What are the problems of pear-shaped muscle syndrome

  1.What is pear-shaped muscle syndrome?
  Pear-shaped muscle syndrome refers to the pain of one side of the hip and leg caused by the compression of the sciatic nerve due to the injury of the pear-shaped muscle.
  2.Why does it cause pear-shaped muscle syndrome?
The pear-shaped muscle is a deep muscle of the hip, starting from the front of the sacral vertebrae, penetrating the sciatic foramen, and 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.
  3.What is the main cause of pear-shaped muscle syndrome?
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 getting 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, for this disease female patients also need to know whether there is gynecological inflammatory disease.
  4.What are the main symptoms of pear-shaped muscle syndrome?
Pain is the main manifestation of pear-shaped muscle syndrome. The pain is mainly in the buttocks, and can radiate to the lower limbs, in severe cases can not walk or walk a distance after the pain is intense, need to rest a moment 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 of them may also be accompanied by numbness in the lateral calf and discomfort in the perineum.
If the pain is severe, you may complain of “cutting” or “burning” pain in the buttocks, difficulty in flexing the legs, kneeling on both knees, and difficulty in sleeping at night. The pain in the affected limb is aggravated by the increase in abdominal pressure due to urination and defecation, coughing and sneezing.
  5.What is the diagnosis of pear-shaped muscle syndrome based on?
The main clinical manifestations of pear-shaped muscle syndrome are as mentioned above: pain in the buttocks and radiates to the back or rear of the ipsilateral lower limb; urination and defecation, coughing and sneezing can increase the pain. In addition, the diagnosis of pear-shaped muscle syndrome also requires the support of some examination signs: the affected hip has obvious pressure pain, especially in the area of pear-shaped muscle, which may be accompanied by atrophy, and diffuse blunt thickening can be palpated, which becomes striated or pear-shaped muscle bundle, and local hardening.
The pain is positive before the straight leg raise at 60°, because the pear-shaped muscle is stretched to tension, so that the compression stimulation of the injured pear-shaped muscle on the sciatic nerve is more serious, so the pain is obvious, but after more than 60°, the pear-shaped muscle is no longer stretched, and the pain is reduced. In addition, in addition to the straight leg raise test, also do the pear muscle tension test. Usually, the pear-shaped muscle tension test is also positive in the case of pear-shaped muscle syndrome.
  6.What is the pear muscle tension test?
  Pear muscle tension test is a method to check the damage of the pear muscle. The specific steps are as follows: the patient lies on his back on the examination bed, straighten the affected limb, do internal rotation, if the sciatic nerve has radioactive pain, and then quickly abduct the affected limb and rotate, the pain is then relieved, that is, the pear muscle tension test is positive. It is the common examination method of pear-shaped muscle syndrome.
  7.What diseases should be distinguished from pear-shaped muscle syndrome?
The main manifestation of pear-shaped muscle syndrome is hip pain and radiation to the affected side, that is, sciatic nerve compression symptoms. There are various diseases that cause sciatic nerve compression symptoms in the clinic, so the diagnosis of pear-shaped muscle syndrome needs to exclude sciatic nerve pain caused by other diseases. The main diseases are sciatica and radicular sciatica. Sciatica has an acute onset, and the pain dissipates along the sciatic nerve pathway from the buttock to the distal end via the posterior thigh and fossa to the lateral calf, with a persistent dull pain that may increase episodically or with a burning stabbing pain that is relieved when standing. Root sciatica is usually caused by disc herniation, spinal osteoarthritis, spinal bone tumors and thickening of the ligamentum flavum, and other intra-vertebral canal and spinal lesions.
The onset of the disease is slow, with a history of chronic low back pain, pain is more pronounced in sitting than walking, and 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, and ankle reflex is reduced or disappears. In addition, pear-shaped muscle syndrome should be distinguished from other diseases causing dry sciatica, such as hip abscess, sciatic nerve syringomyelia and other diseases.
  8.How to treat pear-shaped muscle syndrome?
  The treatment of pear-shaped muscle syndrome can be divided into surgical treatment and non-surgical treatment. The vast majority of patients can be treated by non-surgical treatment, only when non-surgical conservative treatment is ineffective, and the diagnosis is clear to take surgical treatment.
  9.What are the non-surgical treatments for pyriform muscle syndrome?
  Non-surgical treatment for pear-shaped muscle syndrome includes manipulation, local closure, muscle injection, physiotherapy, Chinese herbal medicine, acupuncture and so on. Local closure has a certain role in relieving pain, commonly used 25% glucose water 18ml add 2% procaine 2ml for local injection, once every 3 days, every 2 to 3 times for a course of treatment. It can also be used as local closure with 2% procaine 6ml plus prednisolone 25ml, twice a week, every 3 to 5 times for a course of treatment. Myocardial injection of placental tissue fluid can treat tissue adhesions at the pelvic outlet of the sciatic nerve, once a day, 2 ml each time, 30 times for a course of treatment.
  10.How to treat pear-shaped muscle syndrome with manipulation?
  Manipulation is the main method of treating pear-shaped muscle syndrome, which can significantly improve the symptoms and relieve the patient’s pain. When using manipulation treatment, first of all, we should 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 superior 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, 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 buttocks, and the patient can have a warm and comfortable feeling.
  The operator’s thumbs are pressed against each other, and deep pressure is applied to the dull and thick or hardened pear-shaped muscle and the muscle is pulled back and forth. The popping and pulling about 10 to 20 times, if the thumb strength is not enough to reach the pear muscle, the operator can use the elbow tip to replace the treatment.
  Pressing method: The doctor crosses his hands to press the painful point for about 1 minute.
  The above techniques can be performed sequentially. After the pressure, 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.
  11.Do I need to do the manipulation treatment every day?
  It is not necessary to do it every day, but 2 times a week for 2-3 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 medical 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.

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