manuelletherapie 2006; 10(4): 159-169
DOI: 10.1055/s-2006-927036
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Piriformissyndrom - kritische Beurteilung der Literatur und Diskussion der klinischen Zusammenhänge[1]

Piriformis Syndrome - Critical Literature Evaluation and Discussion of Clinical RelationshipR. Blaser-Sziede
Further Information

Publication History

Manuskript eingetroffen: 12.1.2005

Manuskript akzeptiert: 17.2.2005

Publication Date:
13 September 2006 (online)

Zusammenfassung

Die vorliegende Arbeit liefert einen Überblick und eine kritische Analyse der Literatur zum Piriformissyndrom (PS). Das PS gilt mehrheitlich als Engpasssyndrom des N. ischiadicus im Foramen infrapiriforme, verursacht durch pathologische Veränderungen des M. piriformis. Die Diagnosenstellung erfolgt primär klinisch. Das am häufigsten beschriebene Symptom ist Gesäßschmerz, gefolgt von Schmerzen in der Oberschenkelrückseite und bei Palpation der tiefen Gesäßmuskeln. Für die eigens zur Diagnostik des PS entwickelten Tests gibt es keine kritische Evaluation. An der Schmerzentstehung könnten weitere Muskeln im dorsalen Becken wie der M. obturatorius internus beteiligt sein. Die nach Sacketts [52] Evidenzpyramide bewertete Qualität der Studien ist größtenteils gering.

Abstract

This article presents an overview and a critical analysis of the literature concerning the piriformis syndrome (PS). PS is generally considered as an entrapment syndrome of the sciatic nerve in the infrapiriform foramen caused by pathologic alterations of the piriform muscle. Diagnosis is mainly carried out clinically. The most frequently described symptom is buttock pain followed by pain in the posterior thigh and on palpation of the deep gluteal muscles. There exists no critical evaluation of the tests specifically developed for the diagnosis of PS. Other muscles such as the obturatorius internus muscle could possibly also be involved in the development of pain. The studies were assessed by Sackett’s [52] evidence pyramid and were mostly found to be of low quality.

