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66 Cards in this Set
- Front
- Back
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Contracture of the piriformis m. causes trauma to the muscle fibers
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Piriformis Syndrome/Sciatic Neuritis
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causes epineural irriation of sciatic leading to parathesis
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Piriformis Syndrome/Sciatic Neuritis
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What is the neuro defict in Piriformis Syndrome/Sciatic Neuritis
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NONE!!!
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What is the Incidence/prevalence in Piriformis Syndrome/Sciatic Neuritis?
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6 per 100 cases of sciatica; 6:1 female-to-male ratio
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Derangement of nerve root structure and function causes demylenation, ischemia, axonal transport blocked
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Lumbar Disc Herniation/Sciatic Radiulitus
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Causes radicular pain
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Lumbar Disc Herniation/Sciatic Radiulitus
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Trauma that PRODUCES PGE and bradykinis
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Lumbar Disc Herniation/Sciatic Radiulitus
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Trauma that RELEASES PGE and bradykinis
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Piriformis Syndrome/Sciatic Neuritis
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Trauma that has neuro defictsdecreased DTR’s, flaccid extensor hallicus longus, coldness of foot on affected side
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Lumbar Disc Herniation/Sciatic Radiulitus
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What does Sciatica mean in Latin
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Pain down the back of the leg
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Sciatic nerve root distribution
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L-4, L-5, S-1, S-2, or S-3
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Area of where symptoms of Sciatica appears
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posterior or lateral aspect of the lower extremity extending to the ankle or foot
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Common causes of Sciatica
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mechanical compression of the lumbosacral nerve roots, herniated nucleus pulposus, spinal stenosis, vertebral defect, compression fracture
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Where foramen does the Sciatic nerve exit the pelvis?
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greater sciatic foramen
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Where does the sciatic nerve go after it has exited the pelvis?
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under piriformis muscle into posterior thigh
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Where does the Sciatic nerve branch and what are the branches?
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Just proximal to the popliteal fossa, it branches off into the common peroneal and the tibial nn
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What does the Tibial nerve innervate?
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foot, ankle and knee flexors.
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What does the Common Peroneal innervate?
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toe, ankle extensors and evertors.
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What are the Sign and Symptoms of Sciatica?
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electrical pain L4-S1 to ankle and foot, motor weakness and hypoactive reflex, onset variable, radicular symptoms and not localized to back pain
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Which nerve roots are involved 95% of the time in Sciatica?
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L5 or S1
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What are the aggravating factors of Sciatica?
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trunk flexion or rotation, prolonged sitting or standing, coughing, and sneezing.
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What appears in a long standing Sciatica?
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Muscle Atropy
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What are the Common OMM findings in Sciatica?
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1. sacral shear (unilateral sacral flexion) 2. flexion of L5 with rotation and sidebending to the painful side
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What are the 3 common causes of Pseudoradiculopathies
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1. posterior facet syn 2. sacroiliac joint syn 3. piriformis and other myofascial syn
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How is a Pseudoradiculopathies different than a true radiculopathies?
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Pseudo do NOT compress spinal nerves and respond well to OMT
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How do you do the Straight Leg test
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Raise affect leg until pain is felt
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In the Straight leg test, what does pain with foot dorsiflexion indicate?
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nerve root irritation
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In the Straight Leg Test, pain with raising the non affect(contralateral) leg indicates what?
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space occupying lesion
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What is the difference between hamstring pain and nerve root pain?
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Hamstring in posterior thigh; Nerve root pain can go down to foot
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How do you Perform the Thomas Test?
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Good up and flexed, Dr slides hand under knee of bad leg. Looking for increase gap
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increased distance between knee and table is positive for what condition in the Thomas Test
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iliopsoas restriction
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What is a good test to spot Malingering patients?
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Hoover Test
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How do you perform the Hoover Test?
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Hold patients heels and instruct to lift one leg
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What are the expected findings in the Hoover Test?
