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Context: Piriformis syndrome is often associated with muscle spasms and shortening of the piriformis muscle (PM). Physical therapy, including static stretching of the PM, is one of the treatments for this syndrome. However, the effective stretching position ofthe PM is unclear in vivo. This study aimed to determine the effective stretching positions of the PM using ultrasonic shear wave elastography. Design: Observational study. Methods: Twenty-one healthy young men (22.7 [2.41 y) participated in this study. The shear elastic modulus of the PM was measured at 12 stretching positions using shear wave elastography. Three of the 12 positions were tested with maximum internal rotation at 0°, 20°, or 40° hip adduction in 90° hip flexion. Nine of the 12 positions were tested with maximum external rotation at positions combined with 3 hip-flexion angles (70°, 90°, and 110°) and 3 hip-adduction angles (0°, 20°, and 40°). Results.' The shear elastic modulus of the PM was significantly higher in the order of 40°, 20°, and 0° of adduction and higher in external rotation than in internal rotation. The shear elastic modulus of the PM was significantly greater in combined 110° hip flexion and 40° adduction with maximum external rotation than in all other positions. Conclusion.- This study revealed that the position in which the PM was most stretched was maximum external rotation with 110° hip ftexion and 40° hip adduction. [ABSTRACT FROM AUTHOR]

Objectives: The dry needling of the piriformis muscle (especially in the medial region) is a challenging procedure since there is a high risk of accidentally puncturing the sciatic nerve. This study aimed to explain the variance of the deep limit of the piriformis based on anthropometric and demographic predictors potentially associated with it by exploring if clinicians can select the optimal needle length needed accurately to avoid accidental punctures of the sciatic nerve during palpation-guided dry needling interventions. Methods: An observational study was conducted that included fifty-six patients with piriformis muscle syndrome. We recorded the skin-to-sciatic nerve distance at the location with greatest risk of accidental sciatic puncture (assessed with ultrasound imaging) and demographic (e.g., age, gender, height, weight and body mass index—BMI) and anthropometric (hip circumference) variables. Results: Thirty-four males (n = 34) and twenty-two females (n = 22) were analyzed. Although men presented a significantly greater hip circumference than women (p = 0.007), no skin-to-sciatic nerve distance differences were observed (p > 0.05). Correlation analyses revealed that the sciatic nerve's depth is associated with weight, BMI and hip perimeter (all, p < 0.01) but not with age or height (p > 0.05). Due to shared variance and multicollinearity, the hip circumference was the only predictor included in the regression model, explaining 37.9% of the piriformis muscle's deeper fascia depth variance (R2 Adjusted = 0.379). Conclusions: Although the use of landmarks and measuring the hip perimeter may result in greater dry needling accuracy and a lower risk of adverse events derived from accidental sciatic nerve puncture, ultrasound guidance is encouraged as is the safest method for avoiding serious adverse events. [ABSTRACT FROM AUTHOR]

Piriformis syndrome (PS) is a neuromuscular condition caused by the entrapment of the sciatic nerve at the level of the piriformis muscle (PM) and can cause significant discomfort and disability.PS is often misdiagnosed due to its overlapping symptoms with other lumbar and sciatic issues, and, as such, diagnosing PS remains challenging despite recent invasive and non-invasive diagnostic methods. Diagnostic musculoskeletal ultrasound (MSK US) offers a non-invasive, cost-effective alternative for the identification and evaluation of PS, providing dynamic, realtime imaging of the PM and adjacent structures. This article reviews the applications, advantages, and procedural insights of MSK US in the diagnosis of PS, emphasizing its relevance in rehabilitation settings. We discuss the technical aspects of ultrasound use, interpretation of findings, and integration into clinical practice, aiming to enhance the diagnostic accuracy and therapeutic outcomes for patients with suspected PS. [ABSTRACT FROM AUTHOR]

Background: The traditional approach for diagnosing piriformis syndrome (PS) is to rule out other causes of sciatica. This approach may lead to unnecessary radiological examinations and a waste of time. In contrast to the traditional approach, we aimed to first exclude PS and determine its prevalence by injecting patients with priformis tenderness. Methods: This observational cross-sectional study included patients diagnosed with PS who had sciatica and tenderness on palpation of the priformis muscle and whose pain was reduced by at least 50% with local injection. Age, sex, pain duration, presence of tenderness in the piriformis muscle, Freiberg test, PACE sign, FADIR, Visual Analog Scale (VAS) score, Douleur Neuropathique 4 Questions (DN4) score, and radiological findings were compared between patients who responded and those who did not respond to the priformis injection. Results: A total of 110 patients with sciatica were evaluated, of whom 66 with tenderness on palpation of the primiformis muscle underwent local injection. In 27 of the 66 patients (40.9%), a decrease in the NRS score of >50% was observed after injection, and PS was diagnosed. There were no statistically significant differences in age, sex, pain duration, Pace, FADIR test positivity, radiological findings, NRS, and DN4 scores, but Freiberg test positivity was statistically higher in patients diagnosed with PS. Conclusion: PS is more common than is thought to be a cause of sciatica. A positive Freiberg test is predictive for the diagnosis of PS, but it should be confirmed by tenderness of the priformis muscle and local injection. Many pathologies can be detected incidentally radiographically in PS; however, they are not predictive of the diagnosis. [ABSTRACT FROM AUTHOR]

Background: The aim of the study is to create several classifications of the piriformis muscle (PM): proximal and distal attachments, potential fusions, and the relationship with the sciatic nerve. It is the first comprehensive anatomical examination of this subject. Materials and methods: One hundred and twenty-four lower limbs from 62 cadavers, fixed in 10% formalin, were examined. Results: The piriformis muscle was present in 120 limbs (96.8% of cases). Four types of proximal attachment were described (I-IV). The most common type was Type I, in which the proximal attachment was at the anterior surface of the sacrum, between S2 and S4 (52 lower limbs; 43.3%). The rarest type was Type IV, in which the proximal attachment was at the gluteal surface of the ilium near the margin of the greater sciatic notch and from the gluteus medius (12 cases; 10%). Three types of distal attachment were distinguished. The most common was Type 1, a single tendon. This type comprised 2 subtypes: A and B (105 lower limbs; 87.5%). The other 2 types accounted for 12.5% of the total. Fusions were noted between the piriformis muscle and adjacent muscles in 31.7% of cases. Four patterns were observed in which the sciatic nerve ran against the piriformis muscle. The most common variation in the relationship was the common fibular nerve exiting superior to the piriformis muscle and the tibial nerve passing inferior to it (10 cases; 8.3%). Conclusions: The piriformis muscle is highly morphologically variable in both its proximal and distal attachments and its relationship with the sciatic nerve. There are 4 types of proximal attachment and 3 types of distal attachment. The piriformis muscle shows numerous fusions with its adjacent muscles: gluteus medius or minimus or superior gemellus. A new (fourth) type of relationship was demonstrated between the piriformis muscle and sciatic nerve. The piriformis muscle was absent in 4 cases. [ABSTRACT FROM AUTHOR]

