Ebook Non - Operative treatment of the lumbar spine: Part 2
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Ebook Non - Operative treatment of the lumbar spine: Part 2
Chapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2 when it is in flexion. In approximately 20 % of the population, the piriformis muscle belly is split and one or more parts of the sciatic nerve passes through the piriformis muscle [I]. Typically, when it passes through, it is the peroneal portion of the sciatic nerve that pierces the piriformis mu Ebook Non - Operative treatment of the lumbar spine: Part 2scle. The sciatic nerve itself, as a single nerve, is the largest in the human body. Historically, piriformis syndrome has been an overused diagnosisEbook Non - Operative treatment of the lumbar spine: Part 2
as it has been conflated w ith a lumbosacral radiculopathy which epidemiologically is much more common. Because the L5, SI. and S2 nerve roots innervaChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2d SI nerve roots are so commonly inflamed, and because these spinal nerves are the primary feeders of the sciatic nerve, the diagnosis of piriformis syndrome or “sciatica" is often given when in fact the L5 and/or SI nerve roots are the actual cause. In fact, true piriformis syndrome involves irrita Ebook Non - Operative treatment of the lumbar spine: Part 2tion or inflammation of the piriformis muscle that may result in compression or inflammation of the sciatic nerve.Consider the following patient: SamaEbook Non - Operative treatment of the lumbar spine: Part 2
ntha is a 34-year-old attorney who is an avid early morning runner. While training for a marathon, she developed right buttock pain radiating into herChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2 increased pain with transitioning from sit to stand after she has been silling for a while. She has some numbness in the right lateral lower leg after a long run. On exam, she has a negative straight leg raise. Her piriformis muscle is very tender and pressure reproduces sciatic symptoms into the r Ebook Non - Operative treatment of the lumbar spine: Part 2ight thigh. MRI of her lumbar spine is normal and electrodiagnostic tests are within normal limits.Most spine specialists would agree that Samantha isEbook Non - Operative treatment of the lumbar spine: Part 2
likely suffering from piriformis syndrome. Piriformis syndrome is often suspected when a patient presents with Samantha’s symptoms and then on exam sChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2t her piriformis muscle was very tender and that palpation© Springer International Publishing Switzerland 201565G. Cooper. Non-Operative Treatment of the Lumbar Spine.nni in liiiWftii 1 -ỈIO 0 11.n A 1166il Piriformis Syndromereproduced her symptoms, then a diagnosis of piriformis syndrome would sti Ebook Non - Operative treatment of the lumbar spine: Part 2ll be premature and likely incorrect. An L5-S1 radiculopathy would present in the same way and the piriformis muscle would likely be just as tender beEbook Non - Operative treatment of the lumbar spine: Part 2
cause it may spasm in response to the nerve root inflammation. However, the fact that the dural root tension sign is negative (straight leg raise) is Chapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2a, it is the fact that she has all of the above features and the fact that her lumbosacral MRI is normal and that the electrodiagnostic studies were normal that suggest the diagnosis piriformis syndrome.If Samantha had a positive straight leg raise or an L5-S1 disc herniation or electrodiagnostic st Ebook Non - Operative treatment of the lumbar spine: Part 2udies revealing an L5 and SI radiculopathy, then that would have been the most likely diagnosis. Even with all of the above data points, it is still nEbook Non - Operative treatment of the lumbar spine: Part 2
ot definitive that Samantha has piriformis syndrome but it certainly appears that she does. In the end. piriformis syndrome remains a clinical diagnosChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2 begins with physical therapy. The physical therapy will focus on stretching the piriformis muscle as well as the other hip muscles. Passive modalities such as ultrasound and soft tissue mobilization arc often used to stretch the hip joint capsule as well as the involved and surrounding muscles. Lum Ebook Non - Operative treatment of the lumbar spine: Part 2bar stabilization exercises are often incorporated into the physical therapy program. If an activity such as running is felt to have been contributingEbook Non - Operative treatment of the lumbar spine: Part 2
