Sacroiliac Joint Dysfunction and Piriformis Syndrome

Yih, Erika T.; Sarno, Danielle L.

doi:10.1007/978-3-030-74625-4_2

Cited by 2 publications

(2 citation statements)

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“…The piriformis syndrome with compression of the sciatic nerve occurs quite rarely, just in 6–8% of all sciatica cases [ 24 ]. Numerous anatomical reviews suggested that the piriformis may be a trigger (in case of entrapment neuropathy) [ 3 , 11 ] or a “victim” of several pelvic pathologies [ 10 , 21 , 39 ]. That is why the concept of piriformis syndrome may not exclusively be associated with sciatic nerve pain.…”

Section: Discussionmentioning

confidence: 99%

“…That is why the concept of piriformis syndrome may not exclusively be associated with sciatic nerve pain. Several publications speculated about the role of sacroiliac joint arthritis as a trigger of the piriformis syndrome [ 10 , 28 , 34 , 39 ]. This point of view is worth the attention of anatomists and clinicians because it may explain unusual sciatica cases and piriformis syndrome without sciatic nerve entrapment.…”

Section: Discussionmentioning

confidence: 99%

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Novel anatomical findings with implications on the etiology of the piriformis syndrome

2022

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Purpose The cause of the piriformis-related pelvic and extra-pelvic pain syndromes is still not well understood. Usually, the piriformis syndrome is seen as extra-pelvic sciatica caused by the entrapment of the sciatic nerve by the piriformis in its crossing through the greater sciatic foramen. However, the piriformis muscle may compress additional nerve structures in other regions and cause idiotypic pelvic pain, pelvic visceral pain, pudendal neuralgia, and pelvic organ dysfunction. There is still a lack of detailed description of the muscle origin, topography, and its possible relationships with the anterior branches of the sacral spinal nerves and with the sacral plexus. In this research, we aimed to characterize the topographic relationship of the piriformis with its surrounding anatomical structures, especially the anterior branches of the sacral spinal nerves and the sacral plexus in the pelvic cavity, as well as to estimate the possible role of anatomical piriformis variants in pelvic pain and extra-pelvic sciatica. Methods Human cadaveric material was used accordingly to the Swiss Academy of Medical Science Guidelines adapted in 2021 and the Federal Act on Research involving Human Beings (Human Research ACT, HRA, status as 26, May 2021). All body donors gave written consent for using their bodies for teaching and research. 14 males and 26 females were included in this study. The age range varied from 64 to 97 years (mean 84 ± 10.7 years, median 88). Results three variants of the sacral origin of the piriformis were found when referring to the relationship between the muscle and the anterior sacral foramen. Firstly, the medial muscle origin pattern and its complete covering of the anterior sacral foramen by the piriformis muscle is the most frequent anatomical variation (43% in males, 70% in females), probably with the most relevant clinical impact. This pattern may result in the compression of the anterior branches of the sacral spinal nerves when crossing the muscle. Conclusions These new anatomical findings may provide a better understanding of the complex piriformis and pelvic pain syndromes due to compression of the sacral spinal nerves with their somatic or autonomous (parasympathetic) qualities when crossing the piriformis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Novel anatomical findings with implications on the etiology of the piriformis syndrome

2022

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Piriformis muscle pain syndrome: the myths and reality

Akhmedzhanova,

Isaikin,

Vakhnina

et al. 2024

Medicinskij sovet

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Issues of diagnosis, effective treatment and prevention of chronic pain syndromes represent an urgent problem of modern medicine. About 80% of the population has experienced low back pain (LBP) at least once in their life; in 20% of patients acute LBP becomes chronic. Pain in the gluteal region with radiation to the leg can be caused by damage to various structures (joints, ligaments, deep muscles of the gluteal region, spinal roots), which are closely located and have similar innervation. The article presents a clinical case that illustrates the difficulties of diagnosing deep pain syndrome in the gluteal region in a young athlete. The condition, which was initially considered as myofascial pain syndrome of the piriformis muscle, upon detailed examination and observation turned out to be a rheumatological pathology (Bechterew’s disease). The article discusses the etiology, diagnostic criteria, differential diagnosis and treatment of piriformis muscle syndrome. There are currently no reliable diagnostic tests or validated diagnostic criteria to confirm the diagnosis, and therefore piriformis syndrome should be considered a diagnosis of exclusion. In clinical practice, there is both overdiagnosis of piriformis muscle syndrome with the widespread use of various invasive procedures, and ignorance of this syndrome. In most cases, secondary piriformis syndrome is observed and identification of the causative factor is decisive for the successful treatment of patients. Treatment of piriformis muscle syndrome should include the elimination of provoking factors, kinesiotherapy, NSAIDs, muscle relaxants, and, if indicated, therapeutic blockades, and for chronic pain syndrome, cognitive behavioral therapy and antidepressants. Nimesulide is a NSAID with proven effectiveness and a good safety profile, and therefore can be recommended for the treatment of both musculoskeletal pathologies and symptomatic treatment of rheumatological diseases.

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Sacroiliac Joint Dysfunction and Piriformis Syndrome

Cited by 2 publications

References 94 publications

Novel anatomical findings with implications on the etiology of the piriformis syndrome

Novel anatomical findings with implications on the etiology of the piriformis syndrome

Piriformis muscle pain syndrome: the myths and reality

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