Background: The muscles present in the pelvic girdle compartment demonstrate clinically significant anatomical variation regarding both their site of attachment and additions, such as accessory heads, muscles, or tendinous slips. Many of those variations might be considered potential traps during ultrasound examination, which may result in misdiagnosis. The aim of this study was to raise awareness of such a possibility. Materials and methods: A comprehensive search for morphological variations was performed in PubMed and NIH. Relevant papers were listed, and citation tracking was accomplished. Results: Although several anatomical variations of pelvic girdle muscles have been presented, few studies have examined their relevance in ultrasound imaging. Conclusions: The morphological variability of the pelvic girdle muscles does not vary from such incidence in other regions of the human body; however, further ultrasound studies are needed of the numerous morphological variants that can be found in this region. [ABSTRACT FROM AUTHOR]

Variations of the sciatic nerve and piriformis muscle (SN-PM) relationship must be considered when discussing orthopedic procedures within the region as they may cause increased risk of SN injuries. Thirty-one formalin-embalmed, prosected donors were evaluated using the Beaton and Anson (B&A) classification system (1939). Major landmarks of the SN-PM relationship were identified, including the posterior superior iliac spine (PSIS), ischial tuberosity (IT), greater trochanter (GT), and the middle of the SN as it exits under the PM (S1). Distances measured included: PSIS-IT, PSIS-GT, IT-GT, PSIS-S1, IT-S1, GT-S1, S1-Q (distance of perpendicular line connecting S1 to PSIS-IT), and S1-R (distance of perpendicular line connecting S1 to PSIS-GT). Measurements from 49 lower extremities were evaluated using a two-tailed t-test to compare by sex and laterality; a one-tailed t-test was utilized to compare groups based on anatomical sex. Six donors displayed asymmetric B&A classifications, demonstrating gross anatomical differences within a single individual; however, no measurements were significant when comparing extremities. Seven measurements were statistically significant (p < 0.05) between sexes, indicating notable sex-based differences. These data highlight sex-based differences in the SN-PM relationship, as well as consistencies within measurements among extremities, which can be utilized by clinicians when treating male and female patients needing unilateral or bilateral orthopedic procedures or injections within the gluteal region.

This study assessed the feasibility of using three-dimensional (3D) models of intrapelvic vascular patterns constructed using computed tomography (CT) and magnetic resonance imaging (MRI) fusion data for preoperative planning in patients with locally recurrent rectal cancer. Eleven patients scheduled for pelvic exenteration were included. The 3D fusion data of the intrapelvic vessels constructed using CT and MRI with true fast imaging with steady-state precession sequence (True FISP) were evaluated preoperatively. Contrast ratios (CR) between the piriformis muscle and the intrapelvic vessels were calculated to identify a valid modality for 3D modeling and creating CT/MRI fusion-reconstructed volume-rendered images. The CR values of the internal and external iliac arteries were significantly higher on CT images than MR images (CT vs. MRI; 0.63 vs. 0.45, p < 0.01). However, the CR value of the internal iliac vein was significantly higher on MR than CT images (CT vs. MRI; 0.23 vs. 0.55, p < 0.01). MRI with True FISP yielded high signal-to-noise ratios and aided in delineating the internal iliac vein around the piriformis muscle. More precise 3D models can be constructed using this technique in the future to aid in the resection of locally recurrent rectal cancer. [Display omitted] • MRI with True FISP is superior to what internal iliac vein delineation. • MRI with True FISP yielded high contrast ratios between internal iliac vein and piriformis muscle. • CT/MRI fusion is suitable for preoperative planning for locally recurrent rectal cancer. [ABSTRACT FROM AUTHOR]

The article discusses the challenges faced by physical medicine and rehabilitation (PM&R) residents in accurately palpating lumbopelvic structures. The study aimed to determine deficiencies in palpation skills among residents and whether senior residents had higher accuracy compared to junior residents. Results showed wide variation in palpation accuracy, with some structures being more accurately identified than others. The study suggests that ultrasound can be a valuable tool in improving palpation skills and identifying areas for improvement in clinical practice. [Extracted from the article]

Variations of the sciatic nerve and piriformis muscle (SN-PM) relationship must be considered when discussing orthopedic procedures within the region as they may cause increased risk of SN injuries. Thirty-one formalin-embalmed, prosected donors were evaluated using the Beaton and Anson (B&A) classification system (1939). Major landmarks of the SN-PM relationship were identified, including the posterior superior iliac spine (PSIS), ischial tuberosity (IT), greater trochanter (GT), and the middle of the SN as it exits under the PM (S1). Distances measured included: PSIS-IT, PSIS-GT, IT-GT, PSIS-S1, IT-S1, GT-S1, S1-Q (distance of perpendicular line connecting S1 to PSIS-IT), and S1-R (distance of perpendicular line connecting S1 to PSIS-GT). Measurements from 49 lower extremities were evaluated using a two-tailed t-test to compare by sex and laterality; a one-tailed t-test was utilized to compare groups based on anatomical sex. Six donors displayed asymmetric B&A classifications, demonstrating gross anatomical differences within a single individual; however, no measurements were significant when comparing extremities. Seven measurements were statistically significant (p < 0.05) between sexes, indicating notable sex-based differences. These data highlight sex-based differences in the SN-PM relationship, as well as consistencies within measurements among extremities, which can be utilized by clinicians when treating male and female patients needing unilateral or bilateral orthopedic procedures or injections within the gluteal region. [ABSTRACT FROM AUTHOR]

A persistent sciatic artery (PSA) is a rare congenital vascular anomaly with an extremely low incidence of about 0.04%–0.06%. It is due to the persistence of the embryological axial limb artery, representing a continuation of the internal iliac artery into the thigh through the greater sciatic foramen below the piriformis muscle and down the thigh alongside the sciatic nerve. In normal embryologic development of the lower limb, the axial artery normally regresses after week 12. Persistent sciatic artery is often asymptomatic until a complication develops, it can be classified into two types, complete and incomplete. PSA can cause serious lower limb complications such as acute or critical limb ischemia. [ABSTRACT FROM AUTHOR]

