Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain

2020 ◽  
Vol 102-B (5) ◽  
pp. 556-567 ◽  
Author(s):  
Jung Wee Park ◽  
Young-Kyun Lee ◽  
Yun Jong Lee ◽  
Seunghwan Shin ◽  
Yusuhn Kang ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Hip Pain ◽  
Piriformis Syndrome ◽  
Provocation Tests ◽  
Obturator Internus ◽  
Deep Gluteal Syndrome ◽  
Mri Scans ◽  
Proximal Hamstring ◽  
Terminological Confusion

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556–567.

Piriformis Syndrome: Treatment of a Rare Cause of Posterior Hip Pain with Fluoroscopic-Guided Injection

2015 ◽  
Vol 25 (2) ◽  
pp. 172-175 ◽  
Author(s):  
Akif Albayrak ◽  
Rasit Ozcafer ◽  
Mehmet B Balioglu ◽  
Deniz Kargin ◽  
Yunus Atici ◽  
...  
Keyword(s):  
Hip Pain ◽  
Piriformis Syndrome

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.

scholarly journals Progressive enlargement of a previously coiled posterior inferior cerebellar artery aneurysm

2015 ◽  
Author(s):  
Michael Karsy ◽  
Aaron Cutler ◽  
Christian Bowers ◽  
Richard Schmidt
Keyword(s):  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Endovascular Coiling ◽  
Ct Angiogram ◽  
Cerebellar Artery

Multidisciplinary treatment of cerebral aneurysms includes endovascular coiling and open neurosurgical clipping techniques, however our understanding of long-term outcomes after coiling of large cerebral aneurysms remains limited. We present a case involving the development of a previously coiled posterior inferior cerebellar artery (PICA) aneurysm in a 64-year-old man with lesion enlargement and symptomatic mass effect. CT angiogram demonstrated a 3.9×2.6×2.4-cm partially thrombosed aneurysm adjacent to the left vertebral artery. The patient underwent resection to relieve the compressive effect. We discuss the efficacy of endovascular coiling and surgical clipping in this case as well as review the relevant literature.

Deep gluteal space anatomy and its relationship with deep gluteal pain syndromes

2020 ◽  
pp. 112070002096625
Author(s):  
Maria J Leite ◽  
André R Pinho ◽  
Miguel R Silva ◽  
João C Lixa ◽  
Maria D Madeira ◽  
...  
Keyword(s):  
Average Distance ◽  
Femoral Anteversion ◽  
Ischial Tuberosity ◽  
Lower Limbs ◽  
Pain Syndromes ◽  
Deep Gluteal Syndrome ◽  
Anatomic Dissection ◽  
Trochanteric Region ◽  
Ischiofemoral Space ◽  
Proximal Hamstring

Introduction: Increasing interest has been seen in understanding the anatomy and biomechanics involved in the Deep Gluteal Syndrome, therefore the main objective of our paper was to define the anatomy of the deep gluteal space concerning the important osseous, muscular and neurological structures. Methods: 12 cadaveric models (24 hemipelvises) were used. We proceeded with classical anatomic dissection and evaluated numerous osseous, musculotendinous and neurologic structures and their relationships. We also determined the femoral anteversion and neck-shaft angles. Results: We found that 15.4% of lower limbs examined presented variations in the sciatic nerve (SN) emergence, and this was significantly longer in men. The distance from the SN to the trochanteric region was also significantly lower in males. The average ischiofemoral distance (IFD) was 2.5 ± 1.3 cm, at the same time that the structures comprised in that space showed superior areas, such as the quadratus femoris (QF) with 5.0 ± 1.1 cm and the SN with 1.4 ± 0.3 cm widths. Besides that, we also evaluated the distance from the SN to the lesser trochanter (LT) and the ischial tuberosity (IT), in the ischiofemoral space, reaching average values of 1.1 ± 0.7 cm and 1.5 ± 0.6 cm respectively. Regarding the relationship between the proximal hamstring insertion, we verified that the LT was at an average distance of 1.6 ± 1.1 cm, that the SN was only 0.2 ± 0.3 cm lateral to it, and the PN is just 2.6 ± 1.2 cm proximal to it. Conclusions: Our study confirmed the extreme variation in the SN origin that can contribute to the Piriformis syndrome. The IFD obtained in our study showed that this distance was small for the structures contained in this space. The proximal hamstring insertion showed a significantly more extended footprint in males, which puts the pudendal nerve (PN) at higher risk of iatrogenic injury.

scholarly journals The prevalence of femoroacetabular impingement anatomy in Division 1 aquatic athletes who tread water

2020 ◽  
Vol 7 (2) ◽  
pp. 233-241
Author(s):  
Joanna L Langner ◽  
Marianne S Black ◽  
James W MacKay ◽  
Kimberly E Hall ◽  
Marc R Safran ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Young Patients ◽  
Hip Pain ◽  
Water Polo ◽  
Increased Risk ◽  
Division 1 ◽  
Mri Scans ◽  
Asymptomatic Individuals ◽  
Cam Morphology ◽  
Pincer Morphology

