Outline Thesis Statement: Piriformis syndrome is considered a neuromuscular disorder caused by various abnormalities which contribute to pressure on the sciatic nerve. After examination and determining the cause of this diagnosis a physical therapy treatment plan can then be determined. I. Piriformis syndrome A. General information about the disorder B. Anatomy and normal function of the system 1. Piriformis muscle 2. Sciatic nerve II. Causes and conditions of piriformis syndrome A. Causes according to Dr. Pribut B. Causes according to Physio-pedia 1. Classification of the relationship between the piriformis and the sciatic nerve III. Symptoms and Side effects A. Most common side effects 1. Dr. Revord on Typical Symptoms 2. Dr. Tonley on Typical Symptoms IV. Treatment Plan A. Passive treatment plan B. Strengthening Treatment plan V. Closing A. Difficult to diagnose due to the many conditions that cause the disorder. B. Easy to treat after examination and the cause of problem has been identified Jayme Stachura Dr. Nancy Wilson PTHA 1321 Pathophysiology Research Paper 22 November 2014 Piriformis syndrome is considered a neuromuscular disorder. It is caused by various abnormalities of the piriformis muscle which leads to pressure on the sciatic nerve. The piriformis muscle originates on the anterior surface of the sacrum and attaches to the superior aspect of the greater trochanter of the femur. With proper function its primary motion is external rotation of the hip. It is also considered a hip abductor and extensor when the hip is in flexion. The sciatic nerve lies deep to the piriformis muscle and in some individuals nerve placement may vary. It innervates muscles of the lower extremity that …show more content…
assist with proper muscle function and the ability to stand, walk, run, stair climb, and other movement regarding the lower body. When the sciatic nerve is compressed a sensation of pain, tingling, and numbness is present, this acute nerve pain is also referred to as sciatica. According to Dr. Stephen M. Pribut, this diagnosis can be brought on due to a number of different problems concerning the piriformis. These problems include weak hip abductors, flexion contractures, tight adductor muscle group, tightness of anterior portion of iliotibial tract and tensor fascia lata, limb length difference, tight medial hamstrings, pronation of foot, and running flaws. The website physio-pedia has a different look on the causes of piriformis syndrome, stating that the disorder is more common in women due to the wider quadriceps femoris muscle angle in the os coxae of women. They have also divided the disorder into two categories; primary piriformis syndrome and secondary piriformis syndrome. Primary piriformis syndrome is described as an anatomical variation. Common conditions that can cause primary piriformis syndrome would be a split piriformis muscle, a split sciatic nerve or an anomalous sciatic nerve path. Primary piriformis syndrome is stated to be less common, with an average of 15% of diagnosed cases. Secondary piriformis syndrome is associated with a precipitating cause, such as macrotrauma, microtrauma, ischemic mass effect or local ischemia. Of these, macrotrauma is referred to as the leading cause, affecting 50% of patients diagnosed with piriformis syndrome. Other causes stated include overuse and direct pressure. The physio-pedia website explains the relationship between the placement of the sciatic nerve in correspondence with the piriformis muscle. This classification is divided into six groups defined as Group A- F. Type A is the considered a normal system, with the sciatic nerve lying deep to the piriformis muscle. Type B the sciatic nerve passes through the piriformis muscle while the tibial branch splits inferior. Type C the sciatic nerve passes through the piriformis muscle while the tibial branch splits superiorly. Type D the entire sciatic nerve passes through the muscle belly. Type E the sciatic nerve passes the superior surface of the piriformis muscle and exits the greater sciatic foramen. Lastly the nerve is divided proximally, and may pass through the muscle belly, tendon or part of a congenital bifid muscle. It is beneficial to understand the importance of the relationship between the sciatic nerve and the piriformis muscle prior to treatment to ensure nerve decompression. Though there may be numerous conditions that causes piriformis syndrome, the symptoms and side effects remain congruent amongst professionals. The three most common complaints of piriformis syndrome are sciatica, limited range of motion, and difficulty preforming daily activities. As stated by John P. Revord, M.D. “Typical piriformis syndrome symptoms may include; a dull ache in the buttock, pain down the back of the thigh, calf and foot (sciatica), pain when walking up stairs or incline, increased pain after prolonged sitting, and reduced range of motion of the hip joint”. Consistent with Dr. Revord’s professional opinion, a case study report by Dr. Tonley found in the Journal of Orthopaedic and Sports Physical Therapy states “Symptoms associated with piriformis syndrome typically consist of buttock pain