Piriformis syndrome

　　The main causes of changes in the piriformis muscle include acute injury and chronic strain. The former includes sudden excessive abduction and external rotation of the lower limb, or sudden standing from a squatting position, as well as stretching, flexing, adduction, and internal rotation, which can all cause injury to the piriformis muscle. Long-term carrying heavy loads or due to a certain type of labor that keeps the muscle in a state of excessive tension and traction, or if acute injury is not treated in time, or if the treatment method is inappropriate, can all lead to a chronic course of injury, causing the muscle to appear persistent spasm, congestion, and swelling, gradually degenerating, fascicle thickening, hardening, and adhesion, stimulating, compressing, and involving adjacent nerves and blood vessels, leading to the onset of the disease.

　　In addition, pelvic inflammation, adnexal and tendinous joint lesions can all affect the piriformis muscle, and cold buttocks can also lead to vasoconstriction. Piriformis spasm; lumbar intervertebral disc can also reflexively cause piriformis spasm and lead to the onset of the disease.

　　In addition to general symptoms, piriformis syndrome can also cause other diseases. The complications of this disease are rare, but in cases with long-term illness, muscle atrophy may occur, and other diseases are reported less frequently. Therefore, once it is discovered, it is necessary to treat it actively, and preventive measures should also be taken in daily life.

　　Pain is the main manifestation of piriformis syndrome, mainly located in the buttocks and can radiate to the lower limb. In severe cases, it may be impossible to walk or the pain may be severe after walking a certain distance, requiring a rest for a while before continuing to walk. Patients may feel that the pain is located deeper, and the radiation is mainly to the back or posterolateral side of the same lower limb. Some may also experience numbness on the lateral side of the lower leg and discomfort in the perineal area. In severe cases, the buttocks may present with 'cutting-like' or 'burning-like' pain, with difficulty in flexing the legs, kneeling on the knees, and difficulty sleeping at night. The pain in the affected limb may be exacerbated during urination, coughing, or sneezing due to increased abdominal pressure.

　　Patients with piriformis syndrome may experience buttock pain that radiates to the back or posterolateral side of the same-sided lower limb. To avoid the disease from becoming severe, the following points should be followed:

　　1. The patient takes a standing or sitting position, use the tip of the affected side thumb to press the Shangjiao (BL 23), Chengfu (BL 32), and Ashi points, press each point for 10-20 seconds, until locally feeling sore.

　　2. The patient's position is as before, use the finger pad of the affected side thumb to tap the piriformis muscle area 6-10 times, until locally feeling sore.

　　3. The patient's position is as before, use the finger pad of the affected side thumb to knead the Shangjiao (BL 23) point, from light to heavy and then from heavy to light, for 1-3 minutes, until locally feeling sore, hot, and comfortable.

　　4. The patient's position is as before, use the palm root of the affected side to massage the affected area for 2-3 minutes, until locally feeling warm and comfortable.

　　5. If the disease is treated with proper手法 as soon as possible, the efficacy is very good, and sometimes even a few times or even one time can be cured.

　　6. Patients should avoid re-injury in their daily work and labor, and avoid wind and cold invasion to prevent the condition from worsening.

　　Piriformis syndrome can be diagnosed through the straight leg raising test and piriformis tension test. The specific method is as follows:

　　1. Straight leg raising test

　　Pain during straight leg raising before 60° is considered a positive test.

　　2. Piriformis tension test

　　It is a method to check for piriformis injury, and the specific steps are as follows: the patient lies on the examination bed, extend the affected limb, perform adduction and internal rotation, if there is radiating pain in the sciatic nerve, quickly abduct and externally rotate the affected limb, and the pain will be relieved immediately, indicating a positive piriformis tension test. This is a commonly used examination method for piriformis syndrome.

　　Piriformis syndrome is a muscle injury disease. The injured piriformis muscle stimulates and compresses the sciatic nerve, causing a syndrome mainly characterized by buttock and leg pain, known as piriformis syndrome. Treatment can be carried out with acupuncture or massage therapy, and in severe cases, surgical treatment may be required. Patients should also pay attention to their diet during treatment:

　　Suitable foods

　　Diet should be inclined towards sweet, cool, and moistening, with an emphasis on eating nourishing yin, clearing heat, and producing body fluids. Foods such as lily, silver ear, lotus seeds, cucumber, tomatoes, yam, bitter melon, white sesame seeds, soybean paste, luffa, celery, lotus root, and turtle are cool foods. Fruits such as watermelon, pear, pomelo, and water chestnut are the best for their sweet and cold properties.

　　Unsuitable foods

　　Avoid spicy, aromatic, and hot foods such as alcohol, tea, coffee, all kinds of fried foods, mutton, dog meat, deer meat, as well as ginger, scallion, garlic, chili, pepper, Sichuan pepper, fennel, etc., and strictly prohibit smoking to prevent drying up the body fluids and exacerbating the condition.

　　Patients with piriformis syndrome who have no effect from non-surgical treatment suffer greatly, especially those with neurological damage symptoms that affect normal life. Surgical therapy can be adopted. The surgical methods include the following:

　　1. Some authors believe that the main cause of the disease is the developmental malformation of the piriformis and the sciatic nerve at the pelvic outlet, so cutting the tendons of the piriformis can eliminate the compressive factor and achieve the therapeutic purpose. According to reports, the piriformis fascicle cutting operation in 60 cases has achieved satisfactory results.

　　The surgical method is to ask the patient to lie on the operating table, feel the top of the greater trochanter, and make an arched incision of 4-5 cm above the top of the tip under local anesthesia, separate the gluteal muscles, find the piriformis waist in the trochanteric fossa, and among the external rotator muscle groups of the buttocks, only the piriformis has a long fascicle, which is easy to identify. By lifting the waist of the muscle, it can stimulate the compression of the sciatic nerve, and increase the radiating pain of the lower limb. After cutting the tendons, the tendons retract, and the symptoms are relieved. This operation has little injury, but the application scope of the operation has certain limitations.

　　2. Experts on the pelvic outlet expansion decompression surgery of the sciatic nerve believe that the stenosis of the sciatic nerve outlet caused by various reasons is the cause of clinical symptoms, and therefore the principle of surgical treatment is to expand the pelvic outlet of the nerve. The operation is performed under epidural anesthesia. The patient lies on his stomach. The affected side of the inguinal area is padded to raise the buttocks. The sciatic nerve is exposed by selecting the sciatic nerve incision, separating the nerve to the pelvic outlet, and exploring the cause of the nerve outlet stenosis. Observe whether there are any abnormalities such as masses, adhesions, and thickened blood vessels on the right side of the outlet, check the passability of the outlet, and observe the relationship between the nerve and the piriformis muscle.

　　Under normal circumstances, the fingers can pass through the pelvic outlet smoothly. If there is an outlet stenosis, it cannot pass through. At the same time, the shape and hardness of the piriformis muscle can be felt by hand, and whether there is scar formation, and it can be removed according to circumstances. Finally, the outlet is expanded to the point where the fingers can reach the loose tissue at the pelvic floor. Some people also advocate exploring a segment of the sciatic nerve trunk in the gluteal area to relieve or discover nerve damage over a wider range.