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Chronic Pain Management
Networking Session – Pelvic Pain. Are you Sure Everything is Clear? – Answering your Questions
ESRA19-0681 Gluteal pain and piriformis syndrome
  1. A Krol
  1. St George’s University Hospitals, Department of Anaesthesia and Chronic Pain Service, London, UK

Abstract

Pain in the buttock? is it really a piriformis syndrome? Piriformis syndrome has been attributed to pain in infero-lateral quadrant of the posterior pelvis often associated with sciatica like symptoms, aggravated by walking, stooping and external hip rotation. However, other structures occupying greater sciatic foramen: gemellus superior and inferior, obturator internus, quadratus femoris and hamstring attachment to ischial tuberosity may be a source of pain and cause sciatic nerve entrapment at any level. Clinical examination with posterior pelvis ultrasound scan may help to find the exact location of pain and enhance diagnosis and treatment. Recent development of ultrasound in pain practice brings various specialities together in quest of diagnosis and solution.

Abstract ESRA19-0681 Figure 1
Abstract ESRA19-0681 Figure 1

Fluoroscopy and ultrasound visualisation of piriformis muscle

Abstract ESRA19-0681 Figure 2
Abstract ESRA19-0681 Figure 2

Anatomical and ultrasound visualisation of posterior pelvis structures. A- Sacral cornua; B- Ilium, superior gluteal artery & nerve SGA & N (white arrow), gluteus maximus (Glut Max), Gluteus Medius (Glut Med), Gluteus Minimus (Glut Min); C- Ischial spine, Pudendal artery & nerve (PA & PN – white arrow); D- Piriformis Muscle; E- Obturator internus, inferior gemellus, sciatic nerve (SN), Ischial tuberosity (IT); F- Quadratus femoris (QF), sciatic nerve (SN)

https://doi.org/10.1136/rapm-2019-ESRAABS2019.18

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