piriformis syndrome
Introduction
Piriformis Syndrome Introduction The sciatic nerve pelvic outlet stenosis and piriformis syndrome occur in the pelvic cavity caused by local lesions before the sciatic nerve is separated from the sacral nerve and separated from the pelvis to the buttocks. The former lesion is mainly located in the pelvis. The exit is around, while the latter is mainly caused by lesions of the piriformis itself. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: polio Progressive muscular dystrophy
Cause
Piriformis syndrome
(1) Causes of the disease
Similar to the sciatic pelvic outlet stenosis, in fact, it can also be regarded as one of the causes of stenosis of the sciatic pelvic outlet. The early pathological changes of this disease are mostly after local trauma (acute sprain with extreme abduction and external rotation) More common, the second is the sudden traumatic response when standing up, the light manifested as edema of the piriformis muscle fibers, exudation and telangiectasia, severe piriformis can appear paralysis, hemorrhage and swelling, such as Mild injury, or effective treatment in time, can generally return to normal, but if the injury is too heavy, or repeated multiple damages, plus other pathogenic factors, such as cold, damp, etc., the pathological process continues to develop Form a chronic process with a series of secondary changes.
(two) pathogenesis
It is rare for the piriformis itself to be hypertrophic or scar tissue to compress the sciatic nerve trunk. Many of the piriform muscles due to contracture constitute the stenosis of the sciatic nerve, and the sciatic nerve is embedded in the narrow outlet to cause symptoms. The pathogenesis is essentially Consistent with sciatic pelvic outlet stenosis, similar secondary changes have occurred, including local venous engorgement, thickening of the arterial wall, and other findings.
Prevention
Piriformis syndrome prevention
1. Maintaining optimistic and happy emotions. Stronger long-term or repeated emotional changes such as nervousness, anxiety, irritability, and pessimism can balance the excitation and inhibition processes of the cerebral cortex.
2, need high protein, high energy diet supplement, provide the necessary materials for nerve cell and skeletal muscle cell reconstruction, to strengthen muscle strength, increase muscle, early use of high protein, foods rich in vitamins, phospholipids and trace elements, and active With medicated diet, such as yam, glutinous rice, lotus seed, dried tangerine peel, ginseng, lily, etc., fast food spicy food, quit smoking, alcohol.
3, work and rest combined with forced sexual function exercise, because forced sexual exercise due to skeletal muscle fatigue, is not conducive to the recovery of skeletal muscle function, muscle cell regeneration and repair.
Complication
Piriformis syndrome complications Complications polio progressive muscular dystrophy
Those with longer course of disease can have a prolapsed foot. One of the surgical signs of the plant of the foot. The patient is seated, and the lower limbs are naturally overhanging. If the foot is in the position of the ankle and the body is unable to actively dorsiflexion and internal and external valgus, the foot is drooping. Intrinsic can be seen in sciatic nerve palsy and common peroneal nerve palsy. The former is caused by the intrinsic, the toes can not be dorsiflexion, nor can it be wronged; while the latter is caused by the intrinsic, the toes can be wronged; according to this, the two can be identified. In addition, the intrinsic can also be found in poliomyelitis, progressive muscular dystrophy, hypokalemia, periodic paralysis and lower limb paralysis.
Symptom
Piriformis syndrome symptoms Common symptoms Sensory disturbance Lower extremity induction pain or release... Calf muscle atrophy
1. Symptoms of sciatic nerve injury: Mainly characterized by dry involvement, that is, radiation pain along the sciatic nerve and movement of its dominant area (post-femoral, calf front and back muscles), feeling (outside of the calf, sole And the anterior part of the foot and the reflection (Achilles tendon reflex and sputum reflex) obstacles, etc., the longer course of the disease, there may be symptoms such as calf muscle atrophy or even foot drop.
2. Tenderness point: The most painful (circle jump) is placed at the position of the pelvic nerve pelvic outlet, and it is radiated along the nerve trunk. In addition, it is found that about half of the cases have tenderness at the sputum or sputum. When the piriformis syndrome is present, the tender point is slightly higher than the former by 1 to 2 cm.
