Article

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. HYPOTHESES: 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 degrees . 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 degrees , 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. CONCLUSION: 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.
CI - Copyright (c) 2013. Published by Elsevier Masson SAS.
- Muscle fessier

Langue : ANGLAIS ; FRANCAIS