Piriformis Syndrome Research Articles

Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant

Aims: Variation of the sciatic nerve may increase the risk of iatrogenic injury during total hip arthroplasty or arthroscopy, result in failure of peripheral blocks, or be associated with piriformis syndrome. Studies from Africa are scarce, with none to date from South Africa. Thus, the aims were to document the relationship between the sciatic nerve and piriformis muscle, variation in the bifurcation level and in the length of the nerve. Any significant differences between sexes and sides were also investigated. Methods: The lower limbs of 42 cadavers (84 limbs) were dissected and the relationship between the sciatic nerve and piriformis classified according to the patterns described by Beaton and Anson. The region of sciatic nerve bifurcation was documented, and the length of the nerve was measured in individuals with bifurcation in the thigh. Results: The normal relationship between the sciatic nerve and piriformis muscle was present in 64 limbs (76.2%). The bifurcation level of the nerve was variable in more than half the sample. No significant differences occurred in any of the variant patterns or bifurcation regions between side or sex; however, variations were more common in females than in males. The mean length of the sciatic nerve was 133.30±19.33 mm, with no differences in length between sex or side. Conclusion: Variations in the anatomy of the sciatic nerve occurred in up to half of the sample, which may have implications for increased risk of iatrogenic injury in total hip arthroplasty and arthroscopy, piriformis syndrome or sciatic block failure. Level of evidence: Level 4

The effectiveness of piriformis injection under fluoroscopy and nerve stimulator guidance with local anaesthetic and steroid for management of piriformis syndrome among manual workers in Eastern India: A prospective interventional study

Background: Piriformis syndrome (PS) is a neuromuscular disorder characterized by compression or irritation of sciatic nerve by the piriformis muscle causing pain, tingling, and numbness in the buttocks and sometimes along the distribution of the sciatic nerve descending down to the leg. Pharmacotherapy and physical-therapy remain the first line of management. Local anesthetic (LA) with steroid injection in piriformis muscle is given if conservative management fails. Nerve stimulator, electromyography, radiological imaging, and various other methods have been used to increase the reliability of injections. In the present study, the efficacy of combined fluoroscopy and nerve stimulator guided piriformis injection with LA and steroid for the management of PS has been re-validated among the manual workers of Eastern India. Subjects and Methods: With ethical permission and informed consent from 35 patients of PS fulfilling the inclusion and exclusion criteria were given piriformis injection with 5 mL of 0.25% bupivacaine and 20 mg methyl prednisolone under guidance of a combination of fluoroscopy and nerve stimulator. Thirty-one patients completed the study. Pain in Numeric Rating Scale and Disability by Ronald Morris Disability Questionnaire were recorded for all patients before the procedure, 1 h, 1 week, 3 weeks, and 12 weeks after the procedure and were statistically analyzed. Results: Pain score and back disability score decreased significantly (P < 0.05) after the injection, and the effect was also sustained up to 12 weeks. Conclusions: Injection of LA along with steroid in piriformis muscle under fluoroscopy and nerve stimulator guidance, followed by physiotherapy, is an effective treatment for PS among manual workers.

Chronic and Acute Low Back Pain and Its Relationship to the Sacral X-Axis, Leg Length Changes, Sciatica, Abdominal Pain, Idiopathic Scoliosis, and Incontinence

Several interactive pelvic axes occur during activities of weight-bearing and ambulation. Flexion and extension of the symmetrical innominates occur on the sacral x-axis with weight-bearing. Normal asymmetric innominate rotation occurs on the innominate axis at the pubic symphysis during weight-bearing with normal ambulation. Oblique sacral movement occurs on an oblique sacral axis concurrent with asymmetric innominate movement. Acute and chronic low back pain is commonly caused by a bilateral symmetrical or oblique anterior innominate rotation on the sacrum on an acetabular axis, usually while lifting, bending, lowering, shoveling, sweeping, a pendulous abdomen, during pregnancy, or with a postural forward head. The innominates are caused to sublux slightly cephalad and laterally on the sacral x-axis at the posterior inferior iliac spine (PIIS). This is a measurable movement that puts a rotational shear on the bilateral sacral x-axis and separates the sacral origins of both the gluteus maximus and the piriformis from their ileal origins resulting in pain across the mid-buttocks into the trochanter, down the tensor fascia lata into the lateral knee causing piriformis syndrome, pain across the buttock from the PIIS to the trochanter, a sciatic neuritis or a pseudosciatica. In all probability, true sciatica is probably not from the disc but rather caused where the sciatic nerve exits just below or sometimes through the compromised piriformis. A specific abdominal pain may also accompany acute or chronic low back pain as may an idiopathic scoliosis. An associated posterior movement of the ischial tuberosities can approximate the distal sacrum, loosen muscles of the pelvic floor, decrease kinetic tension on the sacrotuberous ligaments, and cause some degree of incontinence. Dysfunction is all initiated at the sacral x-axes. This is corrected effectively simply with a manual bilateral posterior innominate rotation that reverses all and various symptoms leaving the patient free of pain. Many areas of dysfunction are described, but not all.