that radiates into the hip, posterior aspect of the thigh, and the proximal portion of the lower leg. In general, pain increases with sitting or squatting, but a person with piriformis syndrome may experience difficulty with walking or other functional activities.” After proper examination and analyzing the cause of the symptoms, a physical therapy treatment plan can then be determined. Proper treatment according to Shishir Shah, DO is to refrain from activity and to begin a physical therapy treatment that consists of moist heat, ultrasound and stretching. He also suggests manual therapy including the use of muscle- energy technique, soft tissue massage, and myofascial release and to follow up with ice and electric stimulation. Contrarily, A case study report titled ‘Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report’ shows evidence that a more aggressive treatment plan can be beneficial. The theory behind this study is developed from understanding that while performing functional activities; the piriformis muscle is working eccentrically to compensate for weak agonist muscles. They go on to explain if the agonist muscles are strengthened the piriformis can relax and release pressure from the sciatic nerve. This case involves one 30 year old male who has a history pain for two years. This physical therapy treatment plan consists of a three phase program focused on strengthening of the hip abductors extensors and external rotators along with movement reeducation. Phase one involves non-weight bearing and isolated muscle recruitment, phase two consists of weight bearing exercises and phase three introduces dynamic and ballistic training. The patient received verbal cues to limit adduction and internal rotation so the program could insure strengthening of the hip abductors extensors and external rotators. After 8 treatments over the course of 3 months of physical therapy targeted toward strengthening and movement reeducation, conclusion of this case reveals drastic improvements. It is important to analyze different treatment options for what works best with each individual patient. This diagnosis does not benefit from a general treatment plan but one specifically created for the individual. In closing, Piriformis syndrome can be difficult to diagnose due to the many conditions that cause the disorder.
Once proper examination has been performed and the cause of problem has been identified, this neuromuscular disorder can be easy to
treat. Works Cited "Piriformis Syndrome." - Physiopedia, Universal Access to Physiotherapy Knowledge. Ed. Marlies Verbruggen. 22 Nov. 2014. Web. Pribut, Stephen M. DPM and Perri-Pribut, Amelia B.S., R.N., M.B.A. " Piriformis Syndrome: The Big Mystery or A Pain In The Behind." Dr. Pribut on Piriformis Syndrome. 12 May 2012. Web. Revord, John P. MD. "Symptoms and Diagnosis of Piriformis Syndrome." Spine-health. 8 Apr. 2000. Web. Shah, Shishir DO. "Piriformis Syndrome Treatment & Management." Piriformis Syndrome Treatment & Management. Joseph P. Garry, MD, FACSM, FAAFP, 22 Oct. 2014. Web. Tonley, Jason C. DPT, OCS. "Treatment of an Individual With Piriformis Syndrom Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report." Journal of Orthopaedic and Sports Physical Therapy 40 (2010): 103-111. Print.
The first activity was isolating the gastrocnemius muscle. A cut between the thigh and hip was made so the skin can be pulled down past the lower leg. Then the tendon was cut away from the bone of the heel and one end of the nine-inch string was tied to the tendon. This led to the isolation of the sciatic nerve, found between the hamstring and heel on the lateral side of the thigh. Using fingers, the seams along the quadriceps and hamstring underwent a blunt dissection. In doing so, the glass-dissecting probe was used to free the sciatic nerve embedded in the tissues. A four-inch string was inserted between the nerve and the tissues. Then the transducer was calibrated using a fifty-gram block under the “Frog Muscle” program. Parameter of CAL 1 was changed to zero grams and CAL 2 was changed
In the frontal plane, the movement shows the depression of scapula. The joint involved in this part of the pirouette is the scapulothoracic joint. This motion can be analyzed in the frontal plane or the sagittal due to the movements of the shoulders with the trunk (Hall, 2011). In the transverse plane it is the external rotation of the hip that helps form a pirouette. The muscles used to perform the rotation are the gluteus minimus, piriformis, superior gemellus, inferior gemellus, obturator internus, obturator externus, and quadratus femoris (Hall, 2011). These muscles are used to help the leg move to the correct position for a pirouette.
The gluteus maximus originates from both the ilium and the sacrum and inserts on the femur. The gluteus minimus abducts and rotates the thigh outward. The biceps femoris originates from the tuberosity of the ischium and is responsible for abducting the thigh and flexing the hindlimb or in humans the thigh/leg. The gastrognemius originates from the lateral sesamoid bone of the femur and extends the hindfoot in minks and the calves in humans (Scott).
