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• W2072945762 abstract "The piriformis muscle syndrome (PMS) has remained an ill-defined entity. It is a form of entrapment neuropathy involving compression of the sciatic nerve by the piriformis muscle. Bearing this in mind, a medical examination is likely to be suggestive, as a classical range of symptoms corresponds to truncal sciatica with frequently fluctuating pain, initially in the muscles of the buttocks. The piriformis muscle is biarticular, constituting a bridge in front of and below the sacroiliac joint and behind and above the coxo-femoral joint. It is essentially a lateral rotator but also a hip extensor, and assumes a secondary role as an abductor. Its action is nonetheless conditioned by the position of the homolateral coxo-femoral joint, and it can also function as a hip medial rotator, with the hip being flexed at more than 90°. The main clinical manoeuvres are derived from these types of biomechanical considerations. For instance, as it is close to the hip extensors, the piriformis muscle is tested in medial rotation stretching, in resisted contraction in lateral rotation. On the other hand, when hip flexion surpasses 90°, the piriformis muscle is stretched in lateral rotation, and we have consequently laid emphasis on the manoeuvre we have termed Heel Contra-Lateral Knee (HCLK), which must be prolonged several tens of seconds in order to successfully reproduce the buttocks-centred and frequently associated sciatic symptoms. A PMS diagnosis is exclusively clinical, and the only objective of paraclinical evaluation is to eliminate differential diagnoses. The entity under discussion is real, and we favour the FAIR, HCLK and Freiberg stretching manoeuvres and Beatty's resisted contraction manoeuvre. Le syndrome du muscle piriforme (SMP) est une entité encore mal définie. Il s’agirait d’un syndrome canalaire par compression du nerf ischiatique par le muscle piriforme. Dans ce cadre, l’interrogatoire est évocateur, la symptomatologie clinique correspondant à une sciatalgie tronculaire souvent fluctuante à début fessier. Ce muscle piriforme est bi-articulaire, passant en pont en avant et en dessous de l’articulation sacro-iliaque et en arrière et au-dessus de l’articulation coxo-fémorale. Il est essentiellement rotateur latéral mais aussi extenseur de hanche et participe accessoirement à son abduction. Pour autant son action est conditionnée par la position de l’articulation coxo-fémorale homolatérale. En effet, il deviendrait rotateur médial de hanche, cette dernière étant fléchie au-delà de 90°. De ces considérations biomécaniques découlent les principales manœuvres cliniques. En effet, hanche proche de l’extension, il est testé en étirement en rotation médiale, en contraction contrariée en rotation latérale. En revanche, au-delà de 90° de flexion de hanche, le muscle piriforme est étiré en rotation latérale, et ainsi nous mettons en avant la réalisation d’une manœuvre que nous avons appelé Talon Genou-Contro-Latéral (TG-CL), qu’il faut prolonger plusieurs dizaines de secondes pour reproduire la symptomatologie fessière et souvent sciatique associée. Le diagnostic de SMP est clinique, le bilan paraclinique n’ayant pour but que d’éliminer un diagnostic différentiel. Son entité est réelle et nous privilégions les manœuvres d’étirement FAIR, TG-CL et de Freiberg, ainsi que la manœuvre de contraction résistée de Beatty." @default.
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• W2072945762 date "2013-05-01" @default.
• W2072945762 modified "2023-09-26" @default.
• W2072945762 title "The piriformis muscle syndrome: An exploration of anatomical context, pathophysiological hypotheses and diagnostic criteria" @default.
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• W2072945762 doi "https://doi.org/10.1016/j.rehab.2013.03.006" @default.
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