The Effectiveness of Myofascial Release Over Stretching on Pain and Range of Motion among Female College Students With Piriformis Syndrome

The Effectiveness of Myofascial Release Over Stretching on Pain and Range of Motion among Female College Students With Piriformis Syndrome

Chronic hip pain in adults: Current knowledge and future prospective.

Chronic hip pain is distressing to the patient as it not only impairs the daily activities of life but also affects the quality of life. Chronic hip pain is difficult to diagnose as patients often present with associated chronic lumbar spine and/or knee joint pain. Moreover, nonorthopaedic causes may also present as chronic hip pain. The accurate diagnosis of chronic hip pain starts with a detailed history of the patient and thorough knowledge of anatomy of the hip joint. Various physical tests are performed to look for the causes of hip pain and investigations to confirm the diagnosis. Management of chronic hip pain should be mechanistic-based multimodal therapy targeting the pain pathway. This narrative review will describe relevant anatomy, causes, assessment, investigation, and management of chronic hip pain. The focus will be on current evidence-based management of hip osteoarthritis, greater trochanteric pain syndrome, meralgia paresthetica, and piriformis syndrome. Recently, there is emphasis on the role of ultrasound in interventional pain procedures. The use of fluoroscopic-guided radiofrequency in periarticular branches of hip joint has reported to provide pain relief of up to 36 months. However, the current evidence for use of platelet-rich plasma in chronic hip osteoarthritis pain is inconclusive. Further research is required in the management of chronic hip pain regarding comparison of fluoroscopic- and ultrasound-guided procedures, role of platelet-rich plasma, and radiofrequency procedures with long-term follow-up of patients.

Intraoperative Monitoring and Intra-abdominal Fluid Extravasation During Hip Arthroscopy

To evaluate the relationship between the intraoperative monitoring factors with intra-abdominal fluid extravasation (IAFE) in patients who underwent hip arthroscopy. The secondary purpose was to describe the main intraoperative variables between cases with and without IAFE. We carried out a prospective observational study of 106 hip arthroscopies between June 2017 and June 2018. Within procedures, 54 cases with deep gluteal syndrome (DGS) were included. Ultrasonography was performed by a trained anesthesiologist before and after the surgery to identify the presence of fluid. The hepatorenal (Morison's pouch), splenorenal, retroaortic, suprapubic (longitudinal and transverse), and pleural spaces were examined. During the surgery, the blood pressure, heart rate, temperature, peak inspiratory pressure (PIP), pulmonary compliance, oxygen saturation, and end-tidal carbon dioxide were registered. The incidence of IAFE was 31.1% (33/106; 95% confidence interval 23.0%-40.5%). IAFE in cases with isolated FAI was 15.9% (7/44) in comparison with 52.9% (9/17) of the cases with isolated DGS. Maximum values of PIP greater than 20mm Hg were associated with fluid extravasation (odds ratio 3.22; 95% confidence interval 1.07-9.68). No statistically significant relationship was found in blood pressure, heart rate, temperature, oxygen saturation, end-tidal carbon dioxide, and pulmonary compliance between cases with and without IAFE. Asymptomatic IAFE, as measured by ultrasound, is a frequent event in patients who underwent hip arthroscopy, mainly in cases with DGS. PIP was found to be a useful intraoperative monitoring parameter for the early identification of IAFE in hip arthroscopy. Level II, observational prospective cohort study.

Pressure Pain Threshold in Subjects With Piriformis Syndrome: Test-Retest, Intrarater, and Interrater Reliability, and Minimal Detectible Changes

ObjectiveThis study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles. Study DesignThis study used a comparative and reliability-based design. SettingRehabilitation clinic. ParticipantsPatients (N=30) with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment. InterventionsNot applicable. Main Outcome MeasurePPT. ResultsExcellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86-0.96) and the healthy piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P<.001). ConclusionsDigital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.

