The Piriformis syndrome causes and diagnosis - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 21 сер 2024
- Dr. Ebraheim’s educational animated video describesthe piriformis muscle why it is important.
This educational animated video describes the condition know as piriformis syndrome, the signs and symptoms, etiology, diagnostic tests, and the treatment options.
The sciatic nerve is compressed by the piriformis muscles in the buttock. piriformis syndrome may be associated with lower lumbar-radiculopathy similar to spine pathology. Some patients may have spine surgery without improvement.
Symptoms
•Occasionally develops from blunt trauma to the buttock.
•Localized buttock pain increased by sitting or driving.
•Pain increased by bicycling or running in young individuals.
•Radicular symptoms with pain and paresthesia, however it is not common.
•Pain may present when palpating directly into the area of the greater sciatic notch.
Provocative test
Lasegue’s maneuver
•Reproduction of the pain by the hip is flexed to 90 degrees and the knee extended.
The sciatic nerve is compressed by the piriformis muscle, fibrous bands or by vascular anomalies.
Be aware of possible anatomical variation of the sciatic nerve ( Four types of variations).
The sciatic nerve is composed of the tibial and peroneal divisions which are usually bound together but sometimes may divide as they pass the piriformis muscle.
Relation of the sciatic nerve to the piriformis muscle
1-A normal relationship with the sciatic nerve passing beneath piriformis muscle.
2-Piriformis divided into two parts with the peroneal division of the sciatic nerve passing between the two parts of the piriformis muscle.
3-Peroneal division of the sciatic nerve passes over the muscle and the tibial division passes beneath the undivided piriformis muscle.
4-The entire nerve passes through the divided piriformis muscle.
Diagnosis
•High index of suspicion
•Patient history and exam
•EMG and bone scan are not very helpful
•MRI:
a)enlarged piriformis
b)anomalies of the vessels
c)compression of the nerve.
Diagnostic injection is helpful.
Treatment
•Aquatic therapy
•Physiotherapy
•NSAID medication
•Injections.
•Surgical release of the piriformis muscle and decompression of the sciatic nerve is the last resort.
Consider possibility of piriformis syndrome when treating trochanteric bursitis or patient with sciatica especially after a failed spine surgery.
Patient with sciatica will have pathology in the lumbar spine as shown on MRI such as disc herniation, lumbar stenosis, or degenerative changes.
Patient with piriformis syndrome may not have symptoms or MRI findings related to the lower back.
High index of suspicion in a patient with buttock or leg pain in the absence of lumbar pathology.
This pain is increased while sitting with minimal or no back pain.
Piriformis syndrome is a hidden cause of sciatica.
Thank you Doctor. Your overview has answer many of my questions. Exceelent presentation!!!
Thanks
Thank you so much. Have had this for far too many years but have never heard it explained so well.
Thank you
This narration is highly informative and allows the patient to clearly understand the fundamentals of the various conditions. I will be seeing my doctor Monday and have benefited greatly from this tutorial allowing me to be interactive. Thank you. 👋👱♀️🇺🇲
This was the best video for people who are trying to figure out what is causing the source of the pain for the appropriate treatment.
Thank you!!! This has helped me to understand the pain I've been having for many years. I appreciate the time and effort you have taken to explain this!
Fantastic, very clear and transparent showing knowledge, great visualisation, thank you Dr. Nabil Ebraheim.
Thank tou so much. Your videos help me to better understand my issues. And avoid waking them up in my Pilates class!
Thank you for making this video. This is very helpful.
Extremely helpful! Thank you, Dr. Navil! You have helped me understand this hard to understand condition.
Now I understand why I am in sooo much pain. I definitely had a failed back surgery. Thank you for a clear explanation.
Thank you so much. I m going through a confusion, whether my sciatica is due to Piriformis or disc bulge.
Thank you 🙏 so much Dr Nabil, the best video I ever watched
I am in pain for the last 3 months. I have mainly pain in the morning when I start walking, from the buttock down the leg, have bursitis, and some lower back stenosis. It started from not being able to stand on my left leg, so I had to crawl on knees in order to go to the toilet. I really would like to have MRI. I was also very fit, I always had lower back pain. The buttock pain & the back of the leg is very severe 😢
Accrding to this video my doctor in Sweden SHOULD consider the POSSIBILITY that my sciatica and walking difficulties are caused by a piriformis syndrome. As I am almost sure is the case. But no... In Sweden´s FREE public health care the preferred diagnosis is hip arthritis and no attention at all is given to piriformis syndrome. The doctors tells me that "oh no, the piriformis is a very small muscle and can not cause a serious sciatica, your problem is severe hip arthritis"... well I KNOW I have hip arthritis now and I am SURE it is because I have had a piriformis syndrome with sciatica for many years. Now I will pay a private physioterapeut specialist what is needed to investigate this problem further. If I can cure the piriformis syndrome maybe my hip will heal to some degree.