1 Abschlussarbeit der DVMT-OMT-Ausbildung 2003 - 2005.

Literatur

  • 1 Barton P M. Piriformis syndrome: a rational approach to management.  Pain. 1991;  47 345-352
  • 2 Beaton L E, Anson B J. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle.  Anat Rec. 1937;  70 1-5
  • 3 Beaton L E, Anson B J. The sciatic nerve and the piriformis muscle: their interrelation a possible cause of coccydynia.  J Bone Joint Surg. 1938;  20 686-688
  • 4 Beatty R A. The piriformis muscle syndrome: a simple diagnostic manoeuvre.  Neurosurgery. 1994;  34 512-514
  • 5 Benson E R, Schutzer S F. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment.  J Bone Joint Surg Am. 1999;  81-A 941-949
  • 6 Benzon H T, Katz J A, Benzon H A. et al . Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature.  Anesthesiology. 2003;  98 1442-1448
  • 7 Broadhurst N A, Simmons D N, Bond M J. Piriformis syndrome: correlation of muscle morphology with symptoms and signs.  Arch Phys Med Rehabil. 2004;  85 2036-2039
  • 8 Bustamente S, Houlton P G. Swelling of the leg, deep venous thrombosis and the piriformis syndrome.  Pain Res Manag. 2001;  6 200-203
  • 9 Butler D. The Sensitive Nervous System. Adelaide; Noigroup 2000
  • 10 Chen W S, Wan Y L. Sciatica caused by piriformis muscle syndrome: report of two cases.  J Formos Med Assoc. 1992;  91 647-650
  • 11 Childers M K, Wilson D J, Gnatz S M. et al . Botulinum toxin type A use in piriformis muscle syndrome: a pilot study.  Am J Phys Med Rehabil. 2002;  81 751-759
  • 12 Dezawa A, Kusano S, Miki H. Arthroscopic release of the piriformis muscle under local anaesthesia for piriformis syndrome.  Arthroscopy. 2003;  19 554-557
  • 13 Douglas S. Sciatic pain and piriformis syndrome.  Nurse Pract. 1997;  22 166-168
  • 14 Durrani Z, Winnie A P. Piriformis muscle syndrome: an underdiagnosed cause of sciatica.  J Pain Symptom Manage. 1991;  6 374-379
  • 15 Fanucci E, Masala S, Squillaci E. et al . Pyriformis muscle syndrome: CT/MR findings in the percutaneous therapy with botulinic toxin.  Radiol Med (Torino). 2003;  105 69-75
  • 16 Filler A G, Haynes B A, Jordan S E. et al . Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.  J Neurosurg Spine. 2005;  2 99-115
  • 17 Fishman L M, Zybert P A. Electrophysiologic evidence of piriformis syndrome.  Arch Phys Med Rehabil. 1992;  73 59-64
  • 18 Fishman L M, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome.  Am J Phys Med Rehabil. 2002;  81 936-942
  • 19 Fishman L M, Dombi G W, Michaelsen C. et al . Piriformis syndrome: diagnosis, treatment, and outcome - a 10-year study.  Arch Phys Med Rehabil. 2002;  83 295-301
  • 20 Fishman L M, Schaefer M P. The piriformis syndrome is underdiagnosed.  Muscle & Nerve. 2003;  28 646-649
  • 21 Fishman L M, Konnoth C, Rozner B. Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose-finding study.  Am J Phys Med Rehabil. 2004;  83 42-50
  • 22 Foster M R. Piriformis syndrome.  Orthopedics. 2002;  25 821-825
  • 23 Freiberg A H, Vinke T H. Sciatica and the sacroiliac joint.  J Bone Joint Surg. 1934;  16 126-136
  • 24 Frisch H. Programmierte Untersuchung des Bewegungsapparates. 2. Aufl. Berlin; Springer 1987
  • 25 Gibbons S GT, Comerford M J. Kraft versus Stabilität. Teil 1: Konzepte und Begriffe.  Manuelle Therapie. 2001;  4 204-212
  • 26 Hallin R P. Sciatic pain and the piriformis muscle.  Postgrad Med. 1983;  74 69-72
  • 27 Hanania M, Kitain E. Perisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome.  Reg Anesth Pain Med. 1998;  23 223-228
  • 28 Hopayian K. Sciatica in the community - not always disc herniation.  Int J Clin Pract. 1999;  53 197-198
  • 29 Huber H M. Das Piriformissyndrom - eine mögliche Ursache für Ischialgien.  Schweiz Rundsch Med Prax. 1990;  79 235-236
  • 30 Hughes S S, Goldstein M N, Hicks D G. et al . Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip: report of five cases.  J Bone Joint Surg Am. 1992;  74-A 1553-1559
  • 31 Indrevekam K, Sudmann E. Piriformis muscle syndrome in 19 patients treated by tenotomy - a 1 - 16-year follow-up study.  Int Orthop. 2002;  26 101-103
  • 32 Jankiewicz J J, Hennrikus W L, Houkom J A. The appearance of the piriformis muscle syndrome computed tomography and magnetic resonance imaging. A case report and review of the literature.  Clin Orthop. 1991;  262 205-209
