Alternative Treatment Approach to Piriformis Syndrome梨状肌综合征的治疗方法课件.ppt

An Alternative Treatment Approach to Piriformis Syndrome Korey Pieper, DPT, OCS Marie Potter, DPT, OCS, ATC Rick J Rafael, DPT, OCS, CSCS Jason Tonley, DPT, OCS Kaiser Permanente West Los Angeles Orthopaedic Residency Program September 2008 Piriformis SyndromeDefined “Neuritis of the branches of the sciatic nerve, caused by pressure of an injured or irritated piriformis muscle1.” Symptoms Radiating pain from the low back down over the sacrum into the buttocks and hip region, as well as down the posterior portion of the upper leg to the popliteal region1. Image from Anatomy image from Possible Causes of Piriformis Syndrome Anatomical variation L/S dysfunction Muscle tightness and/or spasm Overuse Post surgical injury SIJ dysfunction Trauma/fall Differential Diagnosis Differential Diagnosis of Hip pain7,8: Intra-articular Extra-articular (Often Managed Operatively) : Labral Tears Loose Bodies Femoroacetabular Impingement (FAI) Hypermobility Capsular Laxity Ligamentum Teres Tear Chondral Damage Snapping Hip Syndrome IT Band Syndrome Greater Trochanteric Bursitis Gluteal Tendon Injury Differential Diagnosis Differential Diagnosis of Hip pain7,8: Extra-articular Causes (Often Managed Non-Operatively): Femoral Neck Stress Fracture Adductor Strain Piriformis Syndrome Sacroiliac Joint Syndrome Tendonitis (hip flexors, abductors, adductors) Differential Diagnosis Other Competing Diagnosis: Lumbar Facet Syndrome Lumbar Disc Herniation Nerve entrapment Ischial Tuberosity Bursitis Lumbar radiculopathy Spinal stenosis Spondylolisthesis Osteoarthritis Common Treatment Options Treatment Options:2,3,4,5,6 Injections L/S stabilization exercises Mobilization/manipulation L/S Mobilization/manipulation SI joint Foot orthotics Soft tissue mobilization Strengthening Stretching Surgical / arthroscopic release Ultrasound