These videos by Nabil Ebraheim are very good indeed and the public health care in Sweden is severely corrupt.
Hello. Are you okay now?
@@sezgigi No, I´m not ok, but after choosing supportive exercise programs as my method for improvement I am at least better. Previously I had a lot of pain in my left buttock and it was quite painful to move. I have also done some MRT´s and they discovered lots of lumbar spine problems and I treat therm now by doing water gymnastics. That works also ! My back is rapidly getting better and that decrease the pressure on my hip joint.
I believe any joint surgery is bad for You if You are able to exercise, improve and find relief that way.
Wonderful as usual our prof
Very helpful, well put together
سلمت الانامل بروفيسورنا الغالي.. انا اسمي هذا الشرح بالمختصر الوجيز... ارفع لك لك القبعة لك ولعلمك.. بارك الله فيك. تحياتي واحترامي لشخصكم الكريم.
من اين انت؟؟
@@Ahmed-dc8ep من كردستان (شمال العراق).
@@hawrealimohammed5161 اهلاً وسهلاً بحضرتك
لفت انتباهي بلاغة اللغة وواضح برضو انك مسلم
حاجة جميلة متابعة العرب لفيديوهات زي دي
@@Ahmed-dc8ep لكم التقدير والاحترام من كل قلبي وأتمنى لكم وللجميع القائمين على نشر المعلومات المفيدة من أشخاص يشار إليهم بالبنان.... ونعم انا مسلم ولله الحمد واتصور انك من مصر المحروسة 😊
@@hawrealimohammed5161 حبببي ربنا يكرمك يا رب
ااه فعلاً من مصر ☺️
Thank you for a very concise and clear explanation, bravo!
Thank you So!! Much! Doc! For being detailed and explaining everything so simple. This information will help my conversation with the orthopedic physician.
Excellent explanation. Thank you so much.
I think the comments are the best knowledge for todays society.
I ve got a bad injury 3 years ago on my left hip, and im still researching what exactly do i have, because the doctors won't tell you nothing, they see you as a number more, that's all
Experiencing this right now and I am so done.... There's got to be something that can be done because therapy isn't working.....
Mine start to hurting when im standing longer then 5 minutes from the buttock down to knee, sometime ankle.
Thanks for the information!
I have both. Herniated bulging disc in my L5-S1 disc and Piriformis Syndrome. When it happens at the same time I've colloquially named it "The Double Whammy" effect.
How are u now
I too have l5 s1 disc problem and symptoms similar to piriformis syndrome
I need to know how to fix this. Over 5 years of physio and varous treatments are not working. I'm getting muscle loss in hamstring and calf now because of the pain.
Eat more Protein.
You're probably not getting enough protein.
Try to eat 1 gram per each pound that you weigh. The less should be 0.7 × (your weight)= the amount of grams per pound per day.
@@Eros13adios what do you mean "the less" I am not trying to be rude, but English is not your first language right?
@@matchpoint14I think he meant the lowest daily amount of protein you should consume to be healthy
Good morning sir
Useful video
Tank u so mch veri hejpful
I have this for sure when Im sitting if I move my bottom and back hurts if I try to stand my bottom and back hurts when I walk my lower back hurts I can’t wait until this goes away I believe I had this b4 no pain in the legs tho
What about pulse therapy directly on the notch??.. that procedure relaxed mine to the point of being non existent!!👍
My pain does not go down my leg. It goes across the bottom of my butt where it meets my thigh, starts midway, goes along the curve and up to my inner thigh. It shocks like stinging bees near my private area which is devastating. Has anyone had this and what did you do to help it? I had a piriformis injection, pain completely went away and two days later came back. Not as strong as the original pain, but still hurts like heck when it hits the area of the inner thigh between the legs.
I can’t walk
- Had to get crutches
- Feels like a hemorrhoid
- Pain travels
- Originally under left butt cheek
- Down the left leg
- Across butthole
- And sometimes to the right side
- Up to both hips
- Feels like I broke my pelvis
- have to have a pillow between my legs when laying down to the side
- with the crutch could not lift my leg
- Each day getting better
- Still on crutches
- 4 days now
@@dzheath I found out that my PAIN was irritation of the CLUNEAL nerves. There are 3 on each side of our butt cheeks and when irritated they cause pain across the area. There is the superior cluneal nerve on top, middle cluneal nerve, and inferior cluneal nerve on the bottom. There are blocks for this to block the pain. They are sensory nerves that cause pain and stinging/shock feeling across the butt, into the privates, hips, and down the leg. You can google cluneal nerves to read up on it.