The mesial piriform region plays a central role in olfaction. Its small size and complex geometry, however, make it a difficult target in functional neuroimaging studies, while histological maps often represent schematic drawings, which are not compatible with requirements for modern imaging. To bridge this gap, cytoarchitectonic analysis and mapping of the region was performed in serial histological sections over their full extent in 10 postmortem brains. The temporobasal areas PirTBd and PirTBv and temporal areas PirTu and PirTit were identified and analyzed. Probabilistic cytoarchitectonic maps of the piriform areas in MNI reference space and high-resolution maps of the amygdala-piriform region on the BigBrain model were calculated as part of the Julich-Brain. Differences in the cytoarchitectonic "texture" of the region were quantified based on the Gray Level Co-Occurrence Matrix. Results showed that allocortical areas were not consistently associated with the rostral Limen insulae, although it was often suggested as a landmark in neuroimaging protocols. PirTu was associated with the uncal tip. PirTit was the largest area, reaching to the temporal pole, with a "temporal" (caudal) and a "temporopolar" (rostral) part having complex neighborhood relationships. The probabilistic maps reflect interindividual variability; they are openly available via the digital EBRAINS platform to serve as an anatomical reference for studies related to olfaction. [ABSTRACT FROM AUTHOR]

Background: The deep learning (DL)-based reconstruction algorithm reduces noise in magnetic resonance imaging (MRI), thereby enabling faster MRI acquisition. Purpose: To compare the image quality and diagnostic performance of conventional turbo spin-echo (TSE) T2-weighted (T2W) imaging with DL-accelerated sagittal T2W imaging in the female pelvic cavity. Methods: This study evaluated 149 consecutive female pelvic MRI examinations, including conventional T2W imaging with TSE (acquisition time = 2:59) and DL-accelerated T2W imaging with breath hold (DL-BH) (1:05 [0:14 × 3 breath-holds]) in the sagittal plane. In 294 randomly ordered sagittal T2W images, two radiologists independently assessed image quality (sharpness, subjective noise, artifacts, and overall image quality), made a diagnosis for uterine leiomyomas, and scored diagnostic confidence. For the uterus and piriformis muscle, quantitative imaging analysis was also performed. Wilcoxon signed rank tests were used to compare the two sets of T2W images. Results: In the qualitative analysis, DL-BH showed similar or significantly higher scores for all features than conventional T2W imaging (P <0.05). In the quantitative analysis, the noise in the uterus was lower in DL-BH, but the noise in the muscle was lower in conventional T2W imaging. In the uterus and muscle, the signal-to-noise ratio was significantly lower in DL-BH than in conventional T2W imaging (P <0.001). The diagnostic performance of the two sets of T2W images was not different for uterine leiomyoma. Conclusions: DL-accelerated sagittal T2W imaging obtained with three breath-holds demonstrated superior or comparable image quality to conventional T2W imaging with no significant difference in diagnostic performance for uterine leiomyomas. [ABSTRACT FROM AUTHOR]

Purpose: The choice of entry point, Greater trochanter (GT), or Piriformis entry (PE) for antegrade intramedullary nailing (IMN) of the femur is crucial. This study was performed to compare these two entry points in the patients with shaft of femur fractures regarding intra-operative parameters, radiological and functional outcomes. Materials and Methods: Twenty-four patients underwent GT entry nailing, while 25 patients underwent PE nailing. Surgical time, Intra-operative blood units transfused, Intra-operative fluoroscopy exposure by number of C-arm shots taken, mean drop in hemoglobin, and incidence of iatrogenic fracture were recorded. Patients were followed up at 4 weeks, 6 weeks, and 6 months to look for radiological healing and improvements in functional outcome using Modified Harris Hip Score (MHHS). MRI of bilateral hips with pelvis was done in 25 patients at 6 months of follow-up to detect any preliminary signs of AVN. Results: The mean drop in hemoglobin in the GT group was significantly lesser than the PE group (p = 0.02). Mean MHHS at 4 weeks post-op was also significantly higher in the GT group (p = 0.01). There was no significant difference between both the groups regarding surgical duration, fluoroscopy exposure, radiological and functional outcomes in the long term. None of the patients who underwent MRI displayed any preliminary sign of AVN. Conclusion: GT entry nails lead to lesser surgical time, fluoroscopy exposure, and intra-operative blood loss. Both the nailing systems achieve excellent fracture unions and comparable functional outcomes in the long term, and there is a minuscule risk of AVN in adult patients undergoing IMN. [ABSTRACT FROM AUTHOR]

Abstract Background Piriformis muscle mass is rare, which is particular for intrapiriformis lipoma. Thus far, only 11 cases of piriformis muscle mass have been reported in the English literature. Herein, we encountered one patient with intrapiriformis lipoma who was initially misdiagnosed. Case presentation The patient is a 50-year-old Chinese man. He complained of osphyalgia, right buttock pain, and radiating pain from the right buttock to the back of the right leg. Both ultrasound and magnetic resonance imaging demonstrated a cyst-like mass in the right piriformis muscle. Ultrasonography-guided aspiration was performed on this patient first, but failed. He was then recommended to undergo mass resection and neurolysis of sciatic nerve. Surprisingly, final histology revealed the diagnosis of intrapiriformis lipoma. The patient exhibited significant relief of symptoms 3 days post-surgery. Conclusion Diagnosis and differential diagnosis of radicular pain are potentially challenging but necessary. Atypical lipoma is prone to be misdiagnosed, especially in rare sites. It is notable for clinicians to be aware of the presence of intrapiriformis lipoma to avoid misdiagnosis and inappropriate treatment.

