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DEEP GLUTEAL PAIN SYNDROME (Piriformis syndrome) - Coggle Diagram
DEEP GLUTEAL PAIN SYNDROME (Piriformis syndrome)
SUBJECTIVE HISTORY
Pain
Buttock and often retro greater trochanter pain
Bilateral, but usually unilateral symptoms
Prolonged sitting pain (>20/30mins)
Pain in hip flexion and knee extension
Insidious
Non-discogenic
Sciatic, nerve entrapment/compression
Gait
Could be limping
OBJECTIVE FINDINGS
Clear spine (over-pressure)
Clear knee (over pressure)
Palpation
Pain in glutes around performs / ischial area - increased with in provocative position.
Special tests
Replicating aggregating postion (leg extension, P+N, poss. adduction, tense of glutes.)
FABER test - Faber position - where does pain come from? If P&N / deep in buttock then points to nerve.
FABER (Sens 89% for any 'hip pathology'
FADIR - rules OUT OA
Straightleg riase- stretches Sciatic nerve - will cause pain
Active Piriformis test Sensation 78%, Spec 80%) - reproduces P&N, pain, parathesia running into thigh.
Piriformis stretch test - illicit similar symptoms = combines with its active test = Sens 91%, Sepc 80%)
Clear SIJ (Stork test-questionable test)
Gait
Patients could limp
P&N in glutei and leg area (sciatic distrubition)
Reports NO back pain
Neurological sensory changes
Night pain, disturbed sleep
Increased symptoms when laying on affected side
Pain with stride into a terminal extension
Pain with stride into terminal extension
2 other types of gluteal nerve entrapment
Pudendal nerve (cyclists syndrome)
POOdendal = also affects incontenance (poo+wee), & sex & rectal pain
Ischiofemoral impingement
Less trochanter pressing into Ichiltuberosity = narrowing gap = pressure on sciatic nerve
Following THR
Pain in posterior leg & deep buttock ache, especially with hip extension+adduction.
Hip extension + adduction
Pain on ischial palpation when performing provocative movement
Can cause back pain due to lack of hip exertion due to pain/irritation
Deep-seated buttock aching pain, sometimes radiates to the knee.
Snapping, clicking, locking sensation during long-stride walking used by lesser trochanter forcefully bypassing the ischium