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Armine Danielyan - One of the best experts on this subject based on the ideXlab platform.

  • Four symptoms define the Piriformis Syndrome: an updated systematic review of its clinical features
    European Journal of Orthopaedic Surgery & Traumatology, 2018
    Co-Authors: Kevork Hopayian, Armine Danielyan
    Abstract:

    Purpose To update the evidence on the clinical features of the Piriformis Syndrome since the first systematic review published in 2010. Method A systematic review of all case, cross-sectional and prevalence studies. Results The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases Piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Conclusions Piriformis Syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis Syndrome is at a stage previously encountered with herniated intervertebral disc: that Piriformis muscle pathology can cause sciatica has been demonstrated, but its prevalence among low back pain and sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.

  • four symptoms define the Piriformis Syndrome an updated systematic review of its clinical features
    European Journal of Orthopaedic Surgery and Traumatology, 2018
    Co-Authors: Kevork Hopayian, Armine Danielyan
    Abstract:

    To update the evidence on the clinical features of the Piriformis Syndrome since the first systematic review published in 2010. A systematic review of all case, cross-sectional and prevalence studies. The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases Piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Piriformis Syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis Syndrome is at a stage previously encountered with herniated intervertebral disc: that Piriformis muscle pathology can cause sciatica has been demonstrated, but its prevalence among low back pain and sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.

Loren M. Fishman - One of the best experts on this subject based on the ideXlab platform.

  • Piriformis Syndrome: Electrophysiology vs. Anatomical Assumption
    Functional Electromyography, 2010
    Co-Authors: Loren M. Fishman, Allen N. Wilkins
    Abstract:

    The FAIR-test for Piriformis Syndrome is the functional electrodiagnostic test which we have done the longest, and for which we have the best evidence. We have encountered stiff resistance and received many valuable suggestions during the 23 years we have used this test, many of which have helped shape the “flagship” test which this chapter describes. Recent advances in imaging techniques and cumulative surgical results have provided significant confirmation of the Syndrome’s pathogenetic mechanism as well as its high incidence in our sedentary, health-clubby civilization.

  • Botulinum neurotoxin type B and physical therapy in the treatment of Piriformis Syndrome: a dose-finding study.
    American Journal of Physical Medicine & Rehabilitation, 2004
    Co-Authors: Loren M. Fishman, Craig Konnoth, Bernard Rozner
    Abstract:

    Objective: To measure dosage effects of botulinum neurotoxin type B with physical therapy in Piriformis Syndrome. Design: Prospective study of consecutive patients complaining of buttock pain and sciatica, measuring serial H-reflex tests in flexion, adduction, and internal rotation; visual analog scale; and adverse effects at 0, 2, 4, 8, and 12 wks. We used an electrophysiologic criterion for Piriformis Syndrome: a 1.86-msec prolongation of the H-reflex with the flexion, adduction, and internal rotation test. Four Piriformis Syndrome groups were identified. Serial groups were injected once with either 5000, 7500, 10,000, or 12,500 units of botulinum neurotoxin type B in successive months under electromyographic guidance in four separate locations of the affected Piriformis muscle, with a 1-mo safety observation period between groups. Patients received physical therapy twice weekly for 3 mos. Results: The flexion, adduction, and internal rotation test and visual analog scale declined significantly, correlating at 72% sensitivity and 77% specificity. A total of 24 of 27 study patients had ≥50% pain relief. Mean visual analog scale score declined from 6.7 to 2.3. A volume of 12,500 units of botulinum neurotoxin type B was superior to 10,000 units at 2 wks postinjection. The most severe adverse effects were dry mouth and dysphagia, approaching 50% of patients at 2 and 4 wks. Conclusion: Physical therapy and 12,500 units of botulinum neurotoxin type B seem to be safe and effective treatment for Piriformis Syndrome. In addition, the flexion, adduction, and internal rotation test seems to be an effective means of diagnosing Piriformis Syndrome and assessing its clinical improvement. Injection may benefit patients for >3 mos.

