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Apostolos H. Karantanas - One of the best experts on this subject based on the ideXlab platform.
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Piriformis Muscle syndrome a cross sectional imaging study in 116 patients and evaluation of therapeutic outcome
European Radiology, 2018Co-Authors: Evangelia E. Vassalou, Pavlos Katonis, Apostolos H. KarantanasAbstract:Objectives To increase the clinical awareness of Piriformis Muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome.
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Piriformis Muscle syndrome a cross sectional imaging study in 116 patients and evaluation of therapeutic outcome
European Radiology, 2018Co-Authors: Evangelia E. Vassalou, Pavlos Katonis, Apostolos H. KarantanasAbstract:To increase the clinical awareness of Piriformis Muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome. Within a 10-year-period, 116 patients referred for radiological evaluation of clinically suspected PMs, with excluded lumbar pathology related to symptomatology, were prospectively studied with MRI and/or computed tomography (CT). Piriformis Muscle (PM), sciatic nerve (SN), Piriformis region and sacroiliac joints were evaluated. PMs was categorised into primary/secondary, according to a reported classification system. Treatment decisions were recorded. Outcome was categorised using a 3-point-scale. Seventy-four patients (63.8%) exhibited pathologies related to PMs. Primary causes were detected in 12 and secondary in 62 patients. PM enlargement was found in 45.9% of patients, abnormal PM signal intensity/density in 40.5% and sciatic neuritis in 25.7%. Space-occupying lesions represented the most common related pathology. Treatment proved effective in 5/8 patients with primary and 34/51 patients with secondary PMs. In 34 patients, imaging revealed an unknown underlying medical condition and altered treatment planning. Secondary PMs aetiologies appear to prevail. In suspected PMs, PM enlargement represented the most common imaging finding and space-occupying lesions the leading cause. Imaging had the potential to alter treatment decisions. • In clinically suspected PMs cross-sectional imaging may reveal variable pathology. • Secondary PMs aetiologies appeared to be more common than primary. • PM enlargement represented the most common imaging finding in clinically suspected PMs. • Space-occupying lesions in the Piriformis region represented the leading cause of PMs. • In clinically suspected PMs cross-sectional imaging may alter treatment planning.
Maryam Ahmadi - One of the best experts on this subject based on the ideXlab platform.
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pressure pain threshold in subjects with Piriformis syndrome test retest intrarater and interrater reliability and minimal detectible changes
Archives of Physical Medicine and Rehabilitation, 2020Co-Authors: Abbas Tabatabaiee, Ismail Ebrahimi Takamjani, Javad Sarrafzadeh, Reza Salehi, Maryam AhmadiAbstract:Abstract Objective This study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected Piriformis Muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected Piriformis Muscles was compared with healthy Piriformis Muscles. Study Design This study used a comparative and reliability-based design. Setting Rehabilitation clinic. Participants Patients (N=30) with unilateral Piriformis Muscle syndrome (30 affected and 30 healthy Piriformis Muscles) were recruited, and the PPT of both the healthy and affected Piriformis Muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment. Interventions Not applicable. Main Outcome Measure PPT. Results Excellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected Piriformis (ICC: 0.86-0.96) and the healthy Piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected Piriformis Muscles. The findings revealed a significant decrease in the PPT of the affected Piriformis Muscle in comparison to the healthy Piriformis Muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P Conclusions Digital algometry is a reliable tool for measuring Piriformis PPT, regardless of the testing session and the rater. Patients with unilateral Piriformis Muscle syndrome have increased tenderness and decreased PPT in the affected Piriformis Muscle in comparison to the healthy Piriformis Muscle.
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ultrasound guided dry needling decreases pain in patients with Piriformis syndrome
Muscle & Nerve, 2019Co-Authors: Abbas Tabatabaiee, Ismail Ebrahimi Takamjani, Javad Sarrafzadeh, Reza Salehi, Maryam AhmadiAbstract:Introduction Piriformis Muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip-joint mobility, and may have an impact on quality of life. Methods Thirty-two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound-guided dry needling (DN) of the Piriformis Muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment. Results At 1-week follow-up, pain intensity was significantly less in the DN group than in the waitlist control group (-2.16 [-1.01 to -3.32], P = .007) by an amount consistent with clinically meaningful improvement. Discussion The findings suggest that DN resulted in clinically meaningful short-term improvement in pain intensity of patients with PMS.
Evangelia E. Vassalou - One of the best experts on this subject based on the ideXlab platform.
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Piriformis Muscle syndrome a cross sectional imaging study in 116 patients and evaluation of therapeutic outcome
European Radiology, 2018Co-Authors: Evangelia E. Vassalou, Pavlos Katonis, Apostolos H. KarantanasAbstract:Objectives To increase the clinical awareness of Piriformis Muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome.
