Piriformis Syndrome and FAIR Test from the View of Magnetic Resonance
Authors:
J. Vacek 1; J. Vymazal 2; K. Mezian 3; Z. Červenková 4
Authors place of work:
Klinika rehabilitačního lékařství FNKV, 3. LF UK, IPVZ Praha
1; Radiologické odd Nemocnice Na Homolce, Praha
2; Rehabilitace MUDr. H. Mezian, Litoměřice
3; Centrum Paraple o. p. s., Praha
4
Published in the journal:
Rehabil. fyz. Lék., 27, 2020, No. 2, pp. 62-68.
Category:
Original Papers
Summary
Musculus piriformis is an important muscle for human biomechanics. It is the most powerful and resistant external rotator of the hip joint as well as a strong abductor. In many locomotive activities including sports it is the subject to reflex long term hyperactivation, and we therefore encounter excessive tonus (hypertonus) and often hypertrophy and shortened muscle. In view of the intimate contact with the narvus ischiadicus the nervous filaments are irritated. It is either due to the pressure of the hypertrophic muscle or the situation when the nerve passes at least partly through the muscle and a traction neuropathy develops. It results to ischialgia which belongs to the low back pain group. Several clinical tests used in practice include the FAIR text (flexion, adduction, internal rotation), which stretches the muscle and in case of increased or provoked ischialgia it is evaluated as positive. In our study we paid attention to the correlation of the FAIR results with MRI finding.
Our cohort included 25 patients with chronic ischialgia, 11 men and 14 women with normal clinical neurological findings. We excluded root lesion S1, discopathy L5/S1, rheumatological or infectious disease and a pathology of the hip joint.
After a clinical examination the patients were examined on the MRI projection to the area of m. piriformis.
In 11 out of the 25 patients examined by NRI we found compression of n. ischiadicus (ischiadic nerve) in foramen infrapiriforme, compression the nerve in passing the muscle in four, no sign of irritation of the nerve in other four patients and other kinds of pathology in six. The results indicated high sensitivity of the GFSAIR test in diagnostics of irritation of n. ischiadicus in the region of foramen infrapiriforme or in passage through the muscle. At the same time the results revealed that without adequate imaging it is impossible to differentiate functional irritation of ischiadic nerve from an irritation by another pathological process. Therefore, from the point of view of correct diagnostics until the recommendation to make it a part of precise diagnostics.
Keywords:
Piriformis syndromE – low back pain – n. ischiadicus – sciatica
Zdroje
1. DEMIREL A., BAYKARA, M,, KOCA, T. T., BERK, E.: Ultrasound elastography findings in piriformis muscle syndrome. Indian J Radiol Imaging. 2018 Oct-Dec;28(4):412-418. doi: 10.4103/ijri.IJRI_133_18.
2. HALLIN, R. P.: Sciatic pain and piriformis muscle. Postgrad Med 1983 ;74:69-72
3. HOPAYIAN, K., DANIELAN, A.: Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features. Eur J Orthop Surg Traumatol. 2018 Feb;28(2):155-164. doi: 10.1007/s00590-017-2031-8. Epub 2017 Aug 23.
4. CHANG, K. V., WU, W. T., MEZIAN, K., NAŇKA, O., ÖZÇAKAR, L.: Anatomic Consideration of Ultrasound Imaging and Guided Injection of the Piriformis Complex. World Neurosurgery; accepted.
5. JANDA, V.: Základy kliniky funkčních neparetických hybných poruch. Učební text. Brno, Ústav pro další vzdělávání středních zdravotnických pracovníků v Brně, 1982.
6. JANDA, V.: Vyšetřování hybnosti. Svalový test, vyšetření zkrácených svalů, vyšetření hypermobility. Praha, Avicenum, 1972.
7. JANKOVIC, D., PENG, P., VAN ZUNDERT, A.: Brief review: piriformis syndrome: etiology, diagnosis, and management. Can J Anaesth. 2013 Oct;60(10):1003-12. doi: 10.1007/s12630-013-0009-5. Epub 2013 Jul 27.
8. LUNG, K., LUI, F.: StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Dec 9, 2018. Anatomy, Abdomen and Pelvis, Superior Gluteal Nerve. [PubMed]
9. MIXTER, W. J., BARR, J. S:. Ruptures of ibntervertebral disc with involvement of the spinal canal. N Engl J Med 1934;211, 210-1
10. NATSIS, K., TOTLIS, T., KONSTANTINIDIS, G. A., PARASKEVAS, G., PIAGKOU, M., KOEBKE, J.: Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 2014 Apr;36(3):273-80. doi: 10.1007/s00276-013-1180-7. Epub 2013
11. PALAMAR, D., AKGÜN, K.: Pelvic injections. In: Özçakar L. et al. Ultrasound imaging & guidance for Musculoskeletal Interventions in Physical and Rehabilitation Medicine 2019. 12. Milan: edi-ermes, s. 247-255. ISBN 9788870516982
12. PECINA, M.: Contributions to the etiological explanaion of the piriformis syndrome. Acta Anat 1979. 105;181-187
13. POKORNÝ, D., JAHODA, D., VEIGL, D., PINSKEROVÁ, V., SOSNA, A.: Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat. 2006 Mar;28(1):88-91. Epub 2005 Nov 26.
14. POKORNÝ, D., SOSNA, A., VEIGL, P., JAHODA, D.: .Anatomická variabilita vztahu pelvitrochanterických svalů a n.ischiadicus Acta Chir Orthop Traumatol Czech. 65(6):336-9. 1998 PMID: 20492810.
15. RIPANI, M., CONTINENZA, M. A., CACCHIO, A., BARILE, A., PARISI, A,. DE PAULIS, F.: The ischiatic region: normal and MRI anatomy. J Sports Med Phys Fitness. 2006 Sep;46(3):468-75. [PubMed].
16. ROBINSON, D. R.: Piriformis syndrome in relation to static pain. Am J Surg1947. 73:355-358.
17. SOLOMON, L. B., LEE, Y. C., CALLARY, S. A., BECK, M., HOWIE, D. W.: Anatomy of piriformis, obturator internus and obturator externus: implications for the posterior surgical approach to the hip.J Bone Joint Surg Br. 2010 Sep;92(9):1317-24. doi: 10.1302/0301-620X.92B9.23893.
18. TAKAO, M., OTAKE, Y., FUKUDA, N., SATO, Y., ARMAND, M., SUGANO, N.: The Posterior Capsular Ligamentous Complex Contributes to Hip Joint Stability in Distraction. J Arthroplasty. 2018 Mar;33(3) s. 919-924. [PubMed].
19. YEOMAN, W.: The relation of arthritis of the sacro-iliac joint to sciatica, with an analysis of 100 cases. Lancet, 1998, s. 1119-1122.
20. ZHANG, W., LUO, F., SUN, H., DING, H.: Ultrasound appears to be a reliable technique for the diagnosis of piriformis syndrome Muscle Nerve. 2019 Apr;59(4), s. 411-416. doi: 10.1002/mus.26418. Epub 2019 Feb 27.
Štítky
Physiotherapist, university degree Rehabilitation Sports medicineČlánok vyšiel v časopise
Rehabilitation and Physical Medicine
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