PİRİFORMİS SENDROMU: BİR OLGU SUNUMU

Piriformis sendromu, kalça ve bel ağrısı ile karakterize nadir görülen nöromusculer bir patolojidir. Non diskojenik lumbalji ve siyatalji nedenidir. Kalçada ağrı, bacak ağrısının kalçanın iç rotasyonuyla artması, palpasyonla siyatik sinir ağrısının ortaya çıkması piriformis sendromunun temel özellikleridir. Klinik olarak lomber disk hernisi ile sıklıkla karışabilmektedir. Piriformis sendromu bel ağrısının çok nadir görülen bir nedeni olup, tanı konulabilmesi için öncelikle bu hastalığın hatırlanması sonra da diğer olası sebeplerin ekarte edilmesi gerekir. Ayrıntılı anamnez ve dikkatli bir fizik muayene ile tanı konmaktadır. Bu yazıda, Manyetik rezonanans (MR) görüntülemede L4-5 kök basısı olan ve yanlışlıkla lomber disk hernisi tanısı alan bir piriformis sendrom olgusunu dikkat çekmeyi amaçladık.

Anahtar Kelimeler:

Piriformis sendromu, siyatalji, lomber disk hernisi

Piriformis Syndrome: A Case Report

The piriformis syndrome is a rare neuromusculer pathology which is characterised by hip and low back pain. It is the cause of non discogenic lumbalgia and sciatica. Hip pain, increase in leg pain with internal rotation of the hip, onset of sciatic nerve pain with palpation are the basic features of piriformis sydrome. Piriformis syndrome is a very rare cause of low back pain and can be diagnosed in order to be remembered first, then the other possible causes should be excluded. Diagnosis is made by detailed history and careful physical examination. Here, we aimed to draw attention to a piriformis syndrome which presented together with L4-L5 radiculopathy in MR imaging and misdiagnosed as lumbar herniated disc.

Keywords:

Piriformis syndrome, sciatica, lumbar herniated disc,

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Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008;108(11):657-64.
Parlak A, Aytekin A, Develi S, Ekinci S. Piriformis syndrome: a case with non-discogenic sciatalgia. Turk Neurosurg. 2014;24:117-9.
Dere K, Akbas M, Luleci N. A rare cause of a piriformis syndrome. J Back Musculoskelet Rehabil. 2009;22:55-8.
Windisch G, Braun EM, Anderhuber F. Priformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat. 2007;29(1):37-45.
Grgic V. Piriformis muscle syndrome: etiology, pathogenesis, clinical manifestasions, diagnosis, differential diagnosis and therapy. Lijec Vjesn. 2013;135:33-40.
Yeoman W. The relation of arthritis of the sacro-iliac joint to sciatica, with an analysis of 100 cases. Lancet. 1928;212(5492):1119-23.
Robinson DR. Pyriformis syndrome in relation to sciatic pain. Am J Surg. 1947;73(3):355-8.
Huerto AP, Yeo SN, Ho KY: Piriformis muscle injection using ultrasonography and motor stimulation-report of a technique. Pain Physician. 2007;10 (5):687-90.
Guvençer M, Akyer P, Iyem C, Tetik S, Naderi S. Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve. Surg Radiol Anat. 2008;30(6):467-74.
Hulberta A, Deyleb GD. Differential diagnosis and conservative treatment for piriformis syndrome: a review of the literature. Curr Orthop Pract. 2009;20(3):313-9.
Niu CC, Lai PL, Fu TS, Chen LH, Chen WJ. Ruling out piriformis syndrome before diagnosing lumbar radiculopathy. Chang Gung Med J. 2009;32:182-7.
Naja Z, Al-Tannir M, El-Rajab M, Ziade F, Daher Y, Khatib H, et al. The effectiveness of clonidine-bupivacaine repeated nerve stimulator-guided injection in piriformis syndrome. Clin J Pain. 2009;25(3):199-205.