![]() ![]() ![]() The video describes posterior facet reduction osteotomy of the greater trochanter for the management of trochanteric impingement, which often is performed in combination with surgical piriformis decompression. Open surgical decompression was indicated in this patient. Pain was reproduced with external rotation, and the patient was neurovascularly intact distally. On physical examination, tenderness is noted at the ischium along the path of the piriformis tendon, at the hamstring insertion, and at the greater trochanter. The patient's pain has not improved with physical therapy and corticosteroid injections in the piriformis, the hip, and the trochanteric bursa arthroscopic right hip labral repair cam and pincer lesion resection and iliopsoas release, which was performed 2 years ago. The video provides an overview of the pathogenesis, diagnosis, and management of piriformis syndrome, followed by the case presentation of a 48-year-old woman with 10 years of right-sided hip pain localized to the buttock and greater trochanter who has no history of trauma. This video demonstrates open surgical decompression in a middle-aged woman with piriformis syndrome. ![]() In general, surgical decompression is reserved for patients with piriformis syndrome refractory to nonsurgical management. Management of piriformis syndrome consists of an initial course of nonsurgical treatment, including physical therapy, the use of NSAIDs, and Botox injection. The sciatic nerve runs under the piriformis muscle, and a hypertrophic piriformis may place pressure on the sciatic nerve. In diagnosing piriformis syndrome, surgeons must rule out lumbar radiculopathy, ischiofemoral impingement, gluteus or hamstring strain, and intrinsic and extrinsic sciatic nerve lesions. One in 20 people who have Western European ancestors could have this inherited disorder, he noted.Ībout half of people with deep vein thrombosis have no symptoms, which is why it's been called a "silent killer," according to the National Institutes of Health.Piriformis syndrome is a relatively rare cause of posterior buttock and hip pain and is diagnosed clinically. Geoff Barnes, vascular medicine specialist at University of Michigan, said in an Oct. Clotting disorder - Bloom's autopsy revealed he had factor V Leiden, his widow noted, a hereditary gene mutation that can increase a person's chance of developing abnormal blood clots.Chronic illness - including heart disease, lung disease, cancer and inflammatory bowel disease.Increased estrogen - due to birth control pills, hormone replacement therapy or pregnancy.Slow blood flow - caused by sitting for a long time, on a transoceanic flight, for example, especially with crossed legs or being confined to a bed after recovering from surgery or because of another medical condition. ![]()
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