Beda Efektivitas Pengaruh Pemberian TENS Dan Stretching Dengan Lllt Dan Stretching Terhadap Penurunan Nyeri Pada Kasus Sindroma Piriformis

Background: Piriformis syndrome causes a decrease in mobility thereby reducing productivity. Objective to find out the difference between giving TENS therapy with stretching and LLLT with stretching to reduce the comfort of cases of Piriformis syndrome. Subjects were 30 piriformis syndrome patients Methods:. Experimental with two pre and post test designs. ANALYSIS: normality test with saphiro wilk obtained VAS score data with normal distribution with p &gt; 0.05 for the first group and LLLT postal group with abnormal distribution data p &lt; 0.05, parametric test with paired sample test in group I get the results sought with significance value p = 0,000 and non parametric Wilcoxon test for group II with p = 0.001. Post and post different tests of the two groups with the mann whitney test obtained p = 0.028. Result: providing TENS therapy with stretching and LLLT with stretching respectively in reducing pain in the case of Piriformis syndrome. Conclusion: Provision of TENS therapy with stretching is more effective than LLLT with stretching in the sense of decreased in cases of Piriformis syndrome.

Feasibility and Reliability of an Ultrasound Examination to Diagnose Piriformis Syndrome

We explored the diagnostic performance of ultrasound examinations in the diagnosis of piriformis syndrome (PS). In our single-center retrospective study, 52 patients with a diagnosis of PS and 50 healthy volunteers were enrolled to undergo ultrasound examination of the piriformis and sciatic nerve. The thicknesses of the piriformis and the diameter of the sciatic nerve were measured to compare the differences between the patients with PS and healthy volunteers. The diagnostic performance of ultrasound examinations was assessed by constructing a receiver operating characteristic curve and calculating the area under the curve. In patients with PS, the piriformis and sciatic nerve were enlarged on the abnormal side compared with the asymptomatic side, accompanied by a decreased echo intensity and an unclear perineurium. In addition, the piriformis thickness and sciatic nerve diameter of those with PS were significantly greater than were those of the healthy volunteers. The diagnostic performance of ultrasonography was significant. The area under the receiver operating characteristic curve for piriformis thickness and sciatic nerve diameter to discriminate between the abnormal and asymptomatic sides was 0.778 and 0.871, respectively. Ultrasound examinations can assist in the clinical diagnosis of PS and have the potential to be an alternative method for the diagnosis of PS for most musculoskeletal clinicians.

Piriformis Injection: An Ultrasound-Guided Technique

Piriformis syndrome is an elusive condition that likely is overlooked and overdiagnosed in equal proportions. Image-guided injection of the muscle is an essential element in the assessment and management of this disorder. Ultrasonography allows visualization of the anatomy of the piriformis and its relation with the sciatic nerve. Ultrasound-guided injection of the muscle can be performed in an effective, reproducible fashion and, with careful attention to the details of the procedure, can be performed with minimal morbidity to the patient. This method has the advantage of being exceptionally well tolerated by the patient and can be performed in the office with minimal patient inconvenience and the opportunity for a real-time assessment of the patient's response to the injection. Our ultrasound-guided technique of piriformis muscle injection is detailed in this article.

Treatment of patients with acute and subacute lumbodynia and lumbar ischialgia

No effect of outpatient treatment is observed in some patients with acute nonspecific lumbodynia and lumbar ischialgia; therefore they are referred to pain management departments or centers for specialized examination and treatment.Objective: to study of the anatomical causes of pain and the efficiency of celecoxib (Dilaxa) treatment in patients with acute and subacute lumbodynia and lumbar ischialgia in the inpatient setting.Patients and methods. Eighty patients (47 women and 33 men; mean age, 51.0±15.3 years) with acute and subacute lumbodynia (n=11) or lumbar ischialgia (n=69) were followed up. Pain intensity was assessed using a visual analogue scale (VAS); functional limitation was rated according to the Roland–Morris scale (RMS). To reduce the intensity of pain syndrome, patients took oral celecoxib (Dilaxa) 200 mg twice daily. Therapeutic blockades with anesthetics and glucocorticoids were used in some cases of damage to the sacroiliac joint (SIJ) or facet joints (FJ). Patients were informed of the benign nature of the disease; they did therapeutic exercises.Results and discussion. The causes of pain were ascertained to be injuries of SIJ (48,8%), FJ and SIJ (18,8%), FJ (17,5%), herniated disc (10%), piriformis syndrome (2.5%), and piriformis syndrome and SIJ injury (2.5%). The duration of treatment averaged 11.0±2.4 days. By the end of the study, there was a clinically significant reduction in pain in 86% of patients. The treatment resulted in a 2.4-fold average reduction in pain intensity (from 7.0 to 2.9 VAS scores): a 4-fold reduction in patients with lumbodynia (from 6.4 to 1.6 scores) and a 2.3-fold one in those with lumbar ischialgia (from 7.1 to 3.1. scores); the degree of disability reduced by an average of 1.9 times (from 8.1 to 4.3 RMS scores): by 3.6 times (from 6.8 to 1.9 scores) and 1.9 (from 8,3 to 4,7 scores) times in patients with lumbodynia and in those with lumbar ischialgia, respectively. No adverse events were observed during the treatment period.Conclusion. There were high SIJ and FJ injury rates in subacute lumbar ischialgia. Celecoxib was noted to be highly effective and safe in treating acute and subacute lumbar ischialgia and lumbodynia.