3. Lower limb rotation test: The limbs are rotated to make the piriformis and superior iliac muscles, the obturator inner muscles and the lower diaphragm muscles are in a state of tension, and even the stenosis at the exit can be induced, which can induce sciatic nerve symptoms, except for radiation pain along the sciatic nerve. There is also a numbness at the bottom of the calf, but in the case of simple piriformis syndrome, it is a symptom induced by external rotation. This is mainly due to contracture of the piriform muscle when the contracture is contracted and the external rotation of the lower extremity causes the outlet to be narrow. The reason.
4. Straight leg raising test: Generally positive, the pain level is between root pain and plexus pain, this test is not specific.
5. Tissue hydraulic pressure measurement: It is more than about 1 times of the normal value (1.33 kPa, 10 mmHg), and the abnormal value is 50% higher than the normal value. This measurement is mainly used for some patients with difficulty in diagnosis.
Examine
Examination of piriformis syndrome
1. Electromyography: As a means of measuring the function of the motor system, it has been widely used to distinguish between weak muscle strength and muscle atrophy, caused by myopathy, or caused by neuropathy, or other causes. Through the needle electromyography, the measurement of muscles in different parts of the body can be understood: (1) whether the muscle lesion belongs to neurogenic damage or myogenic damage; (2) the site of neurogenic damage (anterior horn cells or nerve roots, nerves) (3) whether the lesion is active or chronic; (4) the ability of nerve regeneration; (5) to provide a basis for diagnosis and differential diagnosis of myotonia and its classification. It can be used as a monitoring method for unexplained muscle atrophy, numbness, weakness, physical activity disorder and other diseases. It can also be used as a monitoring method after or after treatment of nerve injury, as well as an objective indicator for rehabilitation, disability and forensic identification.
2, nerve conduction velocity: is a diagnostic instrument to assess the peripheral motor nerve and sensory nerve conduction function. Mainly used for the diagnosis of peripheral neuropathy such as polyneuropathy, hereditary peripheral neuropathy, Guillain-Barré syndrome, carpal tunnel syndrome, peripheral nerve trauma, etc., combined with electromyography to identify anterior horn cells, nerve roots, peripheral nerves and Myogenic diseases, etc.
Diagnosis
Diagnostic identification of piriformis syndrome
Diagnostic criteria
1. History: About half of the cases have had a history of heavy manipulation or a history of traumatic cold.
2. Clinical symptoms: The main manifestation is sciatic nerve dry pain. The tender point is located at the exit of the sciatic nerve, not the paravertebral, the neck test is positive, and the lower limb rotation test is more than 90% positive.
3. X-ray film: more than no positive.
4. Tissue hydraulic pressure measurement: The pressure test around the outlet of the sciatic nerve is higher than 50% of the healthy side, which is diagnostic.
5. Others: EMG, nerve conduction velocity and other tests can be performed as appropriate.
Differential diagnosis
1. Lumbar spinal stenosis: There are intermittent claudication, there are many complaints, less signs, limited lumbar extension and tenderness. There is no obvious tenderness at the outlet of the sciatic pelvis.
2. Lumbar disc herniation: There is typical lower extremity radiation pain, but it is a radiculopathy. The symptoms caused by it are different from the symptoms of sciatic nerve pain, and the waist symptoms are more obvious. For individuals who are difficult to identify, they can further do tissue hydraulic pressure. Determination or myelography.
3. Lumbar spinal canal tumor: persistent pain, especially at night, and symptoms and signs corresponding to the compressed nerve root, and often appear early in the onset of bladder rectal symptoms, for individuals difficult to identify, feasible MRI, CT Check, or use a contrast agent with less side effects such as omnipaque, ampicillin or oxygen for myelography.
4. Pelvic disorders: more common in women, pelvic nerves caused by pelvic plexus compression, in addition to sciatic nerve stimulation and symptoms and signs, upper gluteal nerve, femoral nerve, obturator nerve, lateral femoral cutaneous nerve and genital Nerves can also be affected at the same time. Therefore, the symptoms are more extensive and consistent with the distribution of the sacral nerves. It is generally not difficult to distinguish.
5. Others: Should be different from rheumatism, local muscle fibrosis, hip injury, snoring and local tumors, especially tumors, easy to diagnose due to X-ray film, therefore, for suspects, should After cleaning the enema, take a picture to exclude the lesion.
