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Pain Management Strategies and Alternative Therapies
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Myofascial piriformis muscle pain results in pain with possible tingling or numbness in the buttock, in severe cases; the pain and numbness might extend down the leg in the sciatic nerve distribution which is attributed to the anatomic relationship between the muscle and the nerve. Piriformis muscle injection with local anesthetic and corticosteroids with the aid of radiocontrast and X-ray is shown in Figure 6.13.
Hip Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The piriformis muscle is a flat, pyramid-shaped2 muscle located deep to the gluteus maximus in the buttocks near the top of the hip joint. It originates from the anterior aspect of the sacrum at the level of about S2 to S4. It passes laterally to exit the bony pelvis through the greater sciatic foramen and often attaches to the gluteal surface of the ilium, close to the posterior inferior iliac spine.3 It inserts onto the superior and medial aspects of the greater trochanter. The nerves that innervate the muscle are from the anterior rami of S1 and S2 spinal nerves.4 The arterial supply for this muscle is from the inferior gluteal, superior gluteal, and internal pudendal arteries, all branches of the internal iliac artery.5
Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The sacral plexus is a collection of spinal nerves responsible for the innervation of the skin and muscles of the pelvis and leg. It is located anterior to the piriformis muscle on the surface of the posterior pelvic wall.
Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review
Published in Acta Chirurgica Belgica, 2022
Katleen Jottard, Pierre Bonnet, Viviane Thill, Stephane Ploteau, Stefan de Wachter
For the PN several conflicting settings have been described during its passage: under the piriformis muscle, passing between the SSL and sacrotuberous (STL) ligament, entering the pudendal canal and passing the falciform process [7]. The entrapment site in the space between the SSL and STL is the most common, described in about 70% of the cases [8]. A transligamentous course of the PN through the SSL, which can even be calcified, has also been described. It is also at this level that the piriformis muscle can form a fibrous sheet around the nerve. After its passage between this ligamentous claw, the PN enters the pudendal canal. At the posterior border of the Alcock’s canal, the PN passes over the falciform process of the STL, a fibrous sheet with a sharp upper border parallel to the medial side of the ischial bone. Finally, the pudendal vessels, which are often of considerable size and can be tortuous or dilated, can constrict the nerve.
An overlooked nerve in neuropathies associated with intragluteal injections: the posterior femoral cutaneous nerve
Published in Postgraduate Medicine, 2022
Although the anatomic origin of the PFCN, which has the characteristic of being a purely sensory nerve, can include superior or inferior roots, it derives from the anterior and posterior rami of the first three branches of the sacral plexus [5,6]. It passes through the sciatic foramen and follows a course medially adjacent to the sciatic nerve deep in the gluteus maximus muscle under the piriformis muscle, and separates beginning from the lower edge of the gluteus maximus muscle in the pelvis [6]. Although cluneal and perineal branches of the PFCN are shown in traditional anatomical drawings that they originate from a single origin at the level of the tuber ischiadicum, a recent study has shown that the nerve is divided into two main branches, defined as a high division on the tuber ischiadicum, and gives cluneal and perineal branches from these main branches [7]. With these branches, PFCN provides sensory innervation of the posterior surface of the thigh between the posterior lower hip, popliteal fossa, lower buttock, ischial tuberosity, and perineum [7,8].
Physiotherapist management of a patient with spastic perineal syndrome and subsequent constipation: a case report
Published in Physiotherapy Theory and Practice, 2021
Shankar Ganesh, Mritunjay Kumar
The patient had exaggerated thoracic kyphosis and anterior pelvic tilt. The posterior superior iliac spine on the left side was found inferior compared to the right-hand side (Petty and Moore, 2001) (Figure 1). There was an apparent limb shortening of 3 cms on the left lower limb (Magee, 2008). The sacrum was found to have a right-on-right forward torsion with L5 rotated to the left. The lumbar spring test was negative (Magee, 2008). The straight leg raise was found to be limited on the left side (< 30 degrees). Freiberg sign was positive on the left side (Magee, 2008). There was a loss of end range of motion during lumbar forward flexion. The active movements of hips were normal except left hip internal rotation which was limited (30 degrees on the left side compared to 40 degrees on the right; measured using a goniometer in the prone position). Maitland posterior-anterior mobilization to the spine showed reduced intervertebral segmental motions in the lower thoracic (T 10–12) and lumbar region (L1-5). The left piriformis muscle and bilateral hip flexors were tight (Magee, 2008) and palpation of these muscles revealed local tenderness. No other soft tissue impairments were identified.