Piriformis syndrome

Piriformis syndrome

Http://pm-r.tistory.com

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Piriformis syndrome

piriformis m.이 pelvis에서 sciatic nerve에 local pressure를 가함으로써 sciatica를 유발

통증은 보통 post. thigh로 나타나지만, L5 or S1 dermatome인 knee 이하로도 refer

buttock pain을 호소하고, 전형적으로 sciatic notch의 tenderness를 보임

Entrapment of sciatic n. by piriformis m.

Entrapment of sciatic n. by piriformis m.

Anatomic variations

Reproduction of pain ; Physical Examination

Hip

Flexion

Internal rotation

Adduction

Symptom

dysesthesia in post. thigh, calf or foot (siting or L/E exertion에 의해 심해짐)

buttock pain & tenderness in piriformis

Evaluation

1. Pace's maneuver : resisted abduction & external rotation of thigh

2. Freiberg's maneuver : forceful internal rotation of the extended thigh

3. Beatty maneuver : side-lying and hold flexed knee several inches off the table

4. Fishman : electrophysiologic approach → H waves 이용

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Physical exam

1. prone-lying position에서 hip adduct and knee 90도 flex.

2. supine-lying position에서 hip 60도 flex & adduct 상태에서 internal rotation stress 준다.

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biomechanical deficits

- tight piriformis & external rotators

- hip abductor weakness

- SI joint hypo- or hypermobility

- lower lumbar spine shortening

rehabilitation

- piriformis muscle과 external rotator muscle의 stretching

- sacrum과 pelvis imbalance 평가

- strengthening, stabilization exercise

; pelvic tilt exercise, minibridges, hip external rotation, strengthening ex.

​

Piriformis syndrome

Http://pm-r.tistory.com

​

Piriformis syndrome

piriformis m.이 pelvis에서 sciatic nerve에 local pressure를 가함으로써 sciatica를 유발

통증은 보통 post. thigh로 나타나지만, L5 or S1 dermatome인 knee 이하로도 refer

buttock pain을 호소하고, 전형적으로 sciatic notch의 tenderness를 보임

Entrapment of sciatic n. by piriformis m.

Entrapment of sciatic n. by piriformis m.

Anatomic variations

Reproduction of pain ; Physical Examination

Hip

Flexion

Internal rotation

Adduction

Symptom

dysesthesia in post. thigh, calf or foot (siting or L/E exertion에 의해 심해짐)

buttock pain & tenderness in piriformis

Evaluation

1. Pace's maneuver : resisted abduction & external rotation of thigh

2. Freiberg's maneuver : forceful internal rotation of the extended thigh

3. Beatty maneuver : side-lying and hold flexed knee several inches off the table

4. Fishman : electrophysiologic approach → H waves 이용

​

Physical exam

1. prone-lying position에서 hip adduct and knee 90도 flex.

2. supine-lying position에서 hip 60도 flex & adduct 상태에서 internal rotation stress 준다.

​

biomechanical deficits

- tight piriformis & external rotators

- hip abductor weakness

- SI joint hypo- or hypermobility

- lower lumbar spine shortening

rehabilitation

- piriformis muscle과 external rotator muscle의 stretching

- sacrum과 pelvis imbalance 평가

- strengthening, stabilization exercise

; pelvic tilt exercise, minibridges, hip external rotation, strengthening ex.

​