Background: Piriformis muscle mass is rare, which is particular for intrapiriformis lipoma. Thus far, only 11 cases of piriformis muscle mass have been reported in the English literature. Herein, we encountered one patient with intrapiriformis lipoma who was initially misdiagnosed. Case presentation: The patient is a 50-year-old Chinese man. He complained of osphyalgia, right buttock pain, and radiating pain from the right buttock to the back of the right leg. Both ultrasound and magnetic resonance imaging demonstrated a cyst-like mass in the right piriformis muscle. Ultrasonography-guided aspiration was performed on this patient first, but failed. He was then recommended to undergo mass resection and neurolysis of sciatic nerve. Surprisingly, final histology revealed the diagnosis of intrapiriformis lipoma. The patient exhibited significant relief of symptoms 3 days post-surgery. Conclusion: Diagnosis and differential diagnosis of radicular pain are potentially challenging but necessary. Atypical lipoma is prone to be misdiagnosed, especially in rare sites. It is notable for clinicians to be aware of the presence of intrapiriformis lipoma to avoid misdiagnosis and inappropriate treatment. [ABSTRACT FROM AUTHOR]

Deep gluteal syndrome is a clinical condition in which discomfort may arise due to the pathoanatomy of the subgluteal space. We conducted an anatomical exploration to categorize the relationship of the piriformis muscle, sciatic nerve (SN), and pudendal nerve (PN) to the ischial spine (IS) and sacrospinous ligament. We analyzed 22 cadavers. The piriformis muscle, SN, and PN were exposed through either a transgluteal approach or a gluteal flap. The relationship of the neural structures to the IS, sacrospinous ligament, and ischial bone as they exit the greater sciatic foramen was observed, and the exit zones were classified as zone A, medial to the IS (entirely on sacrospinous ligament); zone B, on the IS; and zone C, lateral to the IS (entirely on ischial bone). The SN was observed either in zone B or zone C in all specimens. The PN was found to be in either zone A or zone B in 97.6% of specimens. The most common combinations were SN in zone B and PN in zone A (type I), and SN in zone C and PN in zone B (type II). The results from this study show clear anatomical differences in the SN-PN relationship, which may play a role in pain seen in deep gluteal syndrome. Moreover, classification of the SN-IS and PN-IS relationships described in this article will help describe different pathologies affecting the deep gluteal area. [ABSTRACT FROM AUTHOR]

Objective: The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed. Methods: The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome. Results: At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test). Conclusion: Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch. [ABSTRACT FROM AUTHOR]

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64–93%), showing involvement of 34–60% for the low back and 15–25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems. Methods: Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization. Results: Over 60 Yogāsana—specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction—are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders. Conclusions: A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body. [ABSTRACT FROM AUTHOR]

The innervation of the pelvic wall muscles is not very clear. This study aimed to reveal the division of neuromuscular compartments and localize the surface position and depth of the center of the intramuscular nerve-dense region (CINDR) of the pelvic wall muscles based on Sihler's staining. Twenty-four adult cadavers were used. To localize the CINDR of the pelvic wall muscles, horizontal (H) and longitudinal (L) reference lines were drawn, and Sihler's staining was used to reveal the intramuscular nerve distribution. The CINDR projection points (P and P′ points) behind and in front of the body surface, the positions of the P points projected onto the H and L lines (PH and PL points), and the depth of CINDR were determined by spiral computed tomography scanning. The piriformis and obturator internus muscles can be divided into two and three neuromuscular compartments, respectively. The PH of CINDR of the piriformis muscle was located at 22.61 ± 2.66% of the H line, the PL was at 28.53 ± 6.08% of the L line, and the puncture depth of the piriformis muscle was at 24.64 ± 2.16% of the PP′ line. The PH of CINDR of the obturator internus muscle was at 16.49 ± 1.20% of the H line, the PL was at 10.94 ± 1.09% of its L line, and the puncture depth was 6.26 ± 0.38 cm. These findings may guide the design of the compartmentalized transplantation of the pelvic wall muscles and improve the target localization efficiency and efficacy for injecting botulinum toxin A to treat pelvic wall muscle spasm. [ABSTRACT FROM AUTHOR]

Purpose: In this article, we report a case of an atypical inferior gluteal artery that passed through the piriformis muscle when it emerged from the pelvic cavity in an elderly Japanese female cadaver. We speculate that this atypical artery could be entrapped and compressed by the piriformis muscle and may therefore be associated with piriformis syndrome; however, the anatomical characteristics of such an atypical artery have not been previously reported. To assess this potential association, the atypical inferior gluteal artery was anatomically examined. Methods: The cadaver examined in this report was a 97-year-old Japanese female who was donated to The Nippon Dental University for use in medical education and research. The atypical inferior gluteal artery and surrounding structures in half of the pelvis were examined macroscopically. Results: The atypical inferior gluteal artery arose from the common arterial trunk, formed by itself and the superior gluteal artery, passed through the superior proximal part of the piriformis muscle, and left the pelvic cavity. It supplies branches to the lower half of the gluteus maximus and proximal part of the long head of the biceps femoris muscle. The piriformis muscle originates from the 2nd to 4th sacral vertebrae and attaches to the greater trochanter via a single short tendon. Conclusion: According to our findings, when the atypical inferior gluteal artery is entrapped and compressed, ischemic signs and symptoms may emerge in the lower buttocks and proximal posterior thigh. These results provide a new perspective for the diagnosis and treatment of piriformis syndrome. [ABSTRACT FROM AUTHOR]

Narrative: DeJarnette was a researcher, author, teacher and developer of the SOT systems method of Chiropractic. DeJarnette stated in his 1967 book Philosophy, Science and Art of SOT that: 'Man is a segmental unit of a great many diversified structures and chemical elements, blended into one cooperative functional unit by the nervous system. This total segmental being is made to function through his muscular system's response to stimuli. The framework is held together by ligaments, and all revolve around the central spinal column. Let this central column fail in any respect and the total is out of harmony and balance Here I describe the pain and spinal patterns that clinically indicate an SOT Category Three and offer treatment approaches which I have found effective in practice to deliver predictable outcomes. [ABSTRACT FROM AUTHOR]

Anatomical variations related to the sciatic nerve and its surrounding structures are well-documented, relevant for certain medical procedures, and identified as contributors to pathological conditions. Variations of the sciatic nerve are often classified by its relative position to the piriformis muscle. However, there are inconsistencies in the description and depiction of these variations, along with instances of atypical variations that do not fall within any specific classification. This case report describes an anatomic abnormality found during a routine cadaver dissection involving the bilateral presence of a double piriformis, absence of sciatic nerve formation (tibial and common fibular nerves never within a shared sheath) and an atypical course of the inferior gluteal vessels perforating the right tibial nerve.