For the lab test part, in this case we can do a muscle biopsy on him. A muscle biopsy is a procedure that removes a small sample of tissue for testing in a laboratory. The test can identify the disease is caused by nerve or by the muscle atrophy.
P3 – Describe the investigations that are carried out to enable the diagnosis of these physiological disorders
Peripheral and central mechanisms involving nerve lesions and their input are substantial when perceiving phantom pain. Due to the impairment of peripheral nerves in the process of amputation, regenerative sprouting of damaged axons occurs and the activity rate of inflamed C-fibres and demyelinated A-fibres spontaneously increases (Flor, 2002). As a consequence of this nerve injury, a neuroma, which is a mass of pruned and tangled axons, may form in the residual limb producing abnormal (ectopic) activity (Katz, 1992). Flor, Nikolajsen and Jenson (2006) proposed that ectopic discharge from a neuroma in the stump illustrates abnormal afferent input to the spinal cord, which is a possible mechanism for unpro...
Other basic cases happen when managed weight has been connected over a nerve, hindering/fortifying its capacity. Evacuating the weight ordinarily brings about continuous help of these paresthesias. (Paresthesia 1)
MG patients have only one-third of the normal numbers of acetylcholine receptors which causes weak and easily fatigued muscles. The muscles under voluntary control are affected. The heart muscles, which are under involuntary control, are not affected. In MG generally, the muscles that control the eye and eyelid movement are affected first, causing the eyelids to sag. Some MG patients may develop double or blurred vision. When only the eye muscles are affected, the disease is known as Ocular Myasthenia. Disease symptoms affecting the facial muscles leads to limitations of facial expressions. Victims have difficulty smiling and expressing emotions on their face.
Myasthenia Gravis is an autoimmune neuromuscular disorder. The term "myasthenia" is Latin for muscle weakness, and "gravis" for grave or serious. It is characterized by random weakness of voluntary muscle groups. Muscle groups most commonly affected include the eye muscles, facial, chewing and swallowing muscles, and shoulder and hip muscles. It is typical for a myasthenic patient to have a flattened smile, droopy eyes and an ineffective cough due to weak expiratory muscles, are all also associated with MG. Most myasthenic patients usually don't complain of extensive feelings of fatigue. They experience localized fatigue in specific, repeatedly used muscles. Today, MG is one of the most thoroughly understood neurological disorders, which has lead to treatments, which enormously improves the length and quality of life of myasthenics.
The basal ganglia are part of the extrapyramidal system and work in conjunction with the motor cortex in providing movement and serve as the relay center. Damage to this area results in Athetoid Cerebral Palsy, the second most common form of cerebral palsy. Involuntary purposeless movements, particularly in the arms, hands, and facial muscles, characterize Athetosis. In addition, the individual can become “stuck” in abnormal positions or postures and require specific positioning to maintain more normal tome and
The human genome is a remarkable system composed of over 3 billion DNA base pairs that encode for the characteristics that makes people distinctly human and unique themselves. Without the genome’s nearly flawless ability to self-replicate the human species would cease to exist. As incredible as this replication methodology is, it is not without its faults. Genetic mutations, though rare and typically harmless, can strike at any time and in various ways. Still, when they do cause harm the effects can be profound and impossible to ignore. Hutchinson-Gilford Progeria Syndrome (HGPS) is an instance where the mutation of just one nucleotide has devastating results. The Mayo Clinic defines progeria as a progressive genetic disorder that causes children to age rapidly, beginning in their first two years of life. This study defines the disease of progeria by outlining symptoms and identifying causes that lead to its diagnosis. In addition, treatment methods and extensive research that give those affected by the disease hope for a brighter future are highlighted.
Lee SE, Cho SH. The effect of McConnell taping on vastus medialis and lateralis activity during squatting in adults with patellofemoral pain syndrome. Journal of Exercise Rehabilitation. 2013;9(2):326-330
Anyone can suffer from torticollis following a muscle injury or nervous system. However, in most cases, the cause of torticollis is unknown. In this case, it is called idiopathic torticollis.
The most common cause of sciatica is a herniated spinal disc (aka slipped disc). When this happens, the natural cushion between the vertebra of your spine ruptures, causing the disc to push out into areas usually occupied by these nerves. The nerves are compressed, and people then experience the symptoms of pain, weakness, and numbness. Other conditions, such as spinal stenosis, spondylolisthesis, or piriformis syndrome can also cause sciatica symptoms by irritating the nerve.
in soft tissue mobilization pressure.” Medicine and Science in Sports and Exercise. April 1999: 531-5.