Cause Of Piriformis Syndrome Research Articles

Anatomically high division of sciatic nerve and its clinical significance

Background / Aim. The sciatic nerve (SN) is a mixed nerve formed in pelvis by joining of L4 - S3 anterior spinal nerve roots. SN can be under the pressure in different regions throughout its course. However, the most frequent site of impingement is under the piriformis muscle which causes the occurrence of piriformis syndrome. High division of SN has its relevance considering the fact that it leads to the compression of nerve resulting in piriformis syndrome. The aim of this study was to determine the connection be-tween anatomical parameters of pelvis and high division of SN, which is considered to be one of the most common causes of piriformis syndrome in both genders. Methods. This study was conducted on 28 formalin fixed cadavers of both genders at the Institute of Anatomy, Faculty of Medicine, University of Belgrade (Belgrade, Serbia) and the Department of Anatomy, School of Medicine, University of St Andrews (St Andrews, United Kingdom). For the measuring of required dimensions, we used a ruler and a caliper. Results. A statistically significant difference in the values of bispinal and bituberal lines was observed. A high division of SN was found on 58.33% of the male cadavers and 80% of the female cadavers. A statistically significant difference in the mean value of the bituberal line between the male and female sex was also recognised. Conclusion. The connection between the anatomical parameters of the pelvis and the level of division of the SN is confirmed. Although on the basis of the results it could be assumed that people with smaller pelvic dimensions would have greater likelihood of developing a piriformis syndrome, the other factors, such as biomechanics related to a wider ?Q angle? in women that could result in a higher incidence of piriformis syndrome, should also be considered.

The Piriformis Syndrome: Evaluation of Seven Cases

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.

Correction to: Piriformis pyomyositis, a cause of piriformis syndrome-a systematic search and review.

The First name of the co-author of the article mentioned above was incomplete. The author's complete name should have been "Md Abu Bakar Siddiq" instead of "Abu Bakar Siddiq". The original article has been corrected.

Tale of Two Non-Discogenic Pains, Sacroiliac Joint and Piriformis Syndromes - A Less Travelled Clinical Entities

Both Sacroiliac Joint Syndrome (SIJS) and Piriformis Syndrome (PS) give rise to sciatica like symptoms and are the causes of low back pain due to its close proximity to the sciatic nerve. Clinical diagnosis of these two conditions are often compounded by the high degree of similarities in their clinical presentations making the diagnosis more speculative than confirmatory in our day to day practice. This is further complicated by non-availability of a reliable test that can confirm as well as distinctly distinguish the diagnosis of both the conditions. In the literature different theoretical basis are separatively given regarding causes of PS and SIJS, but are never discussed colectively which is usually seen in daily clinical practices. The review has emphasized to provide a baseline collective of most of pathogenetic and anatomic factors because of which one syndrome can give rise to another or vice-versa. Therefore the objective of the present review is to update what is known about the clinical characteristics and probable pathogenetic mechanisms of above syndromes for further understanding of the interrelations between PS and SIJS.

Kyste synovial du muscle pyramidal : une étiologie inhabituelle de sciatique

Sciatica can occur due to a spinal lesion, intrapelvic tumor, diabetic neuropathy, and rarely piriformis syndrome. The causes of piriformis syndrome vary by a space-occupying lesion. A ganglionic cyst can occur in various lesions in the body but seldom around the hip joint. In addition, sciatica due to a ganglionic cyst around the hip joint has been reported in one patient in Korea who underwent surgical treatment. We experienced two cases of sciatica from a piriformis ganglionic cyst and we report the clinical characterizes and progress after non-operative treatment by ultrasonography-guided aspiration. The two cases were diagnosed by magnetic resonance imaging and were treated by ultrasonography-guided aspiration. We followed the patients for more than 6 months. The symptoms of piriformis syndrome from the ganglion improved following aspiration and this conservative treatment is a treatment method that can be used without extensive incision or cyst excision. Level of evidenceLevel IV historical case.

Piriformis ganglion: An uncommon cause of sciatica

Sciatica can occur due to a spinal lesion, intrapelvic tumor, diabetic neuropathy, and rarely piriformis syndrome. The causes of piriformis syndrome vary by a space-occupying lesion. A ganglionic cyst can occur in various lesions in the body but seldom around the hip joint. In addition, sciatica due to a ganglionic cyst around the hip joint has been reported in one patient in Korea who underwent surgical treatment. We experienced two cases of sciatica from a piriformis ganglionic cyst and we report the clinical characterics and progress after non-operative treatment by ultrasonography-guided aspiration. The two cases were diagnosed by magnetic resonance imaging and were treated by ultrasonography-guided aspiration. We followed the patients for more than 6months. The symptoms of piriformis syndrome from the ganglion improved following aspiration and this conservative treatment is a treatment method that can be used without extensive incision or cyst excision. Level of evidenceLevel IV historical case.

Clinical Significance of Pathophysiology in Piriformis Syndrome Due to Multiple Variations in the Deep Gluteal Region

A relationship between the piriformis muscle and the sciatic nerve, which is observed to be unusual has been suggested to be a cause of piriformis syndrome. During dissection of a male cadaver, several anatomical variations were encountered. These variations consist of atypical organization of the sacral plexus, unusual origins, trajectories of common fibular, tibial, and inferior gluteal nerves. It is also observed that the presence of a common tendon formed by the deep gluteal muscles (obturator internus, superior gemellus, inferior gemellus, and both piriformis muscles, a duplication of the piriformis muscle) inserts on the greater trochanter of the femur. Additionally, an early division of the sciatic nerve, where a common fibular nerve that runs between the two variant piriformis muscles, and the tibial nerve which is making its way below the inferior piriformis, is also observed. These anatomical variations are found to be bilateral. In these casses the unusual pathway of this sciatic nerve and its relationship with the piriformis may predispose to its impingement at the gluteal region. The prevalence of the piriformis and the sciatic nerve anomalies is 16.2% in surgical cases. Thus, clinicians and surgeons should be aware of the potential complications from these unique variations.

