci
atic nerve paresthesia distribution.
Signs: 1, check the patient''s gait and lower limb at rest position, can provide clues to the diagnosis of piriformis syndrome, the patient may exist limp, as if walking a shorter lower limb
2 patients in the supine position a little habit of maintaining limb elevation and external rotation position
3, straight leg raising test may be positive
4, part of the gluteal muscle atrophy patients
5, piriformis tenderness point along the sciatic nerve can cause pain radiating
6, under the port at the piriformis positive Tinel sign
7, piriformis tension test was positive (Freiberg practices) induced limb internal rotation of sciatica
8, Pace tactics limb abduction induced sciatica symptoms
Lumbar CT, MRI: exclude the waist, pelvic disorders, such as: lumbar disc, pelvic tumors.
Ultrasound: normal piriformis location, size, echo bilateral symmetry, the thickness difference of less than 2mm.
Piriformis syndrome, piriformis affected side due to congestion, edema, swelling, ultrasonography
The piriformis was significantly thicker compared with the contralateral greater than 2mm, echo reduction,
Was hypoechoic in uniform, hole clearance under the narrow piriformisFigure 3,4 ultrasonography was healthy side left and right for the ipsilateral
1. Electromyography testing lower limb in flexion, adduction and internal rotation position, sometimes measured extension of H reflex
Later closed, was the sciatic nerve muscle can be equal to fibrillation potential or simple changes.
2. Segmental somatosensory evoked potentials (SSEPs) can help identify entrapment locations. Electrophysiological diagnosis should be
Lumbar spinal nerve root lesions can affect even or lumbosacral plexus compression syndrome differentiated lesions.
Three distal muscle groups can be involved, but the proximal muscles, such as piriformis syndrome on the buttocks, medium and large
Muscle, skeletal muscle and tensor fascia lata muscle without involvement of spine evidence, identifying information.(1) closed treatment: surgery, you should at least once a week for three consecutive treatment of piriformis closed. There are several different injection methods and drugs, some scholars find a digital rectal exam piriformis pain point, the piriformis injection. Another scholar in the middle of the sacrum and greater trochanter line treatment of piriformis muscle belly closure, the operation to avoid the sciatic nerve. Many scholars advocate use of 25mg prednisolone acetate or methyl prednisolone, alone or in combination with local anesthesia drugs (10ml1% lidocaine) piriformis injection, reducing excessive muscle stress and spasm, reduce inflammation, the majority of Case report effective treatment or cure.Figure 5,6 the treatment of puncture site closure
(2) of botulinum toxin injection: CT monitoring the injection of botulinum toxin treatment of piriformis syndrome, the right amount of botulinum toxin injection, can cause local chemical denervation effect, and a transient injection of muscle paralysis to quickly eliminate or relieve muscle spasm, improving related pain, without apparent muscle weakness, it is the treatment of focal increased muscle tone, spasticity, and other unknown causes an effective means of muscle hypertrophy.
2, surgical treatment:
Non-surgical treatment fails in some patients, but surgical treatment should have a clear surgical indications, including the symptoms, signs, imaging, EMG support. Also excluded by differential diagnosis of lumbar disc and other disorders. Once the imaging findings hematoma, abscess, tumor, surgery is the best choice. Piriformis surgery if found (or muscle health) sciatic nerve entrapment should be cut or partially removed, the lifting of entrapment. If the sciatic nerve and surrounding tissues due to repeated inflammatory stimulation of the formation of adhesions, the complete removal of scar tissue adhesions. When the intraoperative findings fibroma, lipoma and neural stem cystic edema adjacent to the sciatic nerve compression, the tumor will be removed. Abnormal blood vessels of the sciatic nerve cross combination of neural stem scar adhesions around the sciatic nerve compression must be carried out or cut off the blood vessels and release ligation, removal of scar tissue to release, to prevent re-adhesion. According to intraoperative findings do different processing. Surgery should be taken not to damage the inferior gluteal artery and superior gluteal artery, so that its lead from the rear cavity reduction Rupen bleeding. Sciatic nerve injury and surgery do not nourish the blood vessels. After the skin graft sutured drainage retention of a 36-hour 24, such as surgery to stop bleeding and complete film drainage can hold. Most patients should be active after the first day and gradually to load, after a week full weight bearing. Sciatica disappeared immediately after surgery some patients, some patients feel abnormal limb a few weeks away. After surgical decompression and exploration in some patients weakened abductor ship, even after physical therapy and functional exercise to continue to restore its normal function.