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Should feel counter-force upon effort in other hand, If not, they’re not trying
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What is the objective in OMT for Sciatica?
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minimize muscle spasm and to restore normal joint motion
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What four structures should be focused on in OMT for Sciatica?
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sacrum/innominates, lumbars, piriformis, psoas
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What is Piriformis Syndrome?
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abnormality and/or hypertonicity of the piriformis muscle, neuritis of sciatic nerve
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Sitting on a large wallet can cause?
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Piriformis Syndrome
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Hip and buttock pain that radiates down the back of the thigh (not past knee)
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Piriformis Syndrome
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Pain in butt, Low back pain - not a major component, Lack of neurologic symptoms!, Decreased internal rotation of the hip!
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Piriformis Syndrome
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Origin of Piriformis Muscle
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anterior lateral border of the sacrum (2-4)
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Unilateral sacral shear ,Sudden forceful internal rotation of femur, Inflammation of SI joint, Psoas spasm on contralateral side, Irritation of S1, S2 from spinal stenosis or pelvic carcinoma
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Secondary Causes of Piriformis Syndrome
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Insertion of Piriformis Muscle
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upper border of the greater trochanter
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Action of Piriformis Muscle
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external rotation of extended thigh, abduction of flexed thigh
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Innervation of Piriformis Muscle
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L5, S1-2
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How do you find the Piriformis Tender point?
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midpoint between PSIS and ILA, and then midpoint Greater Trochanter
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Treatment for Piriformis Tender point
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Piriformis SCS
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How do you perform Piriformis SCS?
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monitor tender pt, flex pt knee, abduct, flex and externally rotate the hip (135degree), hold, reposition w/o pt help, recheck
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What is Psoas Syndrome?
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spasm of Psoa muscle, position that allows prolonged shortening of the psoas followed by its sudden lengthening
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What are the common causes of Psoas Syndrome?
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working at a desk or crawlspace, road trips, plane trips, trauma strain type
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Secondary Causes for Psoas Syndrome?
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viscerosomatic reflex, psoas fascia touches the sigmoid colon and ureters
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Stooped posture, Back pain, and buttock and posterior thigh pain
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signs and symptoms to Psoas Syndrome
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How do you Dx a Psoas Syndrome?
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Postive Thomas Test, Psoas Tenderpoint, Possibly contralateral piriformis TP
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Origin of Psoas Muscle
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lumbar transverse processes (~L1-5)
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Insertion of Psoas Muscle
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lesser trochanter of femur
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Action of Psoas Muscle
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Flexor of the Trunk
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Innervation of Psoas Muscle
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ventral rami of the lumbar spinal nn.
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What fascia can touch the sigmoid colon and ureters
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Psoas Facia
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Nerves Psoas has relationship to
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iliohypogastric, ilioinguinal, lateral femoral cutaneous, Fermoral, genitofemoral, obturator, upper root of lumbosacral trunk
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non-neutral somatic dysfunction of L1 and/or L2 - dysfunction is usually flexed and to the same side as the spasm
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Psoas Syndrome
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Descrbe the oblique sacrum axis in a Psoas Syndrome
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oblique axis sacral dysfunction - axis is on side of psoas spasm
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Describe the pelvis shift in a Psoas Syndrome
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pelvis shift to the opposite side
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Describe the piriformis muscle in a Psoas Syndrome
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spasm of the opposite piriformis m. resulting in sciatic irritation
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Describe the area of pain felt in a Psoas Syndrome
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gluteal and posterior thigh pain - does not radiate past knee
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A right anterior jones TP affecting the Illiopsoas will affect what posteriorly
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LEFT piriformis TP (opposite side)
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How do you perform Iliopsoas Muscle Energy?
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pt supine, dr on affect side, pt flex thigh toward abs (flatten lumbar lordosis), Pt lowers the leg on the side of the restriction while holding the contralateral thigh against abdomen, DR resist over thigh(above knee) of bad leg as pt tries to raise up, repeat 3-5 and recheck
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