Background: The sciatic nerve is the largest nerve in the human body, formed by the union of five nerve roots (L4-S3) arising from the lumbosacral. The present study was conducted to assess variations of the sciatic nerve. Materials & Methods: The present cross-sectional study was carried out on 80 lower extremities from 40 formalin fixed cadavers were examined during routine dissection. Anatomical variations were classified based on the Beaton and Anson classification system as Type-1: undivided nerve below undivided muscle b) Type-2: divisions of nerve between and below undivided muscle c) Type-3: divisions above and below undivided muscle d) Type-4: undivided nerve between heads e) Type-5: divisions between and above heads f) Type-6: undivided nerve above undivided muscle. Results: Type 1 was found in 65 out of 80 (81.25%) lower limbs and is the most common variation in the adult cadaveric studies examined, followed by type 2 in 8, type 3 in 3, type 4 in 2, and type 5 in 2, respectively, as defined by the present study. The difference was significant (P< 0.05). Conclusion: Clinical significance stems from the sciatic nerve's location, bifurcation, and distribution. Because the sciatic nerve is frequently used in routine medical procedures like anaesthesia, rehabilitation, orthopaedics, and neurology, its lengthy course renders it susceptible to damage. [ABSTRACT FROM AUTHOR]

Background: Hyperuricemia can lead to synovial hyperplasia in the wrist. In severe cases, it can lead to the deposition of gouty stone in the carpal tunnel, resulting in increased pressure in the carpal tunnel and compression of the median nerve to cause carpal tunnel syndrome (CTS), which is called gouty carpal tunnel syndrome (GCTS). As for the surgical treatment of gouty carpal tunnel syndrome, scholars have different opinions on whether it is necessary to remove the superficial flexor tendon. The purpose of this study was to compare the clinical efficacy of trimming and resection of the diseased superficial flexor tendon in the treatment of gouty carpal tunnel syndrome. Methods: Clinical data were collected from May 2016 to July 2021 from 10 patients (13 affected wrists) diagnosed with gouty carpal tunnel syndrome and classified into two groups according to the surgical modality: the diseased portion of the gout-eroded superficial finger tendon was trimmed in 9 wrists, and the diseased superficial finger flexor tendon was excised in 4 wrists. Values related to flexion and extension functions, 2-PD, DASH, BCTQ, VAS and recurrence in the affected fingers were compared between the two groups as well as before and after surgery in each group. Results: All affected limbs used were cleared of gouty stones, finger numbness improved, no skin necrosis occurred, and all incisions healed at stage I. At follow-up (13.58 ± 5.53 months), there was no significant difference between groups in flexion and extension function, 2-PD, DASH, BCTQ, and VAS with respect to the affected fingers, and patients in both groups improved significantly before and after surgery. Treatment of only one wrist involved trimming to remove lesion-affected portions of tendon, which reappeared 1 year after surgery, and there was one case of poor recovery from greater piriformis muscle atrophy in both procedures. Conclusion: Regarding surgical treatment of patients with gouty carpal tunnel syndrome in which the gouty stone has invaded the superficial flexor tendons of the fingers, the diseased superficial flexor tendons can be selectively excised, and the postoperative mobility of the affected fingers may not be impaired. [ABSTRACT FROM AUTHOR]

Background/Aims: Piriformis syndrome is a condition caused by compression of the sciatic nerve, causing pain, tingling and numbness. Although conservative treatment includes hip muscle strengthening and stretching, there is no proven treatment method in the literature. This study was conducted to investigate the effect of stretching and myofascial releasing methods added to traditional physiotherapy in piriformis syndrome. Methods: This prospective, randomised controlled study was completed with 63 individuals between the ages of 20 and 40 years. Participants were randomised into three groups: piriformis muscle stretch group (n=22), self-myofascial release group (n=21) and control group (n=20). All participants were enrolled in a 4-week muscle strengthening home exercise programme. In addition, the two intervention groups performed stretching and self-myofascial relaxation exercises respectively. The primary outcome was pain intensity and the secondary outcome was the range of motion of the hip. Results: After 4 weeks of exercises, the level of pain intensity felt in the hip decreased significantly and hip joint range of motion increased significantly in all three groups (P<0.05). In the intergroup analysis, self-myofascial release was found to be more effective in reducing the pain level (F3=3.595, P=0.034). The increase in hip adduction and extension joint range of motion was found to be higher in the control group (F3=4.931, P=0.011 and F3=6.432, P=0.003 respectively). Conclusions: Stretching and myofascial releasing methods applied in addition to conventional exercises might improve pain intensity and range of motion as alternative methods for treating piriformis syndrome. [ABSTRACT FROM AUTHOR]

The piriformis muscle (PM) is found in the gluteal region, exiting the pelvis through the greater sciatic foramen and dividing it into the suprapiriform and infrapiriform foramina. The piriformis works as part of the hip external rotator muscle group, and is responsible for rotation of the femur upon hip extension and abduction of the femur during flexion of the hip joint. The aim of the present report is to describe a very rare case of the primary three-headed PM. To the best knowledge of the authors, the said variant has not yet been described in the existing literature. The 71-year-old male formalin-fixed cadaver was subjected to routine dissection. After careful removal of the connecting tissue, three separate, primary heads of the PM were identified. The lower head of the PM arose from the middle part of the sacral bone; 87.56 mm long and 9.73 mm wide. The medial head was attached to the internal part of the posterior inferior iliac spine; 121.6 mm long and 20.97 mm wide. The upper head was attached to the external part of the posterior inferior iliac spine; 78.89 mm long and 23.94 mm wide. All heads converged into a common tendon which inserted onto the greater trochanter. The clinical importance of this work comes down to the fact that the aberrant PM may be the reason behind the piriformis syndrome and its associated symptoms. Moreover, knowledge regarding the variant anatomy of the PM is of immense importance to, e.g. anaesthesiologists performing computed tomography- or ultrasound-guided sciatic nerve injection for local anaesthesia, radiologists interpreting imaging studies, and surgeons, especially during posterior approaches to the hip and pelvis. [ABSTRACT FROM AUTHOR]

Anatomical variations of the sciatic nerve were supposed as potential causes for incomplete blocks at the level of the popliteal fossa. Therefore, we aimed to conduct an anatomical and ultrasound survey of the mid-femoral sciatic nerve and its division. A regional block of the sciatic nerve is a procedure for analgesia and anaesthesia of the lower extremity. Various approaches to the sciatic nerve are used in clinical practice. However, the sciatic nerve demonstrates several variations regarding its topography and division. The anatomical study included twenty lower limbs of ten adult cadavers. The ultrasound study involved ten upper legs of five healthy volunteers The sciatic nerve was found distally to the piriformis muscle in all our cadaveric specimens. It was divided into two major branches (common peroneal nerve and tibial nerve) at a mean distance of 68.1 ± 19.3 mm above the popliteal crease. The observed distances ranged widely from 35 to 113 mm. The mid-femoral sciatic nerve and its division were entirely revealed using ultrasound in all volunteers. The sciatic nerve presents significant anatomical variations, which may cause an incomplete block. Understanding ultrasound anatomy and ultrasound appearance of the sciatic nerve is essential for performing ultrasound-guided sciatic blocks. [ABSTRACT FROM AUTHOR]