Anatomical causes of compression of the sciatic nerve in the pelvis. Piriform syndrome

ObjectiveThe piriformis syndrome is one of the etiologies of pelvic pain due to the sciatic nerve's entrapment by the piriformis muscle. Nowadays this syndrome might be difficult to be diagnosed. The aim of this study is to know the prevalence of anatomic variations in our population that may contribute to the appearance of piriformis syndrome. Furthermore, anthropometric measurements of the piriformis muscle and the sciatic nerve procedures are studied for a possible application in the gluteal region. Materials and methodsThe study was carried out in 59 pelvis of 32 cryopreserved bodies. The anatomical variations of piriformis and sciatic nerve founded were described following the Beaton and Anson's classification. Anthropometric measurements of both structures with reference to the greater trochanter of the femur were performed. ResultsThe sciatic nerve and the piriformis had an anatomical variation in a 28.13%. The most frequent variation found was tipus II (21.64%) and tipus III (6.49%).Insertion most frequently observed was an independent piriformis tendon inserted into the trochanteric fossa with 53.85%. ConclusionsThe anatomic variations' incidence in the population studied indicates that those have to be evaluated as a differential diagnosis of gluteal region pain due to the symptoms and signs resemblance with the vertebral disc pathology involving nerve root injury. In addition, anatomical knowledge of this region can be useful for the interpretation of imaging techniques, especially when ultrasound-guided injections are performed.

Development of an Evidence-Based Practical Diagnostic Checklist and Corresponding Clinical Exam for Low Back Pain

ObjectiveThe purpose of this study was to use scientific evidence to develop a practical diagnostic checklist and corresponding clinical exam for patients presenting with low back pain (LBP). MethodsAn iterative process was conducted to develop a diagnostic checklist and clinical exam for LBP using evidence-based diagnostic criteria. The checklist and exam were informed by a systematic review focused on summarizing current research evidence for office-based clinical evaluation of common conditions causing LBP. ResultsDiagnostic categories contained within the checklist and exam include nociceptive pain, neuropathic pain, and sensitization. Nociceptive pain subcategories include discogenic, myofascial, sacroiliac, and zygapophyseal (facet) joint pain. Neuropathic pain categories include neurogenic claudication, radicular pain, radiculopathy, and peripheral entrapment (piriformis and thoracolumbar syndrome). Sensitization contains 2 subtypes, central and peripheral sensitization. The diagnostic checklist contains individual diagnostic categories containing evidence-based criteria, applicable examination procedures, and checkboxes to record clinical findings. The checklist organizes and displays evidence for or against a working diagnosis. The checklist may help to ensure needed information is obtained from a patient interview and exam in a variety of primary spine care settings (eg, medical, chiropractic). ConclusionThe available evidence informs reasonable working diagnoses for many conditions causing or contributing to LBP. A practical diagnostic process including an exam and checklist is offered to guide clinical evaluation and demonstrate evidence for working diagnoses in clinical settings.

Síndrome do Piriforme: estado da arte

A Síndrome do Piriforme é uma condição clínica de ciática não discogênica causada pela compressão do nervo ciático pelo músculo piriforme. Sua fisiopatologia ainda hoje é controversa, podendo ter causas primárias e secundárias. Seu diagnóstico, na maioria dos casos, tem sido clínico e por exclusão. Não existe um teste clínico patognômonico e o exame de ressonância magnética tem sido útil no seu diagnóstico e conduta. O tratamento de escolha a priori é conservador e apresenta bons resultados e, em caso de falha, pode ser indicada cirurgia. É preciso maior conhecimento acerca desta síndrome por parte dos neurocirurgiões, ortopedistas e fisioterapeutas para um diagnóstico precoce e tratamento adequado.

Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach

BackgroundAdvantages of performing bilateral total hip arthroplasty (THA) in one stage include a single hospital stay, a single exposure to anaesthesia risks, and expedited rehabilitation. Controversy persists however, regarding safety, notably morbidity and mortality rates. Importantly, few studies have compared the anterior to the posterior approach for single-stage bilateral THA (1B-THA). The objective of this retrospective study in a uniform patient population was to compare the anterior and posterior approaches for 1B-THA in terms of: 1) early mortality rates, 2) early complications, 3) and 90-day re-admission rates, hospital stay lengths, and blood loss. Hypothesis1B-THA in patients younger than 80 years who have an ASA score of 1 or 2 is associated with no early mortality and with low early morbidity rates regardless of whether the anterior or posterior approach is used. Material and methodsA single-centre retrospective comparative design was used to assess 90-day mortality and morbidity rates in consecutive patients who underwent 1B-THA between 2004 and 2018. The groups managed with the anterior approach (AA) without traction table and posterior approach (PA) were compared. The ASA score was ≤2 and age ≤80 years in all patients. The groups were comparable for age, sex distribution, ASA score, pre-operative haemoglobin level, and reason for THA. ResultsWe included 55 patients managed via the AA and 82 managed via the PA. No patients died in either group. Early complications occurred in 3 patients in the AA group and 6 in the AP group (p=0.74). No differences were noted between the two groups for each type of complication. In the AA group, 3 patients experienced major complications (p=0.06) (2 cerebrovascular events and 1 peri-prosthetic fracture). In the PA group, 6 patients experienced minor complications (1 case each of dislocation, piriformis syndrome, sacral pressure sore, and deep vein thrombosis and 2 cases of ilio-psoas irritation; p=0.08). Operative time was 144minutes (range, 110-195minutes) in the AA group and 171minutes (range, 108–255minutes) in the PA group (p<0.001). Mean hospital stay length was 7.6 days (range, 3-13 days) overall, 6.7 days (range, 5–11 days) in the AA group, and 8.2 days (range, 3–13 days) in the PA group (p<0.001). The early re-admission rate was 2.9% overall, with no difference between the AA group (3.6% [2/55]) and the PA group (2.4% [2/82]) A post-operative blood transfusion was required by 34/137 (24.8%) patients overall, 15/55(27.3%) patients in the AA group and 19/82 (23.2%) patients in the PA group (p=0.58). DiscussionIn selected patients (ASA score 1 or 2 and age ≤80 years), 1B-THA was not followed by any early deaths in the patients managed using the anterior or posterior approach. Total early morbidity rates were low. Neither the types of complications nor the early re-admission rates differed between the AA and PA groups. The shorter operative time in the AA group is ascribable to change in patient installation between the two arthroplasties when the PA is used. Level of evidenceIII, comparative study of consecutive patients.

The PENATALAKSANAAN FISIOTERAPI PADA PENDERITA GANGGUAN NYERI AKIBAT SINDROM PIRIFORMIS DENGAN TEKNIK STRAIN COUNTERSTRAIN DAN CONTRACT RELAX STRETCHING DI KELURAHAN PEKAPURAN RAYA KOTA BANJARMASIN

Continuous use of muscles can may caused hyperactively muscle activity which eventually induced pain and muscle spasm in the lower back area to the backside. In addition, muscle spasm may lead pressure on the nerves to generated swelling, inflammation, and symptoms of nerve irritation. One of the nerve irritations that often results from muscle spasm is piriformis syndrome. Piriformis syndrome is a musculoskeletal condition characterized by pain in the waist, lower back to the backside upper lower limbs that results from shortening or spasm piriformis obtained compression of the sciatic nerve. As a result of these problems, the authors conducted a study to determine the management of physiotherapy using Strain Counterstrain technique and Contract Relax Stretching in reducing pain due to Piriformis syndrome. This research was conducted in the Kelurahan Pekapuran Raya of Banjarmasin City using a case study method with a visual analog scale (VAS) and Brief Pain Inventory Questionnaire (BPI). The results of the study are Strain Counterstrain and Contract Relax Stretching for 12 times therapy in 4 weeks can reduce pain disorders in the condition of Piriformis syndrome.&#x0D;

Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?

