If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read E-letter]](/icons/misc/sectionDOWN.gif)
The Piriformis syndrome: the real "forgotten concept"
- Dominic Hegarty (10 January 2008)
|
|
|||
|
Dominic Hegarty, SpR Anaesthesia & Pain Medicine Dept. Anaesthesia, Cork University Hospital, Cork, Ireland
Send letter to journal:
|
Dear Editor, Sciatic nerve injury and dysfunction is not an uncommon cause of lower limb symptoms. At least 30% of patients with a clinical diagnosis of lumbar disc herniation fail to show radiological or surgical evidence. Buijs et al.(1) remind us of the potential contribution of the sarcoilica joint in low back pain. The piriformis syndrome, described in the literature since 1947 is reported to be responsible for 6-8% of low back pain associated with sciatica (2). The syndrome is characterized by; (a) a history of local trauma; (b) pain localized to the sacroiliac joint, greater sciatic notch, and piriformis muscle extending along the distribution of the sciatic nerve; (c) pain on stooping or lifting and relieved by traction; (d) a palpable sausage-shaped mass at the anatomicn location of the piriformis muscle; (e) a positive Laseagues’s sign; and (f) gluteal atropy in chronic cases. Not only does pathology of the sacroiliac joint and the piriformis syndrome show similar clinical features, but the presentation of pain in the sacroiliac joint may be secondary to the piriformis syndrome. Buijs et al. makes no reference to the possibility of this condition in their report. The authors highlight the difficulties associated with diagnostic tests in the management of sciatica. However, magnetic resonance neurography, a sensitive technique for detecting peripheral nerve pathology, can identify focal signal abnormalities within the sciatic nerve, in particular as it passes through the piriformis muscle in those who suffer from unexplained sciatica (3,4). Most importantly, injection of the piriformis muscle using ultrasound guidance and motor stimulation has shown to be an accurate and safe technique in the treatment of this syndrome (5). Perhaps, it is the piriformis syndrome that is the “forgotten concept” and it should be investigated before an intra-articular diagnostic procedure is undertaken. Reference. 1. Buijs E, Visser L, Groen G. Sciatica and the sacroiliac joint: a forgotten concept Brit J Anaesthesia 2007; 99(5):713-716. 2. Hallin R. Sciatic pain and the piriformis muscle Postgrad. Med 1983; 74;69-72. 3. Lewis A.M, Layzer R, Engstrom J.W, Barbaro N.M, Chin C.T. Magnetic resonance neurography in extraspinal sciatica Arch Neurol 2006; 63:1469-72 4. Filler AG, Haynes J. Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment J Neurosurg Spine 2005; 2:99-115 5.Huerto A.P.S, Yeo, S.N, Ho, K.Y. Piriformis muecle injection using ultrasonography and motor stimulation – report of a technique. Pain Physician 2007; 10:687-690. Conflict of Interest:None declared |
|||