Piriformis syndrome is a form of sciatica caused by compression of the sciatic nerve by the piriformis muscle. It is a relatively uncommon, but not insignificant, cause of sciatica. The diagnosis of piriformis syndrome is complicated by the large differential diagnosis of low back and buttock pain with many diagnoses having overlapping symptoms. This narrative review highlights the relevant anatomy, history, physical exam maneuvers, electrodiagnostic findings, and imaging findings that are used to diagnose piriformis syndrome. Also discussed are posterior gluteal myofascial pain syndromes that mimic piriformis syndrome. The review then outlines the different treatment options for piriformis syndrome including conservative treatment, injections, and surgical treatment. In addition, it provides the reader with a clinical framework to better understand and treat the complex, and often misunderstood, diagnosis of piriformis syndrome.

An elite high school American football athlete sustained a traumatic, isolated, axillary nerve injury. Axillary nerve injuries are uncommon, but serious injuries in American football. With the advent of nerve transfers and grafts, these injuries, if diagnosed in a timely manner, are treatable. This case report discusses the multidisciplinary approach necessary for the diagnosis and treatment of an elite high school American football player who presented with marked deltoid atrophy. The athlete’s injury was diagnosed via electrodiagnostic testing and he underwent a medial triceps nerve to axillary nerve transfer. After appropriate postsurgical therapy, the athlete was able to return to American football the subsequent season and continue performing at an elite level. This case report reviews the evaluation and modern treatment for axillary nerve injuries in the athlete, including nerve transfers, nerve grafts, and return to play.

The purpose of this narrative review is to present the evidence relating to musculoskeletal impairments found in people with nonspecific chronic pelvic pain (CPP). The musculoskeletal impairments assessed in this review include pelvic floor muscle: performance, resting state, strength, activation, posture and movement patterns. A search was performed systematically using PubMed, Cochrane, CINAHL, Embase, and Web of Science databases from 1998 to 2018 to identify studies reporting the relationship between nonspecific CPP and musculoskeletal impairments of the hip, pelvis, and trunk. The search resulted in 2106 articles that were screened by two authors. Remaining articles were screened by an additional two authors for inclusion in this review. Thirty‐one articles remained after initial screening. Full‐text publications were reviewed and an additional 25 articles were excluded. Six additional articles were located through review of the reference lists of included articles. The final review included 12 publications. Seven of these studies were cross‐sectional cohorts or case‐control comparing patients with CPP to asymptomatic controls. The level of evidence for the studies included in this review was low at Levels 4 and 5. We were unable to draw clear conclusions regarding the relationships of musculoskeletal impairments and CPP because validity and use of terms and assessments were inconsistent. Further research is needed with standardized definitions and measurements to better understand the musculoskeletal system as it relates to nonspecific CPP.

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Epithelioid hemangioendothelioma (EHE) is a low-grade, malignant vascular neoplasm that frequently involves the liver, lungs, bone, and soft tissue. Although not commonly associated with a paraneoplastic syndrome, paraneoplastic syndromes in the setting of EHE have been reported. Acute disseminated encephalomyelitis (ADEM) is an acute, autoimmune, demyelinating disorder of the central nervous system that most commonly occurs after an infection or vaccination. We present the case of a 23 year old female who developed the acute onset of fevers, tremors, right sided hemiplegia, global aphasia, and incontinence of urine and stool. MRI demonstrated findings consistent with a demyelinating disorder and brain biopsy confirmed the diagnosis of ADEM. The patient’s work up revealed multiple liver lesions which were biopsy proven EHE. This case report discusses the diagnosis and treatment of two concurrent rare disease processes and the possible association of the processes via a paraneoplastic syndrome.