  • botox and physical therapy in the treatment of Piriformis Syndrome
    American Journal of Physical Medicine & Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, Christopher W Anderson, Bernard Rosner
    Abstract:

    ABSTRACTFishman LM, Anderson C, Rosner B: BOTOX and physical therapy in the treatment of Piriformis Syndrome. Am J Phys Med Rehabil 2002;81:936–942.ObjectiveThis study evaluates the efficacy of botulinum toxin A injections used in conjunction with physical therapy for the treatment of Piriformis syn

  • Piriformis Syndrome: Diagnosis, treatment, and outcome—a 10-year study
    Archives of Physical Medicine and Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, George W. Dombi, Christopher Michaelsen, Stephen Ringel, Jacob Rozbruch, Bernard Rosner, Cheryl Weber
    Abstract:

    Abstract Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis Syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of Piriformis Syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of Piriformis Syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat Piriformis Syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

  • Piriformis Syndrome diagnosis treatment and outcome a 10 year study
    Archives of Physical Medicine and Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, George W. Dombi, Christopher Michaelsen, Stephen Ringel, Jacob Rozbruch, Bernard Rosner, Cheryl Weber
    Abstract:

    Abstract Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis Syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of Piriformis Syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of Piriformis Syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat Piriformis Syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Bernard Rosner - One of the best experts on this subject based on the ideXlab platform.

  • botox and physical therapy in the treatment of Piriformis Syndrome
    American Journal of Physical Medicine & Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, Christopher W Anderson, Bernard Rosner
    Abstract:

    ABSTRACTFishman LM, Anderson C, Rosner B: BOTOX and physical therapy in the treatment of Piriformis Syndrome. Am J Phys Med Rehabil 2002;81:936–942.ObjectiveThis study evaluates the efficacy of botulinum toxin A injections used in conjunction with physical therapy for the treatment of Piriformis syn

  • Piriformis Syndrome: Diagnosis, treatment, and outcome—a 10-year study
    Archives of Physical Medicine and Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, George W. Dombi, Christopher Michaelsen, Stephen Ringel, Jacob Rozbruch, Bernard Rosner, Cheryl Weber
    Abstract:

    Abstract Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis Syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of Piriformis Syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of Piriformis Syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat Piriformis Syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

  • Piriformis Syndrome diagnosis treatment and outcome a 10 year study
    Archives of Physical Medicine and Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, George W. Dombi, Christopher Michaelsen, Stephen Ringel, Jacob Rozbruch, Bernard Rosner, Cheryl Weber
    Abstract:

    Abstract Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis Syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of Piriformis Syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of Piriformis Syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat Piriformis Syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Kevork Hopayian - One of the best experts on this subject based on the ideXlab platform.

  • Four symptoms define the Piriformis Syndrome: an updated systematic review of its clinical features
    European Journal of Orthopaedic Surgery & Traumatology, 2018
    Co-Authors: Kevork Hopayian, Armine Danielyan
    Abstract:

    Purpose To update the evidence on the clinical features of the Piriformis Syndrome since the first systematic review published in 2010. Method A systematic review of all case, cross-sectional and prevalence studies. Results The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases Piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Conclusions Piriformis Syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis Syndrome is at a stage previously encountered with herniated intervertebral disc: that Piriformis muscle pathology can cause sciatica has been demonstrated, but its prevalence among low back pain and sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.

  • four symptoms define the Piriformis Syndrome an updated systematic review of its clinical features
    European Journal of Orthopaedic Surgery and Traumatology, 2018
    Co-Authors: Kevork Hopayian, Armine Danielyan
    Abstract:

    To update the evidence on the clinical features of the Piriformis Syndrome since the first systematic review published in 2010. A systematic review of all case, cross-sectional and prevalence studies. The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases Piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Piriformis Syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis Syndrome is at a stage previously encountered with herniated intervertebral disc: that Piriformis muscle pathology can cause sciatica has been demonstrated, but its prevalence among low back pain and sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.

Cheryl Weber - One of the best experts on this subject based on the ideXlab platform.

  • Piriformis Syndrome: Diagnosis, treatment, and outcome—a 10-year study
    Archives of Physical Medicine and Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, George W. Dombi, Christopher Michaelsen, Stephen Ringel, Jacob Rozbruch, Bernard Rosner, Cheryl Weber
    Abstract:

    Abstract Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis Syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of Piriformis Syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of Piriformis Syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat Piriformis Syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

  • Piriformis Syndrome diagnosis treatment and outcome a 10 year study
    Archives of Physical Medicine and Rehabilitation, 2002
    Co-Authors: Loren M. Fishman, George W. Dombi, Christopher Michaelsen, Stephen Ringel, Jacob Rozbruch, Bernard Rosner, Cheryl Weber
    Abstract:

    Abstract Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis Syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of Piriformis Syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of Piriformis Syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat Piriformis Syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation