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Piriformis Muscle: Clinical Anatomy with Computed Tomography in Korean Population

  • Park, Chan-Hong (Department of Anesthesiology and Pain Medicine, Daegu Wooridul Hospital) ;
  • Lee, Sang-Ho (Department Neurosurgery, Wooridul Hospital) ;
  • Lee, Sang-Chul (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Park, Hahck-Soo (Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University)
  • Received : 2011.02.17
  • Accepted : 2011.03.23
  • Published : 2011.06.01

Abstract

Backgroud: The objective was to evaluate the distance from the skin and the diameter of the piriformis muscle and their relationship to the body mass index (BMI). Methods: The study was a prospective study involving 60 patients. Patients were prepared on a radiological table in the prone position. Several images were obtained of each. In this view, the distance between the subcutaneous tissue and the piriformis muscle, and the diameter of the piriformis, were measured at three points (medially to laterally). Results: The distance to the piriformis from the skin was $6.6{\pm}0.9\;cm$, $6.3{\pm}0.8\;cm$, and $5.2{\pm}0.9\;cm$ in terms of the lateral, center, and medial measurement, respectively. The center of the piriformis had a greater diameter with $1.7{\pm}0.4\;cm$ (0.9-2.5) cm. The distance to the piriformis increased with BMI. Conclusions: This study shows that the lateral of the piriformis muscle has a relatively greater distance from the skin. The center of the piriformis showed a greater diameter than other two portions. We found that the distance of the piriformis from subcutaneous tissues was correlated with BMI, but the diameter of the piriformis was not affected by BMI. These measurements can be used as a reference for determining the piriformis injection site in patients with piriformis syndrome.

Keywords

References

  1. Ozaki S, Hamabe T, Muro T. Piriformis syndrome resulting from an anomalous relationship between the sciatic nerve and piriformis muscle. Orthopedics 1999; 22: 771-2.
  2. Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med 1983; 74: 69-72.
  3. Parziale JR, Hudgins TH, Fishman LM. The piriformis syndrome. Am J Orthop (Belle Mead NJ) 1996; 25: 819-23.
  4. Pace JB, Nagle D. Piriform syndrome. West J Med 1976; 124: 435-9.
  5. Chen WS. Bipartite piriformis muscle: an unusual cause of sciatic nerve entrapment. Pain 1994; 58: 269-72. https://doi.org/10.1016/0304-3959(94)90208-9
  6. Sayson SC, Ducey JP, Maybrey JB, Wesley RL, Vermilion D. Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain 1994; 59: 149-52. https://doi.org/10.1016/0304-3959(94)90060-4
  7. Jeon SY, Moon HS, Han YJ, Sung CH. Post-radiation piriformis syndrome in a cervical cancer patient: a case report. Korean J Pain 2010; 23: 88-91. https://doi.org/10.3344/kjp.2010.23.1.88
  8. Fishman LM, Zybert PA. Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil 1992; 73: 359-64. https://doi.org/10.1016/0003-9993(92)90010-T
  9. Jankiewicz JJ, Hennrikus WL, Houkom JA. The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature. Clin Orthop Relat Res 1991; 262: 205-9.
  10. Karl RD Jr, Yedinak MA, Hartshorne MF, Cawthon MA, Bauman JM, Howard WH, et al. Scintigraphic appearance of the piriformis muscle syndrome. Clin Nucl Med 1985; 10: 361-3. https://doi.org/10.1097/00003072-198505000-00011
  11. Reus M, de Dios Berna J, Vazquez V, Redondo MV, Alonso J. Piriformis syndrome: a simple technique for US-guided infiltration of the perisciatic nerve. Preliminary results. Eur Radiol 2008; 18: 616-20. https://doi.org/10.1007/s00330-007-0799-3
  12. Smith J, Hurdle MF, Locketz AJ, Wisniewski SJ. Ultrasoundguided piriformis injection: technique description and verification. Arch Phys Med Rehabil 2006; 87: 1664-7. https://doi.org/10.1016/j.apmr.2006.08.337
  13. Betts A. Combined fluoroscopic and nerve stimulator technique for injection of the piriformis muscle. Pain Physician 2004; 7: 279-81.
  14. Fanucci E, Masala S, Sodani G, Varrucciu V, Romagnoli A, Squillaci E, et al. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process. Eur Radiol 2001; 11: 2543-8. https://doi.org/10.1007/s003300100872
  15. Huerto AP, Yeo SN, Ho KY. Piriformis muscle injection using ultrasonography and motor stimulation--report of a technique. Pain Physician 2007; 10: 687-90.
  16. Finnoff JT, Hurdle MF, Smith J. Accuracy of ultrasoundguided versus fluoroscopically guided contrast-controlled piriformis injections: a cadaveric study. J Ultrasound Med 2008; 27: 1157-63. https://doi.org/10.7863/jum.2008.27.8.1157
  17. Windisch G, Braun EM, Anderhuber F. Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat 2007; 29: 37-45. https://doi.org/10.1007/s00276-006-0169-x
  18. Russell JM, Kransdorf MJ, Bancroft LW, Peterson JJ, Berquist TH, Bridges MD. Magnetic resonance imaging of the sacral plexus and piriformis muscles. Skeletal Radiol 2008; 37: 709-13. https://doi.org/10.1007/s00256-008-0486-8
  19. Benzon HT, Katz JA, Benzon HA, Iqbal MS. Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology 2003; 98: 1442-8. https://doi.org/10.1097/00000542-200306000-00022

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