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Abstract: Objectives: Piriformis Muscle Syndrome (PMS) is caused by sciatic nerve compression in the infrapiriformis canal. However, the pathology is poorly understood and difficult to diagnose. This study aimed to devise a clinical assessment score for PMS diagnosis and to develop a treatment strategy. Material and methods: Two hundred and fifty patients versus 30 control patients with disco-radicular conflict, plus 30 healthy control subjects were enrolled. A range of tests was used to produce a diagnostic score for PMS and an optimum treatment strategy was proposed. Results: A 12-point clinical scoring system was devised and a diagnosis of PMS was considered ‘probable’ when greater or equal to 8. Sensitivity and specificity of the score were 96.4% and 100%, respectively, while the positive predictive value was 100% and negative predictive value was 86.9%. Combined medication and rehabilitation treatments had a cure rate of 51.2%. Hundred and twenty-two patients (48.8%) were unresponsive to treatment and received OnabotulinumtoxinA. Visual Analogue Scale (VAS) results were ‘Very good/Good’ in 77%, ‘Average’ in 7.4% and ‘Poor’ in 15.6%. Fifteen of 19 patients unresponsive to treatment underwent surgery with ‘Very good/Good’ results in 12 cases. Conclusions: The proposed evaluation score may facilitate PMS diagnosis and treatment standardisation. Rehabilitation has a major role associated in half of the cases with botulinum toxin injections. [Copyright &y& Elsevier]

Abstract: Introduction: The piriformis muscle syndrome (PMS) has remained an ill-defined entity. It is a form of entrapment neuropathy involving compression of the sciatic nerve by the piriformis muscle. Bearing this in mind, a medical examination is likely to be suggestive, as a classical range of symptoms corresponds to truncal sciatica with frequently fluctuating pain, initially in the muscles of the buttocks. Pathophysiological hypotheses: The piriformis muscle is biarticular, constituting a bridge in front of and below the sacroiliac joint and behind and above the coxo-femoral joint. It is essentially a lateral rotator but also a hip extensor, and assumes a secondary role as an abductor. Its action is nonetheless conditioned by the position of the homolateral coxo-femoral joint, and it can also function as a hip medial rotator, with the hip being flexed at more than 90°. The main clinical manoeuvres are derived from these types of biomechanical considerations. For instance, as it is close to the hip extensors, the piriformis muscle is tested in medial rotation stretching, in resisted contraction in lateral rotation. On the other hand, when hip flexion surpasses 90°, the piriformis muscle is stretched in lateral rotation, and we have consequently laid emphasis on the manoeuvre we have termed Heel Contra-Lateral Knee (HCLK), which must be prolonged several tens of seconds in order to successfully reproduce the buttocks-centred and frequently associated sciatic symptoms. Conclusion: A PMS diagnosis is exclusively clinical, and the only objective of paraclinical evaluation is to eliminate differential diagnoses. The entity under discussion is real, and we favour the FAIR, HCLK and Freiberg stretching manoeuvres and Beatty's resisted contraction manoeuvre. [Copyright &y& Elsevier]

Introduction/Background Piriformis muscle syndrome is a painful disorder characterized by buttock and hip pain usually due to sciatic nerve compression. Some previous works have studied the efficacy and safety of botulinum toxin in the management of piriformis muscle syndrome. Our objectives are analyze the efficacy of ultrasound-guided injections of incobotulinumtoxinA (Xeomin ® ) in the reduction of pain in piriformis muscle syndrome, and study if there are differences in the efficacy related with the dilution volume. Material and method A retrospective cohort including patients admitted to Rehabilitation Department from January 1st 2015 to June 30th 2016 was analyzed. 58 patients who fulfilled the required criteria were registered. In all the included patients, Visual Analogical Scale (VAS) was measured before performing a ultrasound-guided injection of 100 units of incobotulinumtoxinA in piriformis muscle, and 6 weeks after the injection. All the injections were performed by the same investigator. All the injections were performed using volume dilutions of 50 U/mL ( n = 18), 20 U/mL ( n = 19) or 10 U/mL ( n = 21). Results After performing Kolmogorov–Smirnov test, we checked that the data did not follow a normal distribution so a non-parametric test (Wilcoxon signed-rank test) was used. There was a statistically significant reduction of pain 6 weeks after incobotulinumtoxinA injection (Z W = −6.649, P < 0.01). All dilutions showed statistically significant reduction of pain: (10 U/mL: Z W = −4.027, P < 0.01; 20 U/mL: Z W = −3.837, P < 0.01; 50 U/mL: Z W = −3.753, P < 0.01). Conclusion IncobotulinumtoxinA seems to be a useful therapy in the management of piriformis muscle syndrome. There are no differences in the efficacy related with the volume of dilution. [ABSTRACT FROM AUTHOR]