  • 33 Kapandji I A. Funktionelle Anatomie der Gelenke. Bd. 2: Untere Extremität. Stuttgart; Enke 1985
  • 34 Karl R D, Yedinak M A, Hartshorne M F. et al . Scintigraphic appearance of the piriformis muscle syndrome.  Clin Nucl Med. 1985;  10 361-363
  • 35 Kirkaldy-Willis W H, Hill R J. A more precise diagnosis for low-back pain.  Spine. 1979;  4 102-109
  • 36 Lang A M. Botulinum toxin type B in piriformis syndrome.  Am J Phys Med Rehabil. 2004;  83 198-202
  • 37 Lee E Y, Margherita A J, Gierada D S. et al . MRI of piriformis syndrome.  AJR Am J Roentgenol. 2004;  183 63-64
  • 38 McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in hip, groin and buttock.  Sports Med. 1999;  27 261-274
  • 39 Meknas K, Christensen A, Johansen O. The internal obturator muscle may cause sciatic pain.  Pain. 2003;  104 375-380
  • 40 Mizugushi T. Division of the piriformis muscle for the treatment of sciatica. Postlaminectomy syndrome and osteoarthritis of the spine.  Arch Surg. 1976;  111 719-722
  • 41 Nakamura H, Seki M, Konishi S. et al . Piriformis syndrome diagnosed by cauda equina action potentials: report of two cases.  Spine. 2003;  28 E37-E40
  • 42 Pace J B, Nagle D. Piriformis syndrome.  West J Med. 1976;  124 435-439
  • 43 Papadopoulos E C, Khan S N. Piriformis syndrome and low back pain: a new classification and review of the literature.  Orthop Clin North Am. 2004;  35 65-71
  • 44 Parziale J R, Hudgins T H, Fishman L M. The piriformis syndrome.  Am J Orthop. 1996;  25 819-823
  • 45 Pecina M. Contribution to the etiological explanation of the piriformis syndrome.  Acta Anat (Basel). 1979;  105 181-187
  • 46 Puranen J, Orava S. The hamstrings syndrome - a new gluteal sciatica.  Ann Chir Gynaecol. 1991;  80 212-214
  • 47 Rask M R. Superior gluteal nerve entrapment syndrome.  Muscle Nerve. 1980;  3 304-307
  • 48 Reichel G, Gaerisch F. Das Piriformissyndrom: Ein Beitrag zur Differentialdiagnose von Lumbago und Kokzygodynie.  Zentralbl Neurochir. 1988;  49 178-184
  • 49 Robinson D R. Pyriformis syndrome in relation to sciatic pain.  Am J Surg. 1947;  73 355-358
  • 50 Rodrigue T, Hardy R W. Diagnosis and treatment of piriformis syndrome.  Neurosurg Clin N Am. 2001;  12 311-319
  • 51 Rossi P, Cardinali P, Serrao M. et al . Magnetic resonance imaging findings in piriformis syndrome: a case report.  Arch Phys Med Rehabil. 2001;  82 519-521
  • 52 Sackett L D, Straus S E, Richardson W S. et al .Evidence-based medicine. How to practice and teach EBM. Edinburgh; Churchill Livingstone 2000
  • 53 Sayson S C, Ducey J P, Maybrey J B. et al . Sciatic entrapment neuropathy associated with an anomalous piriformis muscle.  Pain. 1994;  59 149-152
  • 54 Simons D G, Travell J G. Myofascial origins of low back pain. 2. Torso muscles.  Postgrad Med. 1983;  73 81-92
  • 55 Simons D G, Travell J G. Myofascial origins of low back pain. 3. Pelvic and lower extremity muscles.  Postgrad Med. 1983;  73 99-105
  • 56 Slipman C W, Vresilovic E J, Palmer M A. et al . Piriformis muscle syndrome: a diagnostic dilemma.  Journal of Musculoskeletal Pain. 1999;  7 73-83
  • 57 Solheim L F, Siewers P, Paus B. The piriformis muscle syndrome: Sciatic nerve entrapment treated with section of the piriformis muscle.  Acta Orthop Scand. 1981;  52 73-75
  • 58 Spinner R J, Thomas N M, Kline D G. Failure of surgical decompression for a presumed case of piriformis syndrome. Case report.  J Neurosurg. 2001;  94 652-654
  • 59 Steiner C, Staubs C, Ganon M. et al . Piriformis syndrome: Pathogenesis, diagnosis and treatment.  J Am Ostheopath Assoc. 1987;  87 318-323
  • 60 Stewart J D. The piriformis syndrome is overdiagnosed.  Muscle & Nerve. 2003;  28 644-646
  • 61 Uluutku M H, Kurtoglu Z. Variations of nerves located in the deep gluteal region.  Okajimas Folia Anat Jpn. 1999;  76 273-276
  • 62 Upton A RM, McComas A J. The double crush in nerve entrapment syndromes.  The Lancet. 1973;  2 359-362
  • 63 Vallejo M C, Mariano D J, Kaul B. et al . Piriformis syndrome in a patient after cesarean section under spinal anaesthesia.  Reg Anesth Pain Med. 2004;  29 364-367
  • 64 Yeoman W. The relation of arthritis of the sacroiliac joint to sciatica.  The Lancet. 1928;  II 1119-1122

1 Abschlussarbeit der DVMT-OMT-Ausbildung 2003 - 2005.

Robert Blaser-Sziede, PT

Wassertorstr. 5

D-88316 Isny

Email: blaser-sziede@gmx.de

    >