The sciatic nerve forms from the roots of the lumbosacral plexus and emerges from the pelvis passing inferiorly to the piriformis muscle, towards the lower limb where it divides into common tibial and fibular nerves. Anatomical variations related to the area where the nerve divides, as well as its path, seem to be factors related to piriformis syndrome. OBJECTIVE To analyze the anatomical variations of the sciatic nerve and its clinical implications. METHODS This was a systematic review of articles indexed in the PubMed, LILACS, SciELO, SpringerLink, ScienceDirect and Latindex databases from August to September 2018. Original articles covering variations of the sciatic nerve were included. The level of the sciatic nerve division and its path in relation to the piriformis muscle was considered for this study. The collection was performed by two independent reviewers. RESULTS At the end of the search, 12 articles were selected, characterized according to the sample, method of evaluation of the anatomical structure and the main results. The most prevalent anatomical variation was that the common fibular nerve passed through the piriformis muscle fibers (33.3%). Three studies (25%) also observed anatomical variations not classified in the literature and, in three (25%) the presence of a double piriformis muscle was found. CONCLUSION The results of this review showed the most prevalent variations of the sciatic nerve and point to a possible association of this condition with piriformis syndrome. Therefore, these variations should be considered during the semiology of disorders involving parts of the lower limbs.

Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome.

Piriformis muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip-joint mobility, and may have an impact on quality of life. Thirty-two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound-guided dry needling (DN) of the piriformis muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment. At 1-week follow-up, pain intensity was significantly less in the DN group than in the waitlist control group (-2.16 [-1.01 to -3.32], P = .007) by an amount consistent with clinically meaningful improvement. The findings suggest that DN resulted in clinically meaningful short-term improvement in pain intensity of patients with PMS.

Minimal Invazive Surgical Treatment of Piriformis Syndrome and the Results

Piriformis syndrome is a neuromuscular pain syndrome occurring as a result of compression on the underlying sciatic nerve due to various causes including the hypertrophy, inflammation, mass lesions or anatomical variations occuring in the deep gluteal space. Patients with piriformis syndrome often experience pain and numbness in the hip, thigh and leg, similar to those of sciatica. In addition to clinical findings, electrophysiological examinations and magnetic resonance imaging (MRI) is useful for diagnosis. Once diagnosed, the treatment approach is stepwise and conservative treatment is successful in majority of cases. Surgical treatment should be performed for the cases in whom conservative treatment methods fail and when the sciatic nerve should be decompressed. Surgery is an important treatment option for unresolved piriformis syndrome with its simplicity and low morbidity. Several surgical procedures have been described for the decompression of affected sciatic nerve. Due to excessive fibrosis tissue that may be developed around the sciatic nerve in classical surgical procedures, person's return to social and work life may be delayed. In the present study, we will evaluate the surgical indication criteria of our cases who underwent minimally invasive surgical treatment due to piriformis syndrome, the definition of the surgical procedure and the outcomes.

Causas anatómicas de compresión del nervio ciático en la pelvis. Síndrome piriforme

ObjectiveThe piriformis syndrome is one of the etiologies of pelvic pain due to the sciatic nerve's entrapment by the piriformis muscle. Nowadays this syndrome might be difficult to be diagnosed. The aim of this study is to know the prevalence of anatomic variations in our population that may contribute to the appearance of piriformis syndrome. Furthermore, anthropometric measurements of the piriformis muscle and the sciatic nerve procedures are studied for a possible application in the gluteal region. Material and methodThe study was carried out in 59 pelvis of 32 cryopreserved bodies. The anatomical variations of piriformis and sciatic nerve founded were described following the Beaton and Anson's classification. Anthropometric measurements of both structures with reference to the greater trochanter of the femur were performed. ResultsThe sciatic nerve and the piriformis had an anatomical variation in a 28.13%. The most frequent variation found was tipus II (21.64%) and tipus III (6.49%).Insertion most frequently observed was an independent piriformis tendon inserted into the trochanteric fossa with 53.85%. ConclusionThe anatomic variations’ incidence in the population studied indicates that those have to be evaluated as a differential diagnosis of gluteal region pain due to the symptoms and signs resemblance with the vertebral disc pathology involving nerve root injury. In addition, anatomical knowledge of this region can be useful for the interpretation of imaging techniques, especially when ultrasound-guided injections are performed.