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Pain Originating from the Buttock: Sacroiliac Joint Syndrome and Piriformis Syndrome

Learn about the anatomy, causes, diagnosis, and treatment of sacroiliac joint syndrome and piriformis syndrome. Explore conservative treatments, injections, and surgical stabilization options.

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Pain Originating from the Buttock: Sacroiliac Joint Syndrome and Piriformis Syndrome

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  1. بسم الله الرحمن الرحیم

  2. Pain Originating from the Buttock: Sacroiliac Joint Syndrome and Piriformis Syndrome SirousRezaee. MD

  3. ANATOMY, FUNCTION, ANDINNERVATION

  4. EPIDEMIOLOGY

  5. FIGURE 1Posterior view of the articulations and associated ligaments of the sacroiliac joint and surrounding structures. Sources: Drawing by Jee Hyun Kim. From Cohen SP: acroiliacjoint pain: a comprehensive review of anatomy, diagnosis and treatment.

  6. FIGURE 2Innervation of the posterior sacroiliac joint region. A descending branch of the L4 primary ramus innervates the L5–S1 facet joint and the sacroiliac joint. The L5 and S1 primary rami also innervate the L5–S1 facet joint and the sacroiliac joint. Finally, the S2 and S3 sacral nerves innervate the sacroiliac joint. Source: Paris SV: Anatomy as related to function and pain. Symposium on Evaluation and Care of Lumbar Spine Problems.

  7. ETIOLOGY

  8. TABLE 1 Characteristics of Diagnostic Prevalence Studies Using Double-Blocks as Reference Standard

  9. TABLE 2 Causes of Intra-Articular and Extra-Articular Sacroiliac Joint Pain

  10. DIAGNOSIS AND PRESENTATIONHISTORY AND PHYSICAL EXAM

  11. PAIN REFERRAL PATTERNS

  12. FIGURE 3 Location of pain in a patient with sacroiliac joint syndrome.

  13. RADIOLOGICAL IMAGING

  14. INJECTIONS

  15. TREATMENTCONSERVATIVE

  16. INJECTIONS

  17. NEUROABLATION

  18. TABLE 3 Randomized, Controlled Studies Evaluating Sacroiliac Joint Injections

  19. Continue TABLE 3 Randomized, Controlled Studies Evaluating Sacroiliac Joint Injections

  20. TABLE 4 Alternative Treatments for Sacroiliac Joint Pain

  21. FIGURE 4 Schematic diagram illustrating: A, Target points for right-sided conventional (L4 and L5) and cooled (S1–S3) radiofrequency denervation at the junction of the L5 superior articular and transverse processes (L4 primary dorsal ramus), the sacral ala (L5 primary dorsal ramus), and S1–S3 foramina (lateral branches). B, Anticipated lesions at each of the target points. Source: Cohen SP, Hurley RW, Buckenmaier CC 3rd, et al: Randomized, placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. A B

  22. SURGICAL STABILIZATION

  23. CONCLUSIONS

  24. PIRIFORMIS SYNDROME

  25. ANATOMY OF THE PIRIFORMIS MUSCLEAND THE SCIATIC NERVE

  26. PATHOPHYSIOLOGY, SIGNS AND SYMPTOMS,AND TREATMENT

  27. TECHNIQUES OF PIRIFORMIS MUSCLEAND PERISCIATIC NERVE INJECTIONS

  28. FIGURE 5 Posterior view of the sacrum, ilium, and greater trochanter of the femur, illustrating the course of the piriformismuscle, sciatic nerve, and the site of injection (marked “X”). Source: BenzonHT, Katz JA, Benzon HA, Iqbal MS: Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature.

  29. FIGURE 6 Fluoroscopic image of the insulated needle in the piriformismuscle with the muscle being outlined by the injected radiopaque dye.

  30. KEY POINTS

  31. با تشکر...

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