Piriformis syndrome: diagnosis, causes and treatment
What causes piriformis syndrome
Piriformis syndrome – a kind of pain, caused by sciatica due to spasm of the piriformis muscle.
Spasm leads to a shortening and compaction of muscle fibers, it limits rotational movements of the hip, the pain spread to the groin, the leg to the knee, in the lumbar spine.
This neurotrophic spasserovannye is caused by irritation of the first sacral nerve root spinal nerve .
The structural features of the piriformis
The muscle has a triangular shape. One vertex is attached to a large spit in the area of its apex the tendon then passes through the greater sciatic hole, and fastened by three uniform beams to the sacrum, between the first and fourth sacral holes.
Over the muscle is the capsule of the sacroiliac joint, and beneath it is the anterior surface of the Sacro-bogorny ligament. Together with the muscle through the sciatic foramen passes a bundle of blood vessels and the sciatic nerve.
The piriformis muscle is required to ensure the following:
- rotational movement of the thigh outward;
- stabilizatsii of the hip joint;
- to keep the femoral head inside the acetabulum;
- for the implementation of the forward bends, with a stationary lower extremities.
The causes of the syndrome
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The range of reasons for the development of this pain syndrome is very wide. It is customary to group the causes on the direct source of the syndrome.
At the primary causes of piriformis syndrome stimulus applied directly to muscle:
- Injury in the gluteal or lumbar region (injury can cause a hematoma, damage of muscle tissues, which in turn will lead to irritation of the spine spinal nerve).
- Stretch or tension the piriformis muscle. Often when excessive physical exertion or as a result of the sudden change of position.
- Myositis muscle. The inflammatory process may cause sharp pain.
- Hypothermia. When exposed to cold muscle is much stronger, trying to reproduce the production of more ATP. Such intensity can lead to overexertion of muscles.
- As a result of poorly introduced injection. Can be affected nerve root.
Causes indirectly affect the muscle, but nevertheless lead to the emergence of the syndrome:
- Pathology of the pelvic organs. The inflammation may spread to nearby organs, including muscles.
- When disorders in connective structures of the sacrum and Ilium.
Another classification takes into account the reasons for the relation to the vertebral column.
- if the cause is directly or indirectly connected with the spine;
- spinal cord injury, spine, etc.;
- narrowing of the intervertebral holes;
- development of tumours in the spine;
- manifestations of sciatica in the lumbar spine.
- happen pathological processes of internal organs;
- disturbed functioning of the muscular apparatus in this region.
The symptomatology inherent to the syndrome
Manifestations of this syndrome can be either local (painful sensations arise in close proximity to the piriformis muscle, localized in a certain region; associated with spastic phenomena in the muscle).
In that case, when the symptoms indicate a violation of the innervation of certain parts, say about the signs of compression of the sciatic nerve. And if the violations are in the nature of an insufficient supply of organs, then the symptoms of piriformis syndrome klassificeret, as signs of compression of the arteries and blood vessels.
Local signs include:
- Pain in the region of the gluteal muscles or the sacroiliac joint or the hip joint. Pain aggravated by movement, which directly involved the piriformis muscle.
- Symptom Bonn-Bobrovnikovo. Is relaxing the gluteal muscles in this state can be felt compacted pear-shaped muscle, when pressed there is pain.
- Symptom Vilenkin – when tapped in the area of the piriformis muscle causing pain.
When touched, there is tenderness of the ischium.
Signs of compression of the sciatic nerve
Because the sciatic nerve innervates many of the structures of the lower extremity, and pinched disrupts their functions:
- the spread of pain throughout the leg;
- pain accompanied by a feeling of woodiness, burning;
- a symptom may be depression of the Achilles reflex;
- if pinched fibers forming the tibial nerve, the pain is localized in the biceps muscle of the calf.
The signs of compression of the arteries and blood vessels
- there is a numbness of the fingers of the lower limb;
- blanching of the skin;
- there are attacks of lameness, forcing to stop the movement and after some time at rest, the blood flow is restored and again movement is possible.
Many of the symptoms do not occur singly, but in groups, and irradiation of pain into adjacent areas makes diagnosis more difficult.
