Pelvic and Hip Morphometry in Piriformis Syndrome
Study Details
Study Description
Brief Summary
In this case-control study, 23 patients diagnosed as PS by diagnostic injection with ultrasound guidance were selected as the study group. 22 patients who were excluded from the diagnosis of PS and had anteroposterior (AP) direct radiographic imaging were evaluated as the control group. On the AP Pelvic graph, the femoral neck-shaft angle, the distances between predetermined bony landmarks were measured blindly without knowing the diagnosis, and the findings were compared statistically.
This study aims to evaluate whether the anatomical structure of the pelvis predisposes to the etiopathogenesis of the piriformis syndrome.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Piriformis syndrome (PS) is a neuromuscular disorder consisting of pain and symptoms caused by compression of the sciatic nerve and other structures that pass under the piriformis muscle (PM). Due to difficulties in diagnosis, PS is confused with other pathologies such as lumbar disc pathology, lumbosacral radiculopathy, and sacroiliac dysfunction. As a result, patients are exposed to unnecessary and ineffective treatments, even surgery. The main problems in the PS diagnosis are the absence of objective physical examination findings, radiological findings, and a clear etiology. When the pathophysiology and etiology of PS are considered, there is no identifiable cause in most patients. Previous studies suggest that trauma, anatomical variations, and the trigger point in the muscle may cause PS. No study in the literature radiologically examined the pelvis or hip bone morphological features in PS to the best of our knowledge. This study aims to determine whether pelvic or hip bone morphology features pose a risk for PS in this study.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Piriformis syndrome group Patients who were diagnosed as PS by diagnostic injection with ultrasound guidance |
Diagnostic Test: Ultrasound guided diagnostic injection
4 cc lidocaine %2 injection into the piriformis muscle was performed for the diagnosis of piriformis syndrome. It was performed by the ultrasound-guidance to increase the accuracy of the injection.
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| Age and sex match control group Patients who were excluded from the diagnosis of PS and had anteroposterior (AP) direct radiographic imaging |
Outcome Measures
Primary Outcome Measures
- Femoral Neck-Shaft Angle (NSA) [The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken.]
The NSA, also called caput collum-diaphyseal angle or inclination angle, defined as the angle between the longitudinal femoral shaft axis and femoral head-neck axis.
- Posterior Superior Iliac Spine (PSIS)- Trochanter Major (TM) [The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken.]
The distance between the posterior superior iliac spine and the greater trochanter
- PSIS-Ischial Tuberosity (IT) [The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken.]
The distance between the posterior superior iliac spine and the apex of the ischial tuberosity
- IT-TM [The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken.]
The distance between the apex of the ischial tuberosity and the greater trochanter
- Sacrum-TM [The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken.]
The distance between the sacrum and the greater trochanter
Eligibility Criteria
Criteria
For Piriformis syndrome group (study group);
Inclusion Criteria:
- A dramatic relief of pain following piriformis muscle local anesthetic injection
Exclusion Criteria:
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Having a neurological deficiency
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Having lumbar, sacroiliac, hip, and thoracolumbar pathology (inflammatory or degenerative)
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Operation history at the lumbar and hip region
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Being in the gestational or lactational period
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Body mass index of greater than 35
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History of inflammatory or infectious disease
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Active psychiatric illness, severe systemic, vascular or malign disease
For the control group
Inclusion criteria:
-Having Anteroposterior pelvic radiographs for other medical reasons
Exclusion criteria:
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Having a present piriformis syndrome or a history of piriformis syndrome
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Having a neurological deficiency
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Having lumbar, sacroiliac, hip, and thoracolumbar pathology (inflammatory or degenerative)
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Operation history at the lumbar and hip region
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Being in the gestational or lactational period
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Body mass index of greater than 35
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History of inflammatory or infectious disease
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Active psychiatric illness, severe systemic, vascular or malign disease
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Fatih Sultan Mehmet Research and Traning Hospital | Istanbul | Turkey | 34752 |
Sponsors and Collaborators
- Fatih Sultan Mehmet Training and Research Hospital
Investigators
- Study Director: Gamze Güleç, MD, Fatih Sultan Mehmet Training and Research Hospital
- Study Director: Ilknur Aktas, MD, Fatih Sultan Mehmet Training and Research Hospital
- Study Chair: Feyza Unlu Ozkan, MD, Fatih Sultan Mehmet Training and Research Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
- Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am. 1999 Jul;81(7):941-9.
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- Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010 Dec;19(12):2095-109. doi: 10.1007/s00586-010-1504-9. Epub 2010 Jul 3. Review.
- Jankovic D, Peng P, van Zundert A. Brief review: piriformis syndrome: etiology, diagnosis, and management. Can J Anaesth. 2013 Oct;60(10):1003-12. doi: 10.1007/s12630-013-0009-5. Epub 2013 Jul 27. Review.
- Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 2009 Jul;40(1):10-8. doi: 10.1002/mus.21318. Review.
- Pace JB, Henning C. Episacroiliac lipoma. Am Fam Physician. 1972 Sep;6(3):70-3.
- Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am. 2004 Jan;35(1):65-71. Review.
- Probst D, Stout A, Hunt D. Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment. PM R. 2019 Aug;11 Suppl 1:S54-S63. doi: 10.1002/pmrj.12189. Epub 2019 Jul 22. Review.
- FSMEAH