Piriformis Syndrome and Other Nerve Entrapments of the Posterior Pelvis

2018 ◽  
Author(s):  
Aaron G. Filler
Keyword(s):  
Peripheral Nerve Injury ◽  
Pudendal Nerve ◽  
Cauda Equina ◽  
Piriformis Syndrome ◽  
Piriformis Muscle ◽  
Spinal Nerves ◽  
Nerve Entrapments ◽  
Obturator Internus ◽  
Surgical Options ◽  
Obturator Internus Muscle

Not every case of neurologically based pelvic/genital numbness/incontinence is due to cauda equina syndrome. Pelvic pain, incontinence, and sexual dysfunction can result from treatable peripheral nerve injury or entrapment affecting the pudendal nerves or impar ganglion. Learning the signs, physical exam findings, tests, and surgical options greatly expands a neurosurgeon’s range. The pudendal nerve and nerve to the obturator internus muscle arise after S2, S3, and S4 spinal nerves traverse the piriformis muscle. They exit the sciatic notch with the sciatic nerve but then re-enter the pelvis, where the pudendal nerve then gives off bladder, rectal, and genital branches.

Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches

2017 ◽  
Vol 33 (06) ◽  
pp. 395-401 ◽  
Author(s):  
Eric Wan ◽  
Andrew Goldstein ◽  
Hillary Tolson ◽  
A. Dellon
Keyword(s):  
Sexual Function ◽  
Pudendal Nerve ◽  
Rating Scale ◽  
Athletic Injury ◽  
Nerve Blocks ◽  
Obturator Internus ◽  
Age At Surgery ◽  
Numeric Pain Rating Scale ◽  
Obturator Internus Muscle ◽  
The Mean

Background This study describes outcomes from a new surgical approach to treat “anterior” pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN). Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS). Results Fourteen patients reported their condition pre- and postoperatively. Mean postoperative follow-up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms. Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.

Manual therapy and visual color-impulse therapy in the rehabilitation of patients with piriformis syndrome

2020 ◽  
pp. 95-101
Author(s):  
V. A. Frolov ◽  
M. S. Akopyan
Keyword(s):  
Manual Therapy ◽  
Muscle Tone ◽  
Randomized Study ◽  
Integrated Approach ◽  
Medical Rehabilitation ◽  
Piriformis Syndrome ◽  
Piriformis Muscle ◽  
Group I ◽  
Combined Use ◽  
Visual Color

Introduction. Piriformis syndrome (PS) is a condition accompanied by tension of the piriformis muscle and followed then by compression of the sciatic nerve passing through the piriformis muscle. According to statistics, PS occurs in 6–35 % of patients with lower back pain. Practitioners still face difficulties in treating patients with PS, and it necessitates the searching of new therapy methods and assessment of their compatibility.The goal of research — to study the clinical efficacy of the combined use of manual therapy and visual colorimpulse therapy in patients with piriformis syndrome.Materials and methods. A prospective, controlled, randomized study was conducted in 2019 at the Department of Sports Medicine and Medical Rehabilitation of I. M. Sechenov First Moscow Medical State University. In accordance with the inclusion criteria, 40 patients participated in the study. All participants, depending on the used treatment methodology, were divided by the method of simple randomization using envelopes into two equal groups. In the main group (group I), an integrated approach to treatment was tested: manual therapy in combination with visual color-impulse therapy (CIT); and in the other group (group II) only manual therapy was used.Results. The combined use of manual therapy and CIT in patients with piriformis syndrome leads to a significantly more pronounced decrease in the pain degree and normalization of impaired muscle tone. Also, an integrated approach helps to eliminate existing angiospastic disorders of the lower extremities.Conclusion. The study shows a clear positive dynamics in the integrated use of manual therapy methods in combination with visual color-impulse therapy in the treatment of patients with piriformis syndrome. It is planned to continue the study and assess the possibilities of using the combined technique in different groups of patients (athletes, pregnant women) with this syndrome. 

Surgical treatment of lumbosacral plexus injuries

2004 ◽  
Vol 1 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Eva Maria Lang ◽  
Jörg Borges ◽  
Thomas Carlstedt
Keyword(s):  
Cauda Equina ◽  
Femoral Nerve ◽  
Severe Trauma ◽  
Lumbosacral Plexus ◽  
Spinal Root ◽  
Content Type ◽  
Spinal Nerves ◽  
Nerve Grafts ◽  
Nerve Transfers ◽  
Fine Print

Object. The purpose of this study was to analyze therapeutic possibilities and clinical outcomes in patients with lumbosacral plexus injuries to develop surgical concepts of treatment. Methods. In a retrospective investigation 10 patients with injuries to the lumbosacral plexus were evaluated after surgery. The patients were assessed clinically, electrophysiologically, and based on the results of magnetic resonance imaging and computerized tomography myelography. In most patients a traction injury had occurred due to severe trauma that also caused pelvic fractures. In most cases the roots of the cauda equina of the lumbosacral plexus had ruptured. In cases of spinal root ruptures repair with nerve grafts were performed. In cases in which proximal stumps of the plexus could not be retrieved palliative nerve transfers by using lower intercostals nerves or fascicles from the femoral nerve were performed. Conclusions. Lesions of the proximal spinal nerves and cauda equina occur in the most serious lumbosacral plexus injuries. Patients with such injuries subjected to reconstruction of spinal nerves, repair of ventral roots in the cauda equina, and nerve transfers recovered basic lower-extremity functions such as unsupported standing and walking.

Cauda Equina Repair in the Rat: Part 1. Stimulus-Evoked EMG for Identifying Spinal Nerves Innervating Intrinsic Tail Muscles

2009 ◽  
Vol 26 (8) ◽  
pp. 1405-1416 ◽  
Author(s):  
Don J. Blaskiewicz ◽  
Igor Smirnov ◽  
Tudor Cisu ◽  
Lara R. DeRuisseau ◽  
Dennis J. Stelzner ◽  
...  
Keyword(s):  
Cauda Equina ◽  
Spinal Nerves
Sign in / Sign up

Export Citation Format

Share Document