Piriformis syndrome, diagnosis and treatment

@article{Kirschner2009PiriformisSD,
  title={Piriformis syndrome, diagnosis and treatment},
  author={Jonathan Kirschner and Patrick M. Foye and Jeffrey L. Cole},
  journal={Muscle \& Nerve},
  year={2009},
  volume={40}
}
Piriformis syndrome (PS) is an uncommon cause of sciatica that involves buttock pain referred to the leg. Diagnosis is often difficult, and it is one of exclusion due to few validated and standardized diagnostic tests. Treatment for PS has historically focused on stretching and physical therapy modalities, with refractory patients also receiving anesthetic and corticosteroid injections into the piriformis muscle origin, belly, muscle sheath, or sciatic nerve sheath. Recently, the use of… 
La sindrome del piriforme
TLDR
Treatment for PS has historically been focused on stretching and physical therapy modalities, with refractory patients also receiving anesthetic and corticosteroid injections into the piriformis muscle origin, belly, muscle sheath, or sciatic nerve sheath.
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A narrative review highlights the relevant anatomy, history, physical exam maneuvers, electrodiagnostic findings, and imaging findings that are used to diagnose piriformis syndrome and outlines the different treatment options including conservative treatment, injections, and surgical treatment.
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Background Piriformis syndrome (PS) is an uncommon disease characterized by symptoms resulting from compression/irritation of the sciatic nerve by the piriformis muscle. Uncertainty and controversy
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Two double-blind, placebo-controlled studies have strongly supported the efficacy of onabotulinumtoxinA in management of piriformis syndrome and limited open studies suggest that type B toxin (rimaB) is also effective.
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This article explores the various sources of controversy surrounding piriformis syndrome including diagnosis, investigation and management and a proposal for diagnostic criteria which include signs and symptoms, imaging, and response to therapeutic injections.
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The piriformis injection should be considered when symptoms persist after attempts have been made with conservative methods, and it is simple and fast and does not require a lot of needle manipulation.
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TLDR
Piriformis Syndrome is a condition that located in the buttock region may cause muscle spasms and buttock pain and must be considered in the variable diagnosis of low back pain,sacroiliac or hip joint pathologies.
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The clinician’s review the clinical conditions and anatomical features of this condition, encapsulating the osteopathic medical approach to management and diagnosis, and an interdisciplinary evaluation is recommended for the optimization of diagnosis and treatment approach.
Piriformis Muscle Syndrome, Post Discectomy: a Comprehensive Review of its Diagnostic Process and Management, Illustrated with the Aid of a Case Report
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TLDR
This review, with the help of a case study, provides a detailed account of the possible biopsychosocial risk factors underlying piriformis muscle syndrome, post discectomy and evidence-based multidisciplinary management underlying this condition.
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Six key features of the piriformis syndrome are described: a history of trauma or direct fall to the buttock; difficulty walking; worsening with squatting or lifting; a sausage-like mass within the muscle; positive straight leg raising test (SLR test) and gluteal atrophy.
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