Definition.
Pyriform muscle syndrome is a condition in which pain in one hip and leg is predominantly caused by compression of the sciatic nerve due to injury to the pyriform muscle.
Anatomy.
The pear-shaped muscle is a deep muscle of the buttock, starting from the front of the sacral vertebrae, penetrating the greater sciatic foramen, while dividing it into the superior and inferior foramina of the pear-shaped muscle, ending at the greater trochanter of the femur. The pear-shaped muscle mainly cooperates with other muscles to accomplish large external rotation movements. The sciatic nerve travels just through the inferior foramen of the pear-shaped muscle out of the pelvis to the hip. It can be seen that the anatomical relationship between the pear-shaped muscle and the sciatic nerve is very close, if the pear-shaped muscle is injured or the pear-shaped muscle and the sciatic nerve anatomical variation may cause the sciatic nerve to be squeezed and various symptoms occur.
Etiology.
Pear-shaped muscle injury is the main cause of pear-shaped muscle syndrome, most patients have a history of trauma, such as flashing, twisting, crossing, standing, squatting with heavy objects on the shoulder, walking with weight and cold, etc.. Certain actions such as lower limb abduction, external rotation or squatting into a straight position when the pear-shaped muscle elongation, stretching and injury to the pear-shaped muscle.
After the injury of the pear-shaped muscle, local congestion and edema or spasm, repeated injury leads to hypertrophy of the pear-shaped muscle, can directly compress the sciatic nerve and pear-shaped muscle syndrome. Secondly, the anatomical relationship between the pear-shaped muscle and the sciatic nerve is mutated, which can also lead to compression or stimulation of the sciatic nerve and produce pear-shaped muscle syndrome.
In addition, due to some gynecological disorders such as inflammation of the pelvic ovaries or adnexa and inflammation of the sacroiliac joint may also affect the pear muscle, affecting the sciatic nerve through the inferior foramen of the pear muscle and the corresponding symptoms occur. Therefore, female patients with this disease also need to know the presence of gynecological inflammatory diseases.
Clinical manifestations.
Pain is the main manifestation of pear-shaped muscle syndrome. The pain is mainly in the buttocks and may radiate to the lower extremities. In severe cases, the pain may not be able to walk or may be severe after walking for a certain distance, requiring a short rest before continuing to walk. Patients may feel that the pain is deeper in location, and when it is dissipated, it is mainly to the back or posterior lateral side of the ipsilateral lower limb, and some may also be accompanied by numbness of the lateral calf and perineal discomfort.
Some people with severe pain may complain of “cutting” or “burning” pain in the buttocks, difficulty in flexing the legs, and difficulty in sleeping at night. The pain in the affected limb is aggravated by increased abdominal pressure due to urination, coughing, sneezing, etc.
It can be divided into surgical and non-surgical treatment. The vast majority of patients can be treated non-operatively, and surgical treatment is only used when non-operative conservative treatment is ineffective and the diagnosis is clear.
Patients should immediately stop running, cycling and any other activity that may trigger pain. If pain is present even in the sitting position, the patient should be placed in a standing position or the affected hip should be elevated. Although traction therapy is the usual treatment, it is rarely effective. Any forced straightening of the knee joint can cause pain.
Non-surgical treatments for pear-shaped muscle syndrome include manipulation, local closure, muscle injection, physical therapy, Chinese herbal medicine, and acupuncture. Local closure has a certain effect on relieving pain, which may be related to the reduction of fat around the muscle, reducing the compression of the nerve. 18ml of 25% glucose water is commonly used to add 2% procaine 2ml for local injection, once every 3 days, every 2-3 times for a course of treatment. Local closure with 2% procaine 6ml plus prednisolone 25ml is also used, twice a week, every 3 to 5 times for a course of treatment. Placental tissue fluid can be injected intramuscularly to treat tissue adhesions at the pelvic outlet of the sciatic nerve, 2 ml once a day for 30 times as a course of treatment.
Manipulation is the main method of treatment for pear-shaped muscle syndrome, which can significantly improve the symptoms and relieve the patient’s pain. When using manipulative treatment, the first thing is to choose the right site. The patient can be prone, both lower limbs posterior extension, so that the waist and hip muscles relaxed, the operator from the posterior iliac spine to the femur to make a line, the midpoint of the line straight down 2cm is the sciatic nerve out of the lower foramen of the pear-shaped muscle site, the two sides of the pear-shaped muscle. Manual treatment around this area, the following techniques are commonly used.
Massage and kneading method.
The operator crosses his hands and presses the painful point of the buttock with force, and the patient can have a feverish and comfortable feeling.
Plucking method.
The operator presses the thumbs of both hands on top of each other, presses the pear-shaped muscle with force and plucks it back and forth in the area of blunt thickness or hardening, and it should be noted that the direction of plucking should be perpendicular to the direction of the pear-shaped muscle fibers. If the thumbs are not strong enough to reach the pear-shaped muscle, the operator can use the elbow tip to replace the treatment.
Compression method.
The surgeon’s hands should be crossed to press the painful point for about 1 minute.
The above techniques can be performed sequentially. After pressing, the operator holds the patient’s ankle with both hands and does continuous small up and down shaking with slight force for about 10 to 20 times and ends.
The manual therapy does not need to be done every day, but twice a week for 2 to 3 weeks. Patients should be reminded that they should go to the relevant departments of the regular hospital for treatment to ensure safety and effectiveness, and should not go to the illegal practice of individual massage office for treatment. Manual therapy is safe and effective for operators who have received formal learning and training, but if the individual massage personnel who have not learned anatomical knowledge, inevitably crude and brutal, there is still a certain degree of danger.