The pain pathomechanism of chronic low back pain (LBP) is complex and the available diagnostic methods are insufficient. Patients present morphological changes in volume and cross-sectional area (CSA) of lumbosacral region. The main objective of this study was to assess if CSA measurements of pelvic muscle will indicate muscle atrophy between asymptomatic and symptomatic sides in chronic LBP patients, as well as between right and left sides in healthy volunteers. In addition, inter-rater reliability for CSA measurements was examined. The study involved 71 chronic LBP patients and 29 healthy volunteers. The CSA of gluteus maximus, medius, minimus and piriformis were measured using the MRI manual segmentation method. Muscle atrophy was confirmed in gluteus maximus, gluteus minimus and piriformis muscle for over 50% of chronic LBP patients (p < 0.05). Gluteus medius showed atrophy in patients with left side pain occurrence (p < 0.001). Muscle atrophy occurred on the symptomatic side for all inspected muscles, except gluteus maximus in rater one assessment. The reliability of CSA measurements between raters calculated using CCC and ICC presented great inter-rater reproducibility for each muscle both in patients and healthy volunteers (p < 0.95). Therefore, there is the possibility of using CSA assessment in the diagnosis of patients with symptoms of chronic LBP. [ABSTRACT FROM AUTHOR]

Aims: To investigate the musculoskeletal morphomechanical properties (i.e., the thickness and elastic modulus) and the total count of power Doppler signals near the sacroiliac joints in patients with ankylosing spondylitis (AS) and non-AS individuals. Material and methods: Twenty participants with AS [median age (interquartile range): 31.7 (11.04) years] and 19 controls [36.3 (10.5) years] with no AS history were recruited. Bilateral ultrasound image acquisition was performed, including the short posterior sacroiliac ligament, interosseous sacroiliac ligament, long posterior sacroiliac ligament, iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament. The intraclass correlation coefficients (ICC) of ultrasound parameters, laboratory test results of human leukocyte antigen B27, C-reactive protein, and erythrocyte sedimentation rate, and self-reported physical and disease activity scores were also obtained. Results: The ligaments and piriformis muscle were thicker and stiffer (greater elastic modulus) in participants with AS than in non-AS participants (all p<0.01). The measurements showed good or excellent reliability (all ICC(3,1)>0.85). The numbers of power Doppler signals detected in the iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament were higher in participants with AS than in non-AS participants (all p<0.001). A correlation was identified between disease duration and the elastic modulus of the piriformis muscle (r=0.640, p=0.003). Conclusion: We conclude that the ligaments and proximal piriformis muscle of AS participants have increased thickness, elastic modulus, and power Doppler signal than those of non-AS individuals. These reliable findings may serve as potential markers for the early diagnosis of AS and for assessing medication effects. [ABSTRACT FROM AUTHOR]

Background: Pain in the hip and buttock areas is the hallmark of piriformis syndrome (PS), a neuromuscular disorder that can radiate to the lower back and thigh. The condition can be brought on by several abnormalities, such as anatomical variations in the piriformis muscle that compress the sciatic nerve or shortening, spasm, hypertrophy, or inflammation of the muscle. There is a 5% to 36% incidence rate of PS in those with low back pain. This study aims to explore the impact of ELDOA (Elongation Longitudinaux avec Decoaptation Osteo-Articulaire) and the Nerve Flossing Technique on alleviating pain and enhancing flexibility in individuals with piriformis syndrome. Methods: Thirty patients with piriformis syndrome will be split into two groups at random: Group A will receive the ELDOA method, with fifteen participants, and Group B will receive the Nerve Flossing method with fifteen participants. A traditional treatment plan will also be given to both groups. Over four weeks, there will be three therapy sessions every week.Pain levels and flexibility will be evaluated using the Numerical Pain Rating Scale (NPRS) and the piriformis length test at the commencement of the study and after the four-week intervention. Results: Within-group analysis revealed a statistically significant (p<0.05) effect for all outcome measures following the intervention. Group A had a pre-mean of 6.4 and a post-mean of 4.53 for Nprs a pre-mean of 26 and a post-mean of 29.466 for the piriformis length test. Group B had a pre-mean of 6.4 and a post-mean of 3.13 for NPRS a pre-mean of 25.866 and a post-mean of 32.266 for the piriformis length test. Conclusions: The study's findings show that both the ELDOA and the Nerve Flossing Technique (NFT) are effective in relieving pain and improving flexibility in people with piriformis syndrome. However, the study found that NFT outperforms ELDOA in terms of pain relief and flexibility in the context of piriformis syndrome. [ABSTRACT FROM AUTHOR]

Anatomical variation of neuromuscular structures of the gluteal region is common. The piriformis muscle, in particular, has an important relationship with the sciatic nerve and may be associated with distinct clinical conditions. We report an incidental finding of unilateral piriformis muscle agenesis diagnosed on computed tomography and magnetic resonance imaging, a rare anatomical variant of the gluteal region.

Background: The sciatic nerve (SN) is the widest nerve of the human body that exits the pelvis through the greater sciatic foramen, usually below the piriformis muscle (PM), and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The aim of this paper is to examine and identify the SN variations in relation to the PM, its prevalence, pattern, and course. Methods: A prospective-descriptive cross-sectional study was carried out to determine the frequency of anatomical variations in the exit of the SN in relation with the PM in 20 anatomical bodies (corpses) of both genders, in equal numbers. Results: The dissection of 40 SNs in corpses of both sexes in equal numbers showed that the SN exited inferior to the PM in 37 lower limbs (92.5%); between the fascicles of the PM and inferior to the PM in two lower limbs (5%); and in one thigh, between the fascicles of the PM and superior to the PM (2.5%). Our study reported that the SN divides in its terminal branches more commonly in the proximal part of the popliteal fossa in 55% of cases, in the gluteal region in 35% of cases, and in the middle third of the thigh in 10% of cases. Conclusions: Anatomical variations of the SN in relation to the PM are challenging for the diagnostic and therapeutic procedure in many clinical and surgical cases. Rapid recognition of the SN changes makes surgical approaches more accurate and effective. Our study confirmed that the SN exits the pelvis most commonly below the PM, although some anatomical variations may occur.