Abstract Femoroacetabular impingement (FAI) is a disorder that causes hip pain and disability in young patients, particularly athletes. Increased stress on the hip during development has been associated with increased risk of cam morphology. The specific forces involved are unclear, but may be due to continued rotational motion, like the eggbeater kick. The goal of this prospective cohort study was to use magnetic resonance imaging (MRI) to identify the prevalence of FAI anatomy in athletes who tread water and compare it to the literature on other sports. With university IRB approval, 20 Division 1 water polo players and synchronized swimmers (15 female, 5 male), ages 18–23 years (mean age 20.7 ± 1.4), completed the 33-item International Hip Outcome Tool and underwent non-contrast MRI scans of both hips using a 3 Tesla scanner. Recruitment was based on sport, with both symptomatic and asymptomatic individuals included. Cam and pincer morphology were identified. The Wilcoxon Signed-Rank/Rank Sum tests were used to assess outcomes. Seventy per cent (14/20) of subjects reported pain in their hips yet only 15% (3/20) sought clinical evaluation. Cam morphology was present in 67.5% (27/40) of hips, while 22.5% (9/40) demonstrated pincer morphology. The prevalence of cam morphology in water polo players and synchronized swimmers is greater than that reported for the general population and at a similar level as some other sports. From a clinical perspective, acknowledgment of the high prevalence of cam morphology in water polo players and synchronized swimmers should be considered when these athletes present with hip pain.

Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy

2012 ◽  
Vol 46 (12) ◽  
pp. 883-887 ◽  
Author(s):  
Angelo Cacchio ◽  
Fabrizio Borra ◽  
Gabriele Severini ◽  
Andrea Foglia ◽  
Frank Musarra ◽  
...  
Keyword(s):  
Reliability And Validity ◽  
Provocation Tests ◽  
Pain Provocation ◽  
Proximal Hamstring

scholarly journals Problemy terminologiczne w glottodydaktyce – źródła, przykłady, konsekwencje

Neofilolog ◽  
2021 ◽  
pp. 123-140
Author(s):  
Magdalena Aleksandrzak
Keyword(s):  
Individual Differences ◽  
Foreign Language ◽  
Teaching And Learning ◽  
Language Teaching ◽  
Theoretical Perspective ◽  
Relevant Literature ◽  
Foreign Language Teaching ◽  
Research Project ◽  
Communication Interaction ◽  
Terminological Confusion

The present paper discusses selected terminological problems typical of the field of foreign language teaching and learning. The discussion concentrates on several terms commonly used in various glottodidactic debates, namely: competence, communication, interaction, discourse, authenticity and individual differences. The article attempts to indicate the sources of inconsistencies in the terminology, offers several examples and interpretations of these terms in questions from the relevant literature, and determines potential consequences. The aim of the paper is also to indicate areas of glottodidactic research which may be particularly sensitive to such terminological confusion and to stress the necessity of identifying the theoretical perspective and defining the terms central to the particular research project or discussion.

scholarly journals Progressive enlargement of a previously coiled posterior inferior cerebellar artery aneurysm

2015 ◽  
Author(s):  
Michael Karsy ◽  
Aaron Cutler ◽  
Christian Bowers ◽  
Richard Schmidt
Keyword(s):  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Endovascular Coiling ◽  
Ct Angiogram ◽  
Cerebellar Artery

Multidisciplinary treatment of cerebral aneurysms includes endovascular coiling and open neurosurgical clipping techniques, however our understanding of long-term outcomes after coiling of large cerebral aneurysms remains limited. We present a case involving the development of a previously coiled posterior inferior cerebellar artery (PICA) aneurysm in a 64-year-old man with lesion enlargement and symptomatic mass effect. CT angiogram demonstrated a 3.9×2.6×2.4-cm partially thrombosed aneurysm adjacent to the left vertebral artery. The patient underwent resection to relieve the compressive effect. We discuss the efficacy of endovascular coiling and surgical clipping in this case as well as review the relevant literature.

scholarly journals Current Management of Pleuropulmonary Blastoma: A Surgical Perspective

Children ◽  
2019 ◽  
Vol 6 (8) ◽  
pp. 86 ◽  
Author(s):  
Samantha Knight ◽  
Tristan Knight ◽  
Amir Khan ◽  
Andrew J. Murphy
Keyword(s):  
Relevant Literature ◽  
Multidisciplinary Treatment ◽  
Lung Parenchyma ◽  
Surgical Approaches ◽  
Pleuropulmonary Blastoma ◽  
Current Management ◽  
Diagnosis And Prognosis ◽  
Pulmonary Cysts ◽  
Age Of Diagnosis

Pleuropulmonary blastomas (PPB) are pediatric, embryonal cancers of the lung parenchyma and pleural surfaces and are among the most common DICER1—related disorders. These tumors undergo evolution through several forms, allowing division into types I, Ir, II, and III, with correlates to the age of diagnosis and prognosis. We sought to provide a comprehensive review of the relevant literature describing the characteristics of these tumors and their multidisciplinary treatment, with an emphasis on surgical management. We describe the complementary roles of chemotherapy and surgery in the successful management of this disease. We discuss the timing of surgery and options for surgical approaches. We address the differentiation of PPB from congenital pulmonary airway malformation and the role of DICER1 testing for children with pulmonary cysts.

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