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Piriformis Muscle syndrome a cross sectional imaging study in 116 patients and evaluation of therapeutic outcome
European Radiology, 2018Co-Authors: Evangelia E. Vassalou, Pavlos Katonis, Apostolos H. KarantanasAbstract:To increase the clinical awareness of Piriformis Muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome. Within a 10-year-period, 116 patients referred for radiological evaluation of clinically suspected PMs, with excluded lumbar pathology related to symptomatology, were prospectively studied with MRI and/or computed tomography (CT). Piriformis Muscle (PM), sciatic nerve (SN), Piriformis region and sacroiliac joints were evaluated. PMs was categorised into primary/secondary, according to a reported classification system. Treatment decisions were recorded. Outcome was categorised using a 3-point-scale. Seventy-four patients (63.8%) exhibited pathologies related to PMs. Primary causes were detected in 12 and secondary in 62 patients. PM enlargement was found in 45.9% of patients, abnormal PM signal intensity/density in 40.5% and sciatic neuritis in 25.7%. Space-occupying lesions represented the most common related pathology. Treatment proved effective in 5/8 patients with primary and 34/51 patients with secondary PMs. In 34 patients, imaging revealed an unknown underlying medical condition and altered treatment planning. Secondary PMs aetiologies appear to prevail. In suspected PMs, PM enlargement represented the most common imaging finding and space-occupying lesions the leading cause. Imaging had the potential to alter treatment decisions. • In clinically suspected PMs cross-sectional imaging may reveal variable pathology. • Secondary PMs aetiologies appeared to be more common than primary. • PM enlargement represented the most common imaging finding in clinically suspected PMs. • Space-occupying lesions in the Piriformis region represented the leading cause of PMs. • In clinically suspected PMs cross-sectional imaging may alter treatment planning.
Nicholas M Barbaro - One of the best experts on this subject based on the ideXlab platform.
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a novel method for sciatic nerve decompression cadaveric feasibility study with potential application to patients with Piriformis syndrome
Translational Research in Anatomy, 2015Co-Authors: Richard Isaiah Tubbs, Nicholas M Barbaro, Marios Loukas, James C Barton, Caroline C Watson, Theofanis Kollias, Robert J Ward, Aaron A CohengadolAbstract:Abstract Introduction Approaches for proximal sciatic nerve decompression use a transgluteal route, but are associated with morbidity and complications. An alternative anterior approach to the sciatic nerve was designed. Methods Five adult human cadavers (10 sides) were used. In the supine position and with lower limbs abducted, an incision was made 3-cm inferolateral to the pubic tubercle of each specimen. With blunt dissection, a Muscle-splitting approach through the obturator foramen was performed through the underlying adductor Muscles and deeper obturator Muscles that traversed the obturator foramen. Within the pelvis, a laparoscope was inserted in the surgical corridor, which was extraperitoneal. The obturator neurovascular bundle was identified medially and followed posterolaterally toward the greater sciatic foramen. The sciatic nerve was identified. The Piriformis Muscle was identified as it exited the greater sciatic foramen. Microscissors were inserted and under visualization with the laparoscope, the Piriformis Muscle was transected near the spine. Results The Piriformis was well visualized and transected. The Muscle was best visualized inferolateral to the sciatic nerve. No gross damage to the sciatic nerve or surrounding neurovascular structures occurred. Mean distance from the superomedial edge of the obturator foramen to the ischial spine was 7.2 cm for left sides and 7.3 cm for right sides. Conclusions Use of a laparoscope to approach the Piriformis Muscle from an anterior intrapelvic, extraperitoneal approach via the obturator foramen is feasible. Clinical use of this method is in order to demonstrate use in patients with suspected compression of the sciatic nerve by the Piriformis Muscle.