The article discusses the importance of recognizing sacrotuberous ligament (STL) pain in cases of resistant piriformis syndrome (PS). While PS is typically diagnosed through clinical tests, STL pain can mimic PS symptoms and may require a revision of the diagnosis. Studies suggest that STL plays a significant role in pelvic stability and may contribute to pathologies related to the piriformis muscle. The article calls for increased awareness of STL pain in refractory PS cases and highlights the need for further research on conservative and minimally invasive treatments for STL pain. [Extracted from the article]

The posterior approach (PA) for hemiarthroplasty (HA) in patients with femoral neck fracture (FFN) has a high risk of dislocation; however, by preserving the piriformis muscle, the dislocation rate could be lowered considerably. The aim of this study was to compare the surgical complications of the piriformis-preserving posterior approach (PPPA) and the PA in patients with FNF treated with HA. On 1 January 2019, the PPPA was introduced at two hospitals as the new treatment standard. The sample size was calculated based on a 5 percentage point dislocation reduction and 25% censoring; a sample of 264 patients per group was determined. An approximately 2-year inclusion period with 1-year follow-up was estimated, including a historical cohort from 2 years before the PPPA introduction. Data were retrieved from health care records and X-ray images from the hospitals' administrative databases. Relative risk (RR) and 95% confidence intervals were calculated using Cox regression and adjusted for age, sex, comorbidity, smoking, surgeon experience and implant type. There were 527 patients included in the study, of which 72% were women and 43% were above 85 years old. There were no baseline differences between the PPPA and PA groups in sex, age, comorbidity, body mass index, smoking, alcohol, mobility, length of surgery, blood loss or implant positioning, but there were differences in 30-day mortality, surgeon experience and implant type. The dislocation rate reduced from 11.6% in the PA group to 4.7% in the PPPA group (p = 0.004), with an RR of 2.5 (1.2; 5.1). The reoperation rate reduced from 6.8% with the PA to 3.3% with the PPPA (p = 0.022), with an RR of 2.1 (0.9; 5.2), and total surgery-related complications reduced from 14.7% with the PA to 6.9% with the PPPA (p = 0.003), with an RR of 2.4 (1.3; 4.4). Changing from PA to PPPA in patients with FNF treated with HA resulted in a more than 50% reduction in dislocation and reoperation rates. This approach was easily introduced and may enable further lowering of dislocation rates through the sparing of all short external rotators. [ABSTRACT FROM AUTHOR]

The pressure pain threshold is commonly employed to assess pain in various conditions. Despite its widespread use, the measurement of pressure pain thresholds is not consistently described across studies. Therefore, this review aimed to systematically examine the evidence regarding the assessment of pressure pain thresholds in patients with low back pain, including the protocols and body sites employed. Six databases were systematically screened from their earliest records to May 2023 to identify studies utilizing pressure pain thresholds. Eligibility screening was conducted for the identified studies, and the included studies underwent appraisal using the appropriate tool corresponding to their study design. Upon categorizing based on the type of pain, we included 5 studies involving acute low back pain and 43 studies with chronic pain. The meta-analysis was conducted to compare subjects with and without pain, revealing no significant difference for the paraspinal region (SMD = −4.19, 95%CI = −11.7 to 3.32, z = −1.09, p =.27), piriformis (SMD = −1.24, 95%CI = −4.25 to 1.76, z = −0.81, p =.42) and quadratus lumborum musculature (SMD = −0.37, 95%CI = −1.35 to 0.60, z = −0.75, p =.45). The paraspinal and gluteal musculature are the most frequently evaluated. Concerning the protocols for assessment, no consensus was identified. However, studies that assessed chronic low back pain typically adhered to a similar approach regarding the number of measures and a constant increase in pressure. [ABSTRACT FROM AUTHOR]

Low back pain is a serious threat to human health and the illness jeopardizes the human workforce and pressurizes the health system in the community. Low back pain might be related to piriformis syndrome (PS), which is a disorder presented as muscular spasm and hypertrophy that is strongly associated with piriformis thickness. Nevertheless, the relationship between piriformis thickness and morphological and functional changes of the gluteal muscles in PS remains unclear. This study aimed to investigate the association between the thickness, strength, and activation of piriformis and gluteus muscles (maximus and medius) among low back pain (LBP) patients with and without PS. This is a case-control study conducted at HSNZ and UiTM from 2019–2020. A total number of 91 participants (LBP + PS (n = 36), LBP − PS (n = 24), and healthy (n = 31)) were recruited in this study. Negative radiography, specific symptoms, and a positive PS test were applied for PS diagnoses. The thickness, strength, and activation of piriformis and gluteus muscles were measured using ultrasonography (USG) and a surface electromyogram, respectively. Resultantly, the one-way ANOVA test demonstrated no significant difference in piriformis thickness between LBP + PS and LBP − PS (p > 0.01). Piriformis thickness was inversely correlated with gluteus maximus strength (r = −0.4, p < 0.05) and positively correlated with gluteus medius activation (r = 0.48, p < 0.01) in LBP + PS. Stepwise linear regression for LBP + PS revealed a significant association between piriformis thickness and gluteus maximus strength (R = −0.34, accounted for 11% of the variance) and gluteus medius activation in prone lying with the hip in an externally rotated, abducted, and extended (ERABEX) position (R = 0.43, accounted for 23% of the variance). With the adjustment of age and gender, piriformis thickness, gluteus maximus strength, and gluteus medius activation in prone lying with hip ERABEX demonstrated a significant association, but no independent effect of age and gender was detected within the range. Meanwhile, a significant association between piriformis thickness and gluteus maximus thickness was observed (R = 0.44, accounted for 19% of the variance) in the LBP − PS group. These findings may assist to elucidate the actions and functions of piriformis and gluteus muscle in LBP with and without PS. [ABSTRACT FROM AUTHOR]

To compare the safety and accuracy of three dry needling locations in the piriformis muscle using human donors. Observational dissection study of embalmed human donors. A licensed physical therapist of 17 years clinical experience and 5 years teaching dry needling placed three needles in a medial, midpoint, and lateral location of 14 piriformis muscles of seven embalmed human donors. Block dissection allowed for observation of tissues the needles traversed and recording of the structures that the needles pierced. The lateral needle pierced piriformis in 3/14 trials, and contacted sciatic nerve in 0/14 trials. The medial needle pierced both piriformis and sciatic nerve in 11/14 trials. The midpoint needle pierced the piriformis in 11/14 trials, and contacted sciatic nerve in 3/14 trials. Fisher's Exact test (p < 0.001) found a nonrandom association between dry needle placement, and dry needle contact. When dry needling the piriformis, a lateral approach can avoid the sciatic nerve, but cannot accurately pierce the piriformis tendon. Furthermore, while a midpoint and medial approach finds the piriformis muscle with the same accuracy, the midpoint location avoided the sciatic nerve more often. [ABSTRACT FROM AUTHOR]