Chronic Expanding Hematoma Extending over Multiple Gluteal Muscles Associated with Piriformis Syndrome

We report on a patient with an unusual, slowly enlarging hematoma of the left buttock. A 62-year-old man presented with a 6-year history of an enlarging mass of the left buttock. He had first noted the mass 6 years earlier and had had sciatica of the left lower limb for the last 2 months. He denied any history of antecedent trauma. The lesion extended over 3 gluteal muscles (the gluteus medius, gluteus minimus, and piriformis). On microscopic examination, the lesion showed typical signs of chronic expanding hematoma. The sciatica was relieved after surgical removal of the lesion. The lesion had not recurred at the last follow-up 4 years after the operation. The present case suggested that chronic expanding hematoma can extend into multiple muscles due, perhaps, to long-term growth and the anatomical and functional conditions of the affected muscles. Our case also suggests that chronic expanding hematoma can be a cause of piriformis syndrome.

Accessory piriformis muscle: An easily identifiable cause of piriformis syndrome on magnetic resonance imaging

Accessory piriformis muscle: An easily identifiable cause of piriformis syndrome on magnetic resonance imaging

A rare cause of a piriformis syndrome

A less common but important cause of buttock and leg pain known as "Piriformis Syndrome". Piriformis syndrome is all intrinsic pathology of the piriformis itself, such as myofascial pain, anatomical variations, hypertrophy, and myositis ossificans or it is caused by trauma to the pelvis or buttock. In this case report we are going to present a rare cause of piriformis syndrome. Our first case was a 32 year old woman. She was referred to our pain clinic for leg pain that radiates from buttock to backside of the knee for 5 years. She did not have any problems in her history or laboratory findings. But in her lower extremity ortho roentgenogram, her leg was 2 cm short at the effected side. Second case was a 23 year old woman who had pain radiating from gluteal region to backside of the knee. In her history she had a car accident two years ago. In this accident, she had a fracture of collum femoris, and her leg was 1 cm short at the effected side. We conclude that "short leg" is one of the rare causes of piriformis syndrome and can be seen alone or with the other causes. The injection on piriformis muscle could be more effective for the patients who have PS after the "short leg" treated.

Bilateral high division of the sciatic nerve: incidence and clinical implications in Nigeria.

Introduction: The sciatic nerve (L4-S3) comprised of the tibial and common fibular (peroneal) components contained in the same epineural sheath usually leaves the pelvis via the greater sciatic foramen beneath the piriformis muscle. They usually separate in the lower thigh above the popiteal fossa. Variations in this arrangement have been reported. We noted one such variation in our study. Materials / Methods: The gluteal region and posterior thigh of 26 cadavers were dissected over a two session period (2004/05 and 2005/06) with emphasis on the sciatic nerves and its related structures. Results: One out of the twenty-six had the sciatic nerve dividing into its two main branches in the pelvis and the common peroneal passing over the piriformis muscle as it enters the posterior thigh. Conclusion: High division of the sciatic nerve is seen in 3.8% of Nigerians and could predispose to injury during intragluteal injection, may be the cause of piriformis syndrome, sciatica, failed sciatic nerve block in anesthesia and predispose to injury during posterior hip operations. Keywords: Sciatic nerve, high division, nerve injury, nerve block.Tropical Journal of Medical Research Vol. 11 (2) 2007: pp. 12-13

Poster 91: Tumor infiltration of the piriformis muscle resulting in piriformis syndrome: a case report

Setting: Tertiary care hospital. Patient: A 53-year-old female with high-grade, non-Hodgkin’s lymphoma. Case Description: The patient was admitted to the rehabilitation unit after a complicated hospital course. She complained of persistent right buttock pain associated with pain and numbness radiating down her right posterolateral leg to her lateral foot. She did not complain of low back pain, left lower-extremity symptoms, or bowel or bladder dysfunction. Her pain was accentuated with adduction, internal rotation, and flexion of her right lower limb. She demonstrated tenderness, increased pain, and worsening of symptoms with palpation over the right piriformis muscle. Neurologic exam revealed intact strength with normal tone, however, light touch was abnormal in the right L5-S1 dermatomes. Magnetic resonance imaging revealed an extensive pelvic tumor involving the cervix and adnexal regions extending to the margins of the right piriformis muscle. Assessment/Results: Tumor infiltration throughout the pelvis involving the right piriformis muscle likely resulted in right buttock and lower-extremity pain and parathesias. Discussion: A literature search revealed no other cases of tumor infiltration causing piriformis syndrome. The most common etiology of piriformis syndrome is local trauma resulting in muscle spasm, inflammation, and hypertrophy. As a result, the sciatic nerve is compressed either between the piriformis muscle belly and the bony pelvis or between 2 inflamed fascicles. In this case report, it is probable that compression of the sciatic nerve resulted from direct compression by the tumor or as a result of secondary inflammation within the muscle belly. Furthermore, the tumor infiltration may have caused irritation of the piriformis resulting in muscle spasms and thus compression of the sciatic nerve as it pierced the muscle. Conclusion: Tumor infiltration of the piriformis muscle is a rare cause of piriformis syndrome.