to the development of the piriformis syndrome, then it is important to evaluate the gait and address any suboptimal mechanics. In addition, the mechaChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2s do not respond to physical therapy and home exercises, or if the symptoms arc too severe to allow the patient to participate with the exercise regimen. then a trigger point into the piriformis muscle is often used. Ideally, ultrasound guidance is used for the injection in order to ensure proper lo Ebook Non - Operative treatment of the lumbar spine: Part 2calization of the needle into the belly of the piriformis muscle as well as to ensure avoidance of any vascular structures and also to avoid direct inEbook Non - Operative treatment of the lumbar spine: Part 2
jection into the sciatic nerve [2]. The trigger point injection for piriformis syndrome often uses a small dose of steroid in addition to lidocaine orChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2toxin injection may be helpful [3,4]. The goal of using botulinum toxin (e.g.. Botox) is to relax the muscle and facilitate further physical therapy. The main risk of botulinum toxin injection in this instance is to paralyze the muscle too much in which case the gait may be thrown off further and th Ebook Non - Operative treatment of the lumbar spine: Part 2is may potentially lead to other musculoskeletal problems.As a last resort, surgical release of the piriformis muscle in which the piriformis tendon iEbook Non - Operative treatment of the lumbar spine: Part 2
s loosened may be considered if symptoms are ongoing and debilitating and symptoms have not improved with aggressive conservative care. Surgical releaChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2ed Further Reading1Jankiew icz JJ. Hennrikus WL. Houkoin JA. The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature. Clin Orthop. 1991:262:205-9.2Blunk JA. Nowotny M. Scharf J. Benrath J. MR1 verification of Ebook Non - Operative treatment of the lumbar spine: Part 2ultrasound-guided infiltrations of local anesthetics into the piriformis muscle. Pain Med. 2013:14( 10): 1593-9.3Fishman LM. Konnoth c. Rozner B. BotuEbook Non - Operative treatment of the lumbar spine: Part 2
linum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose finding study. Am J Phys Med Rehabil. 2004:83( I ):42-50.Chapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2936-42.5Syasyon sc. Ducey JP. Maybrey JB. et al. Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain. 1994:59( 1): 149-52.6Dezawa A. Kusano s. Miki H. Arthroscopic release of the piriformis muscle under local anesthesia for piriformis syndrome. Arthroscopy. 2003;19(5): Ebook Non - Operative treatment of the lumbar spine: Part 2554-7.7Rossi p. Cardinal! p. Serrao M. et al. Magnetic resonance imaging findings in piriformis syndrome: a case report. Arch Phys Med Rehabil. 2001:8Ebook Non - Operative treatment of the lumbar spine: Part 2
2(4):519-21.8Vandertop wp. Bosma NJ. The piriformis syndrome. A case report. .1 Bone Joint Surg Am. 1991:73(7): 1095-7.Chapter 12Spinal StenosisThe woChapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2rowing) of the spine canal. While anything that narrows the spinal canal (e.g.. a disc herniation) will create stenosis, conventionally when “spinal stenosis” is used as a diagnosis, it refers to a predominance of the stenosis originating from the posterior elements (c.g.. facet joint arthropathy, b Ebook Non - Operative treatment of the lumbar spine: Part 2uckled ligamcnlum flavum) although there is often an element of disc herniation contributing to the stenosis.The anatomic finding of some degree of spEbook Non - Operative treatment of the lumbar spine: Part 2
inal stenosis is “part of aging” in the sense that after the age of 65, just about everyone is going to have some degree of spinal stenosis on MRI [1.Chapter 11Piriformis SyndromeThe function of the piriformis muscle is to externally rotate the hip when the hip is in extension and to abduct the hip Ebook Non - Operative treatment of the lumbar spine: Part 2sis and symptoms, there are typically other levels within that patient’s spine that reveal some amount of stenosis without symptomatology.When spinal stenosis does cause symptoms, the symptoms do not generally occur because of a true compression of the spinal nerves but rather the reduced space in t Ebook Non - Operative treatment of the lumbar spine: Part 2he spinal canal creates a greater propensity for the patient to develop inflammation around the nerve roots as a result of the stenosis and this leadsEbook Non - Operative treatment of the lumbar spine: Part 2
to symptoms. In rare cases the nerves may become truly mechanically compressed in which case the symptoms arc generally severe and progressive.CommonGọi ngay
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