I. Pear-shaped muscle syndrome
The pear-shaped muscle starts from the front of the 2nd, 3rd and 4th sacral vertebrae and is distributed on the inner surface of the small pelvis, entering the hip through the foramen magnum and ending at the greater trochanter of the femur. This muscle is prone to injurious inflammatory changes due to acute or chronic injury, or anatomical variation, which can irritate or compress nerves and produce low back pain, called pear-shaped muscle syndrome, also known as femoral nerve pelvic outlet syndrome.
Pear-shaped muscle injury is mostly caused by violent movements such as lower limb abduction, external rotation or internal rotation. The symptoms are very similar to disc herniation, but the patient has no lumbar pain and spinal signs, there is obvious localized pressure pain and radiating pain in the pear-shaped muscle, the pain is reduced after straight leg elevation 60°, and the local pain disappears; the pain disappears after pear-shaped muscle block.
Patients complained of pain in the buttocks and lower limbs, mostly chronic, sometimes with acute attacks, aggravated by walking or activity, intermittent claudication may occur, alleviated by bed rest. The straight leg start height test may be positive, and may be accompanied by numbness in the lateral aspect of the calf and foot. Physical examination can be seen atrophy of the gluteus muscle, pressure pain in the area of the sciatic major cut, rectal palpation may be touched swollen and deformed pear-shaped muscle, and can cause the appearance of the above symptoms.
1）.Patients with pear-shaped muscle syndrome, no obvious pressure pain and deformity of the lumbar region, no restriction of movement;
(2), positive pear muscle tension test, pear muscle tension test is a method to check pear muscle injury. The specific steps are as follows: the patient lies supine on the examination bed, the affected limb straight, do internal rotation, such as the sciatic nerve has radioactive pain, and then quickly abduct the affected limb external rotation, the pain is then relieved, that is, positive pear muscle tension test. It is the common examination method of pear-shaped muscle syndrome.
3）.After the pressure point is closed locally with a long needle, the pain is immediately relieved.
II. Sciatica
Primary sciatica: that is, inflammatory lesion of the sciatic nerve, or direct injury to the sciatic nerve (hip injection, surgery). The onset of the disease is acute, and the pain is along the pathway of the sciatic nerve from the buttock to the distal end via the posterior thigh and fossa to the lateral calf, and the pain is persistent and dull, and may increase episodically or be burning-like stabbing pain, and the pain is relieved when standing. Some people suddenly feel a sharp pain in one side of the buttock, and the leg and foot on the same side also tingle, and then the pain slowly disappears.
Radicular sciatica
It is mostly caused by disc herniation, spinal osteoarthritis, spinal bone tumor and thickening of the ligamentum flavum and other lesions in the spinal canal and spine. The onset of the disease is slow, with a history of chronic low back pain, pain is more pronounced in sitting position than walking, pain is relieved or disappears in lying position, symptoms can recur, skin sensation of the lateral calf and dorsum of the foot is reduced or disappears, flexor strength of the foot and toe dorsiflexion is reduced, ankle reflex is reduced or disappears, such lesions can be X-rayed to assist in diagnosis.
Fourth, hip abscess
There is a difference between deep and superficial abscesses. Generally, abscesses formed in subcutaneous soft tissues are called superficial abscesses, while abscesses formed in deep subfascial and muscular layers and deep tissue spaces are called deep abscesses. The developed muscle of the buttocks is divided into blocks, the largest of which is the gluteus maximus, and if there is a purulent infection in that muscle or between the muscles, a deep abscess will be formed.
V. Sciatic nerve sheath tumor
Nerve sheath tumors occur in sensory, motor or mixed peripheral nerve sheath cells, mostly in cervical and extremity nerves, usually about 3 cm in size, a few have more than 10 cm, sciatic nerve sheath tumors are raised in the buttocks, and a huge mass is found deeper.
Supragluteal neuritis is also called “posterior branch of lumbar spinal nerve pain”.
The etiology is multifaceted, such as small intervertebral joint lesions, osteophytes, posterior spinal nerve compression, and chronic aseptic inflammation of the posterior branch. Because the superior gluteal cutaneous nerve comes from the lateral cutaneous branch of the posterior branch of the spinal nerve from lumbar 1 to lumbar 3 and is distributed in the lateral skin of the upper gluteal area, pain often appears in the lumbar, gluteal and thigh areas and rarely exceeds the knee joint. A comprehensive judgment is made based on history, symptoms and signs. There is pressure pain and soft tissue stripe-like hardness at 3-5 cm below the highest part of the iliac crest.
VII. Dense sacroiliac arthritis
Non-specific inflammation characterized by osteosclerosis, with highly dense osteosclerosis, especially in the lower 2/3 of the iliac crest, but no change in the joint space. There is recurrent lower back pain, sometimes radiating down to the buttocks and thighs on both sides.
VIII. Pseudosciatica
The gluteus minimus muscle in the buttock swells after frostbite and presses on the sciatic nerve causing pain. The buttock pain caused by pseudosciatica is not painful in the lower back but most painful in the buttocks, and there is pressure pain.