I have this pain and I have a lumbar disc herniation, but I do not have any pain down my leg, it stops at my buttock but it is painful. Thankfully it is not down my leg but there is NO way any doctor can tell for sure what is causing it.
I'm only 20, why am I experiencing this?? 😭😭
It could be an injury, did you do anything strenuous? Using back and legs? One commenter got it doing pilates
That's cute I'm 18 had it for 3 years
How to treat it
Has anyone had any success in alleviating this condition from treatment with Traditional Thai Massage, or could such treatment potentially be too aggressive & aggravate the symptoms ?
Tried this, didn't work. 😢
Wow just wow
I get this pain only while driving. What would you advise?
drive standing
Walking
Does working out help, glute muscles
From my own personal experience the glute muscles have no positive or negative interplay with the piriformis
You do not mention spinal stenosis?
I was diagnosed with that by an orthopedic surgeon. He does surgery only… not physio or musculoskeletal balancing. He said he has no idea on all that - it’s not his focus.
I learned that even the wrong exercise can irritate the nerve to the point of stenosis so all the doctors see is the result of your issues, not the cause which in my case they simply say are the disc bulges. It ain’t necessarily so. I have a several disc bulges etc, bad MRI. but apparently most people have that, including asymptomatic ones…. Many sciatica surgeries fail to solve the issues, according to what I read. I almost solved my issues going at it myself, with a vibration plate. See my other comment. No surgeries, injections or infiltrations. Medication reduced to the minimum, only when I expect to walk or stand a lot.
My hip muscles are melting, what should I do?
Melting?
Anyone here who overcame this? I need to know how'd you do it?
I am also suffering from this do you know how to recover
I’ve been struggling with this for a year. It’s so bad
I’m overcoming it slowly. This video is helping a lot. ua-cam.com/video/V4wMKAF6ZzA/v-deo.html
I do it twice a day, first thing in the morning and right before bed.
Ayurveda can cure
I've been rolling around on a tennis ball. Which has improved it considerably.
Does a person here know if, or not that iritation causes a reaction to the muscles?
Small, or even greater iritation levels?
Please, and thanks in front.
And thank you again Sir for spending your time in making another video to teach.
Oh.
Does a person also know if the human lungs emit its own body chemicals?
Is all human chemical production just hormonal production?
Im wondering if acupuncture would help.
I tried this too and dry needling, didn't work
😢
Not sure why I heard ridiculous syndrome somewhere and bust out laughing! 😂
Hey doctor, I had something like a piriformis or sciatica issue for 4 months I tried everything... But stretches would be so painful even though I did it for 2 months but then I decided to get injections or last result surgery as they are saying there is something showing in he mri.... I've never had a back issue it's always been my butt then down the right side of my leg to my calf but miraculously it has been gone for more than 1 week would I still go ahead with the injections they still havent called for my appointment it takes weeks I hear thanks
دكتور انا عملت الاشعة الرنين والدكتور يقول انزلاق غضروفي طبعاً قالي تحتاج الى عملية انا رفضت وقلت اخذ ابر الستيرود وبعد مافادتني لكن بعد فترة الاحظ ان الالم اكثر في اسفل الارداف اذا جلست على سطح صلب يصير عندي تنمل . فهل الي اعاني منه متلازمة الكمثري .
فاذا كان الحقنة في العمود الفقري لم تنفع هل هذا يعني ان المشكلة في الغضلة الكمثرية
Surgery ??? Not necessary. I have piriformis syndrome occasionally. If it is severe I visit a chiropractitioner, if it is mild I use some simple exercises. But I would never accept surgery for it.
👍
Please help me i have piriformis and iam constipated. Anal sphincter is not loose 😭😭😭
My buttocks is too tight and painful.
I watched few of these and they never show a proper diagram, why don't they show a normal person standing and show the area on the buttock that the piriformis is and where it hurts. These stupid diagrams do not show the exact spot of the location I can't tell if it is low on the hip or high on the hip there is nothing to gauge it by on this diagram but a big hip bone, we need a better reference, how can these people not know any better. I have not found once half way decent doctor
🙏🌈🙏
Thank you so much 🙏❤️❤️❤️❤️
I am going thro the same thing a lot of back pain numbness in the back of my thigh and calf and foot after xrays doctor said it was lower spine arthritis but the physio says its piriformis syndrome thing is its not respondong to physio treatment so now i am confused and in more pain😢
Dear Doctor, Can we live without piriformis muscle. A Doc wants to remove my Piriformis muscle because I have PS.
I got the injury while dancing i a bboy… I can twist feeling the pain 😢