Syndrome myofascial du muscle piriforme et sciatalgie persistante chez le lombalgique en rééducation
ABSTRACT ContexteLe syndrome myofascial du muscle piriforme est fréquent, en milieu de rééducation, chez le lombalgique chronique. Le diagnostic
de sciatique persistante est souvent évoqué dans ce contexte.
ObjectifsÀ partir d’un cas clinique, mieux définir la symptomatologie clinique et le traitement de la pathologie fonctionnelle du muscle
RésultatsLes infiltrations de corticoïdes sous contrôle tomodensitométrique et une rééducation spécifique permettent une diminution
de la contracture et de la douleur musculaires, autorisant la reprise du programme de réentraînement à l’effort du lombalgique.
DiscussionLa reconnaissance précoce, par le spécialiste de médecine physique, du syndrome myofascial du muscle piriforme peut permettre
d’éviter des investigations lombaires inutiles et une perte de temps péjorative pour le programme de rééducation du lombalgique.
BackgroundMyofascial syndrome affecting the piriformis is quite common in rehabilitation patients with low back pain and may present
as persistent sciatica.
GoalsBased upon a clinical case, define the symptomatology and treatment of myofascial piriformis muscle syndrome.
ResultsComputerized tomography-controlled corticoid injections and specific rehabilitation relieve muscle contracture and pain, allowing
the back pain program to be resumed.
DiscussionThe physiotherapist’s knowledge of myofascial syndrome affecting the piriformis may help early diagnosis and treatment, thus
avoiding unnecessary lumbar investigations.
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ABSTRACT: The piriformis syndrome (PS) is a controversial cause of hip pain because of the lack of objective findings to support the diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging revealed PS in a 27-year-old woman. This case may be one of the first reports in the literature on a piriformis muscle enlargement documented by CT and MR imaging.Clinical Orthopaedics and Related Research 02/1991; DOI:10.1097/00003086-199101000-00029 · 2.88 Impact Factor
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ABSTRACT: Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis syndrome: diagnosis, treatment, and outcome[mdash ]a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of piriformis syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of .881 and .832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD = .2275) to 12.96% poststudy (SD = .1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 [plusmn] 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of piriformis syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat piriformis syndrome. [copy ] 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and RehabilitationArchives of Physical Medicine and Rehabilitation 03/2002; 83(3):295-301. DOI:10.1053/apmr.2002.30622 · 2.44 Impact Factor
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ABSTRACT: Patients with lumbosacral and buttock pain provide tacit support for recognizing the piriformis muscle as a contributing factor to the pain (piriformis syndrome). One hundred and twelve cadaveric specimens were observed to elucidate the anatomical variations of the piriformis muscle referred to the diagnostic and treatment of the piriformis syndrome. The distance between the musculotendinous junction and the insertion was measured and the piriformis categorized into three types: Type A (71, 63.39%): long upper and short lower muscle belly; Type B (40, 35.71%): short upper and long lower muscle belly; Type C (1, 0.9%): fusion of both muscle bellies at the same level. The diameter of the piriformis tendon at the level of the musculotendinous junction ranged from 3 to 9 mm (mean: 6.3 mm). The piriformis showed the following possible fusions with adjacent tendons. In type one (60, 53.57%) a rounded tendon of the piriformis reached the upper border of the greater trochanter. In type two (33, 29.46%) it first joined into the gemellus superior tendon and at last both fused with the obturator internus tendon and inserted into the medial surface of the greater trochanter. A fusion of the piriformis, obturator internus and gluteus medius tendon with the same insertion area as above was observed in type three (15, 13.39%) and finally in type four (4, 3.57%) the tendon fused with the gluteus medius to reach the upper surface of the greater trochanter. Based on this survey anatomical causes for the piriformis syndrome are rare and a more precise workup is necessary to rule out more common diagnosis.Surgical and Radiologic Anatomy 03/2007; 29(1):37-45. DOI:10.1007/s00276-006-0169-x · 1.33 Impact Factor