03 Jan Piriformis syndrome
In everyday clinical practice we use to encounter the common problem, i .e 8/10 patients complaint of pain in buttock.
So let’s try to understand why it is so
Basically in our buttock there is group of muscles known as gluteal muscles. Among these is piriformis muscles which gets spasm and causes buttock pain, it can irritate the sciatic nerve which passes through this area which leads to pain, numbness, tingling along the back of leg and foot. This condition is known as PIRIFORMIS SYNDROME.
In 1928, Yeoman introduced the idea that ‘sciatic’ type symptoms may be caused by extra-spinal compression of the sciatic nerve as it passes through the Piriformis muscle
In 1947 Robinson coined the term Piriformis syndrome to describe this clinical presentation
Its diagnosis remains controversial when Robinson introduced the term Piriformis syndrome
SIX CARDINAL features were described to aid formulation of the diagnosis:
1: history of trauma to gluteal region
2: pain in the region of sacroiliac joint, greater sciatic notch or piriformis muscle
3:Acute exacerbation through lifting or stooping.
4: Palpable tenderness of the piriformis muscle.
5:Positive STRAIGHT LEG RAISE(SLR)
6:Possible Gluteal Atrophy
1: Positive FADIR (pain reproduced with flexion, adduction, internal rotation of the affected hip)test
2:Positive Pace sign(pain reproduced with resisted external rotation and abduction of the affected hip)
The patient is in side lying position with the test leg uppermost. The patient flexes the test hip to 60 degree with the knee flexed.
The examiner stabilizes the hip with one hand and applies a downward pressure to the knee. If piriformis muscle is tight, pain is elicited in the muscle. If the piriformis muscle is pinching the sciatic nerve, pain results in the buttock and sciatica may be experienced by the patient. Resisted lateral rotation with the muscle on stretch (hip medially rotated) can cause the same sciatica.
A range of proposal are offered
1: STRETCHING/STRENGTHINING of the piriformis muscle
2: Correction of altered lower limb biomechanics/foot posture
3:Non-steroidal anti-inflammatory drugs or muscle relaxants
4: Local injection therapy
5: Surgical correction
BENSON AND SCHUTZAW
JOURNAL OF BONE AND SURGERY
CHRISTENSES REHAB RECCOMANDATION FOR PIRIFORMIS
SAIMA MIR (PT)