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A novel method for sciatic nerve decompression: Cadaveric feasibility study with potential application to patients with Piriformis syndrome
Elsevier, 2015Co-Authors: Richard Isaiah Tubbs, Nicholas M Barbaro, Marios Loukas, James C Barton, Caroline C Watson, Theofanis Kollias, Robert J Ward, Aaron A. Cohen-gadolAbstract:Introduction: Approaches for proximal sciatic nerve decompression use a transgluteal route, but are associated with morbidity and complications. An alternative anterior approach to the sciatic nerve was designed. Methods: Five adult human cadavers (10 sides) were used. In the supine position and with lower limbs abducted, an incision was made 3-cm inferolateral to the pubic tubercle of each specimen. With blunt dissection, a Muscle-splitting approach through the obturator foramen was performed through the underlying adductor Muscles and deeper obturator Muscles that traversed the obturator foramen. Within the pelvis, a laparoscope was inserted in the surgical corridor, which was extraperitoneal. The obturator neurovascular bundle was identified medially and followed posterolaterally toward the greater sciatic foramen. The sciatic nerve was identified. The Piriformis Muscle was identified as it exited the greater sciatic foramen. Microscissors were inserted and under visualization with the laparoscope, the Piriformis Muscle was transected near the spine. Results: The Piriformis was well visualized and transected. The Muscle was best visualized inferolateral to the sciatic nerve. No gross damage to the sciatic nerve or surrounding neurovascular structures occurred. Mean distance from the superomedial edge of the obturator foramen to the ischial spine was 7.2 cm for left sides and 7.3 cm for right sides. Conclusions: Use of a laparoscope to approach the Piriformis Muscle from an anterior intrapelvic, extraperitoneal approach via the obturator foramen is feasible. Clinical use of this method is in order to demonstrate use in patients with suspected compression of the sciatic nerve by the Piriformis Muscle. Keywords: Surgery, Anatomy, Sciatic nerve, Endoscopy, Laparoscopy, Piriformis, Gluteal Muscle
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magnetic resonance neurography in extraspinal sciatica
JAMA Neurology, 2006Co-Authors: Aaron M Lewis, Robert B Layzer, John W Engstrom, Nicholas M Barbaro, Cynthia ChinAbstract:Background Sciatica without evidence of lumbosacral root compression is often attributed to Piriformis syndrome. However, specific diagnostic tools have not been available to demonstrate sciatic nerve entrapment by the Piriformis Muscle. Objective To evaluate the use of magnetic resonance (MR) neurography in identifying abnormalities of the sciatic nerve in patients with unexplained sciatica. Design Case series from a retrospective medical record review. Patients Fourteen patients with sciatic distribution pain and normal results on MR imaging for lumbosacral radiculopathy were referred for MR neurography of the lumbosacral plexus and sciatic nerves. Results In 12 patients, MR neurography demonstrated increased fluid-attenuated inversion recovery signal in the ipsilateral sciatic nerve. In most patients, this abnormal signal was seen at the sciatic notch, at or just inferior to the level of the Piriformis Muscle. To date, 4 patients have undergone surgical decompression, with excellent relief of symptoms in 3 of them. Conclusion Magnetic resonance neurography often identifies an abnormal increased signal in the proximal sciatic nerve in patients with extraspinal sciatica and allows more accurate diagnosis of sciatic nerve entrapment in suspected cases.
Pavlos Katonis - One of the best experts on this subject based on the ideXlab platform.
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Piriformis Muscle syndrome a cross sectional imaging study in 116 patients and evaluation of therapeutic outcome
European Radiology, 2018Co-Authors: Evangelia E. Vassalou, Pavlos Katonis, Apostolos H. KarantanasAbstract:Objectives To increase the clinical awareness of Piriformis Muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome.
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Piriformis Muscle syndrome a cross sectional imaging study in 116 patients and evaluation of therapeutic outcome
European Radiology, 2018Co-Authors: Evangelia E. Vassalou, Pavlos Katonis, Apostolos H. KarantanasAbstract:To increase the clinical awareness of Piriformis Muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome. Within a 10-year-period, 116 patients referred for radiological evaluation of clinically suspected PMs, with excluded lumbar pathology related to symptomatology, were prospectively studied with MRI and/or computed tomography (CT). Piriformis Muscle (PM), sciatic nerve (SN), Piriformis region and sacroiliac joints were evaluated. PMs was categorised into primary/secondary, according to a reported classification system. Treatment decisions were recorded. Outcome was categorised using a 3-point-scale. Seventy-four patients (63.8%) exhibited pathologies related to PMs. Primary causes were detected in 12 and secondary in 62 patients. PM enlargement was found in 45.9% of patients, abnormal PM signal intensity/density in 40.5% and sciatic neuritis in 25.7%. Space-occupying lesions represented the most common related pathology. Treatment proved effective in 5/8 patients with primary and 34/51 patients with secondary PMs. In 34 patients, imaging revealed an unknown underlying medical condition and altered treatment planning. Secondary PMs aetiologies appear to prevail. In suspected PMs, PM enlargement represented the most common imaging finding and space-occupying lesions the leading cause. Imaging had the potential to alter treatment decisions. • In clinically suspected PMs cross-sectional imaging may reveal variable pathology. • Secondary PMs aetiologies appeared to be more common than primary. • PM enlargement represented the most common imaging finding in clinically suspected PMs. • Space-occupying lesions in the Piriformis region represented the leading cause of PMs. • In clinically suspected PMs cross-sectional imaging may alter treatment planning.
