Is There an Association Between Lumbosacral Radiculopathy and Painful Gluteal Trigger Points?

Adelmanesh, Farhad; Jalali, Ali; Shooshtari, Seyed Mostafa Jazayeri; Raissi, Gholam Reza; Ketabchi, Seyed Mehdi; Shir, Yoram

doi:10.1097/phm.0000000000000261

Cited by 14 publications

(17 citation statements)

References 19 publications

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“…Because the symptoms are similar, LDH-related gluteal pain can be misdiagnosed as superior cluneal nerve entrapment neuropathy (SCNEN) or muscle strain. Yasuhiro Chiba [3] reported five patients with intermittent LBP due to SCNEN who had previously received conservative treatment and who underwent surgery and achieved good results. Adelmanesh F [4, 6] reported that trigger points in the superior-lateral quadrant of the gluteal area are highly specific indicators for radicular LBP.…”

Section: Discussionmentioning

confidence: 99%

“…Gluteal pain is also a complaint among some patients with LDH and is sometimes the only complaint. Approximately three-quarters of patients with unilateral radicular pain presented with gluteal pain [3]. …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown an association between radicular LBP and GP [3–7]. Studies locating the specific level responsible for gluteal pain in lumbar disc hernias have rarely been reported.…”

Section: Introductionmentioning

confidence: 99%

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Which level is responsible for gluteal pain in lumbar disc hernia?

Fang

Zhou

Liu

et al. 2016

BMC Musculoskelet Disord

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BackgroundThere are many different reasons why patients could be experiencing pain in the gluteal area. Previous studies have shown an association between radicular low back pain (LBP) and gluteal pain (GP). Studies locating the specific level responsible for gluteal pain in lumbar disc hernias have rarely been reported.MethodsAll patients with lumbar disc herniation (LDH) in the Kanghua hospital from 2010 to 2014 were recruited. All patients underwent a lumbar spine MRI to clarify their LDH diagnosis, and patients were allocated to a GP group and a non-GP group. To determine the cause and effect relationship between LDH and GP, all of the patients were subjected to percutaneous endoscopic lumbar discectomy (PELD).ResultsA total of 286 cases were included according to the inclusive criteria, with 168 cases in the GP group and 118 cases in the non-GP group. Of these, in the GP group, 159 cases involved the L4/5 level and 9 cases involved the L5/S1 level, while in the non-GP group, 43 cases involved the L4/5 level and 48 cases involved the L5/S1 level. PELD was performed in both groups. Gluteal pain gradually disappeared after surgery in all of the patients. Gluteal pain recrudesced in a patient with recurrent disc herniation (L4/5).ConclusionsAs a clinical finding, gluteal pain is related to low lumbar disc hernia. The L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. No patients with gluteal pain exhibited involvement at the L3/4 level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1204-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Which level is responsible for gluteal pain in lumbar disc hernia?

Fang

Zhou

Liu

et al. 2016

BMC Musculoskelet Disord

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“…При этом существенное значение имеют нейрогенное воспаление, центральная и периферическая сенситизация. Роль дополнительных скелетномышечных источников боли и их вклад в формирование болевого синдрома при дискогенной радикулопатии обсуждается в ряде других исследований [14,15]. Так, F. Adelmanesh и соавт.…”

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“…Так, F. Adelmanesh и соавт. [14] изучали взаимосвязь пояснично-крестцовой радикулопатии и болевых триггерных точек в мышцах ягодичной области. Триггерные точки были выявлены у 76,4% пациентов с радикулопатией, что достоверно чаще, чем у здоровых добровольцев (1,9%; р<0,001).…”

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Conservative treatment for patients with discogenic lumbosacral radiculopathy: results of a prospective follow-up

Parfenov

Исайкин

2018

Nevrologiâ, nejropsihiatriâ, psihosomatika

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Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal antiinflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

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Back Pain with Leg Pain

Vulfsons

Bar

Eisenberg

2017

Curr Pain Headache Rep

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Bogduks' editorial in the journal PAIN (2009) helps us to differentiate and define the terms somatic referred pain, radicular pain, and radiculopathy. In addition, there are other pathologies distal to the nerve root that could be relevant to patients with back pain and leg pain such as plexus and peripheral nerve involvement. Hence, the diagnosis of back pain with leg pain can still be challenging. In this article, we present a patient with back and leg pain. The patient appears to have a radicular pain syndrome, but has no neurological impairment and shows signs of myofascial involvement. Is there a single diagnosis or indeed two overlapping syndromes? The scope of our article encompasses the common diagnostic possibilities for this type of patient. A discussion of treatment is beyond the scope of this article and depends on the final diagnosis/diagnoses made.

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Is There an Association Between Lumbosacral Radiculopathy and Painful Gluteal Trigger Points?

Abstract: Although rare in the healthy volunteers, most of the patients with lumbosacral radiculopathy had gluteal trigger point, located at the painful side. Further studies are required to test the hypothesis that specific gluteal trigger point therapy could be beneficial in these patients.

Cited by 14 publications

References 19 publications

Which level is responsible for gluteal pain in lumbar disc hernia?

Which level is responsible for gluteal pain in lumbar disc hernia?

Conservative treatment for patients with discogenic lumbosacral radiculopathy: results of a prospective follow-up

Back Pain with Leg Pain

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