Diagnosis of the syndrome
As soon as the patient comes into the doctor’s office for diagnostics, the last noted features of the gait, posture and typical movements.
For a reliable diagnosis of piriformis syndrome, the patient is exposed to a number of studies. Among them:
- Checks symptom Bonn – Bobrovnikovo.
- Rattle foot on the subject of symptom Vilenkin.
- Rattle in the lower lumbar or upper sacral spinous processes. In case of reduction of the gluteus Maximus talking about the positive symptom Grossman.
- Conduct palpation of the attachment of the piriformis muscle – the area of the greater trochanter and the sacroiliac joint. A positive result is the occurrence of pain.
- Testing the state of the ilio-sacral and Sacro-spinous ligaments.
- As a method of diagnosis using transrectal palpation of the piriformis muscle. In that case, if a muscle is determined by the elastic and painful, the result is considered positive.
- The process of elimination. Directly in the piriformis muscle injected anesthetic solution (its appearance depends on individual tolerance), and if the pain symptoms disappear, make conclusions about the presence of piriformis syndrome.
If you suspect the presence of this syndrome as accompanying any disease (cancer, spinal injury), are assigned to specific instrumental methods:
- computed tomography;
- x-ray examination of the lumbosacral;
- radioisotope scanning (in the case of suspicion of the presence of tumor formation).
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Principles of treatment
All methods of treatment for piriformis syndrome that are used should be aimed at treating the causes of this pain syndrome. Treatment is always systematically and comprehensively.
Mainly used conservative methods of treatment, except the cases when the syndrome is a consequence of the disease, the treatment of which is impossible without operative intervention.
Medication of piriformis syndrome includes:
- for relaxation, reduction of pain entered the muscle relaxants;
- nonsteroidal anti-inflammatory drugs;
- analgesics with strong pain;
- drugs to improve circulation. Reduce inflammation, help in the resumption of innervation.
The technique is developed individually. Frequently applicable are:
- postisometric relaxation of muscles;
- posticipata relaxation of muscles.
The main physiotherapy treatments include:
- magnetic-laser therapy;
Among the highlights are:
- laser acupuncture;
- vacuum therapy;
- acupuncture, etc;
- therapeutic massage.
Many techniques are used comprehensively and a decision about how to treat piriformis syndrome definitely is done under the supervision of a physician.
The blockade of the piriformis muscle
In that case, if the voltage of the piriformis muscle lasts for quite a long period of time, causing a number of troubles, in the framework of the treatment of blockade of the muscles of the anesthetic.
To do this, in the supine position outlining three main points: ischial tuberosity, the top of the greater trochanter and caudineural spine of the Ilium and connect into a triangle. From the latter point to hold the line so that the angle was divided into two equal parts. This line is conventionally crushed into three parts and at the border of the lower and middle parts are making a mark.
In this area local anesthesia the connective tissue, and then insert a needle to get into the belly of the piriformis muscle. And injected the anesthetic.
Relax muscle, relieve pain and restore needs motor activity by using physical exercise.
When piriformis syndrome is important the order of the exercises!
- Motion is the knees towards each other and in different directions. Runs smoothly, lying on back, knees in p
- Not changing position, to perform a unidirectional shaking a clenched knees.
- Movement on standing. From a sitting position, with the serried knees widely separated and feet done moving up, helping first hand, leaning against the seat, and after separation of hands with a partner to complete the lift.
All individual exercises will help to make the physiotherapist, taking into account age, weight, physical shape and at every stage of treatment.
Not promptly treated, the syndrome can lead to the following consequences:
- Impaired functioning of the muscles of the lower limbs;
- There are signs of degradation of the ligaments and joint function;
- Problems with the pelvic organs.
Some measures will avoid lengthy rehabilitation and expensive treatment. This is especially true for people who have the tendency to diseases of the lumbar:
- you should avoid excessive physical exertion;
- attentive to health (at the first signs of sciatica to seek assistance);
- to avoid hypothermia;
- try a long time to be in the same position, in spite of its comfort.
The occurrence of piriformis syndrome is always accompanied by a number of uncomfortable feelings, but the qualitative diagnosis will allow to start timely treatment, and to reduce symptoms to a minimum until full recovery.