Scenario 9 Piriformis syndrome Flashcards
describe the piriformis and its actions/attachments?
Flat band like muscle
Proximal attachment-> Ant aspect of sacrum and gluteal surface of ilium
Distal attachment-> Upper border and medial side of GT
Nerve supply-> Sacral plexus L5 S1 and S2
Action-> Lateral rotation of thigh and abduction in sitting
Describe Piriformis syndrome
Uncommon neuromuscular disorder
Caused by piriformis compressing the sciatic nerve
Causes-> can occur due to injury of the piriformis, overuse of the piriormis, injury to lumbar spine
Talk also about Trigger points in piriformis and how this may refer pain down the leg without neural compression- this would be somatic pain not radicular pain.
Please understand radicular pain and somatic pain
Problem List
Pain 6/10 VAS score
Stabbing shooting pain, intermittent->nerve root
Lumbar flexion
Lifting the leg to tie shoe laces (hip flexion)
Hip external rotation
Ax techs?
Nerve conduction testing
Myotomes->resisted testing of all lower limb
Dermatomes-> light touch and pin prick of all dermatomes in lower limb
Reflexes-> test Patella and Achilles tendon reflexes-> compare both sides
Neurodynamics – SLR, Slump
Piriformis muscle tests- all 4
What positions do you use for the SLR
Supine Lying MR hip slightly Passively ext knee & flex the hip R1 or P1 Add DF inv/ev, PF inv, Cx Flex Test sciatic nerve See if it reproduction of his pain
Treatment choice?
Needs to target the muscle or nerve
Therefore muscle stretch, trigger point release, contract relax, hold relax,
How would you stretch piriformis?
Stretch piriformis as this has become tight which is compress the sciatic nerve
Stretch in lying
Lying on your back with both knees bent, gently place the ankle of the side to be stretched upon your opposite knee. Then place the hand of the same side to be stretched on your knee and ask them to push knee away from them.Hold: 20 - 30 secondsReps: 2 - 3Times per Day: 2 - 3