Background. The sciatic nerve is the largest and thickest branch of the lumbosacral plexus. It separates into numerous branches and exhibits multiple anatomical variations that may result in nerve compression, a factor that is attributed to its location in the pelvis. This study aims to detect sciatic nerve branch variation and its association with the piriformis muscle and to establish the prevalence of each variant using routine pelvic MRI examinations. Methods. This was a cross-sectional retrospective study of patients who underwent pelvic MRI studies from January 2018 to December 2020. Collected data included patient demographics, anatomical type of sciatic nerve (according to the Beaton and Anson classification system) and history of radiculopathy or sciatic nerve symptoms. Data was collected, and descriptive statistics were analyzed with a p < 0.05 considered as statistically significant. Results. A total of 188 patients were included in the study. The majority (95.7%) of the patients exhibited the type 1 variant, while type 2 and type 3 variants exhibited a prevalence of 3.2% and 1.1%, respectively. No statistically significant difference in history of radiculopathy and sciatica was identified between the different anatomical variants. Conclusions. The sciatic nerve's anatomical variation in relation to the piriformis muscle can be identified on routine pelvic MRI scans, with most of the detected variants being type 1. This study confirms the anatomical variations of the sciatic nerve in the pelvic region which can be detected on routine MRI. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and clinical implications of variant sciatic nerve anatomy in relation to the piriformis muscle on magnetic resonance neurography (MRN), in patients with lumbosacral neuropathic symptoms. Materials and Methods: In this retrospective single-center study, 254 sciatic nerves, from 127 patients with clinical and imaging findings compatible with extra-spinal sciatica on MRN between 2003 and 2013, were evaluated for the presence and type of variant sciatic nerves, split sciatic nerve, abnormal T2-signal hyperintensity, asymmetric piriformis size and increased nerve caliber, and summarized using descriptive statistics. Two-tailed chi-square tests were performed to compare the anatomical variant type and clinical symptoms between imaging and clinical characteristics. Results: Sixty-four variant sciatic nerves were identified with an equal number of right and left variants. Bilateral variants were noted in 15 cases. Abnormal T2-signal hyperintensity was seen significantly more often in variant compared to conventional anatomy (40/64 vs. 82/190; p = 0.01). A sciatic nerve split was seen significantly more often in variant compared to conventional anatomy (56/64 vs. 20/190; p < 0.0001). Increased nerve caliber, abnormal T2-signal hyperintensity, and asymmetric piriformis size were significantly associated with the clinically symptomatic side compared to the asymptomatic side (98:2, 98:2, and 97:3, respectively; p < 0.0001 for all). Clinical symptoms were correlated with variant compared to conventional sciatic nerve anatomy (64% vs. 46%; p = 0.01). Conclusion: Variant sciatic nerve anatomy, in relation to the piriformis muscle, is frequently identified with MRN and is more likely to be associated with nerve signal changes and symptomatology. [ABSTRACT FROM AUTHOR]

Piriformis syndrome, an often-overlooked cause of sciatica, commonly presents as chronic gluteal pain and poses a diagnostic challenge, particularly in patients with axial spondyloarthritis (axSpA).To examine piriformis muscle abnormalities on sacroiliac magnetic resonance imaging (MRI) and their association with clinical outcomes in patients with axSpA.This cross-sectional study included 100 axSpA patients (50 radiographic [r-axSpA], 50 non-radiographic [nr-axSpA]), classified by the 2009 ASAS Axial Spondyloarthritis criteria, who underwent MRI evaluations of the sacroiliac joints over a 6-month period. Piriformis evaluation included the measurement of muscle size, signal intensity, and the assessment of fatty infiltration. Sciatic neuritis was assessed by identifying enlarged sciatic nerves or increased signal intensity. Data collection included demographic details, disease activity, and functionality parameters. Statistical analysis was performed using appropriate methods, with P < 0.05 indicating significance.Piriformis syndrome findings were identified in 10% of patients, with a slightly higher incidence in r-axSpA patients (12%) compared to nr-axSpA patients (8%); however, this difference was not statistically significant (P = 0.739). Patients with these MRI findings had significantly higher disease activity, as indicated by the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (3.5 vs. 2.82; P = 0.015), and greater functional impairment, measured by the Bath Ankylosing Spondylitis Functional Index (5.45 vs. 2.7; P = 0.041).This study highlights the presence of MRI findings associated with piriformis syndrome among axSpA patients, which are linked to increased disease activity and reduced function. Recognizing piriformis syndrome as a co-morbidity may improve diagnosis and treatment, leading to better patient outcomes. [ABSTRACT FROM AUTHOR]

Piriformis syndrome is an extremely uncommon condition that results in sciatic nerve entrapment at the level of the piriformis muscle, which leads to excruciating pain in the lower back, buttocks, and leg. An abnormal condition of the piriformis muscle, such as hypertrophy, inflammation, or anatomical abnormalities, is the most common root cause of this problem. We discuss the case of a 46-year-old woman with right gluteal pain and sciatic neuropathy who was diagnosed with piriformis syndrome as a result of an accessory pyriformis muscle that was discovered by magnetic resonance imaging (MRI). [ABSTRACT FROM AUTHOR]

Introduction: Piriformis Syndrome (PS) is a neuromuscular condition caused due to tightness of piriformis muscle along with the irritation of the sciatic nerve. Management of PS so far involved only musculoskeletal component with none working on the neural component. So, authors intent to work on combined effectiveness of Dry Needling (DN) and Neurodynamic Mobilisation (NDS) as a new emerging technique for better management of PS. Case Report: Four patients were involved (3 females and 1 male) who experienced untreated and recurrent PS for a prolonged period (1-2 years) during their fourth decade. After reassessment of the patients, PS was confirmed by Flexion Adduction and internal rotation (FAIR), Beatty maneuver, and Straight Leg Raise (SLR). Baseline and post measurements were taken using outcome variables VAS, Pain Pressure Threshold, h-reflex, hip rotations range of motion, and Lower Extremity Functional Scale (LEFS). Patients recruited were given a 10-days treatment with dry needling for 10 minutes on alternate days and continuous neurodynamic mobilisation (sliders and tensioners) comprising 30 repetitions/minute for 2 sets with a 1-minute rest in between, in addition to conventional therapy. The study revealed substantial improvement in pain scores, pressure threshold, h-latency, hip rotations and functional capabilities of the lower extremities. A study demonstrated a notably substantial enhancement in addressing symptoms associated with both the muscular and neural aspects, along with the overall improvement in quality of life. Addressing to it neural and muscular with NDS and DN has long lasting effects and reduced frequency of reoccurrence of PS symptoms. [ABSTRACT FROM AUTHOR]