Pelvic and Hip Morphometry in Piriformis Syndrome

Study Overview
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Brief Summary
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In this case-control study, 23 patients diagnosed as PS by diagnostic injection with ultrasound guidance were selected as the study group. 22 patients who were excluded from the diagnosis of PS and had anteroposterior (AP) direct radiographic imaging were evaluated as the control group. On the AP Pelvic graph, the femoral neck-shaft angle, the distances between predetermined bony landmarks were measured blindly without knowing the diagnosis, and the findings were compared statistically. This study aims to evaluate whether the anatomical structure of the pelvis predisposes to the etiopathogenesis of the piriformis syndrome.

Detailed Description
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Piriformis syndrome (PS) is a neuromuscular disorder consisting of pain and symptoms caused by compression of the sciatic nerve and other structures that pass under the piriformis muscle (PM). Due to difficulties in diagnosis, PS is confused with other pathologies such as lumbar disc pathology, lumbosacral radiculopathy, and sacroiliac dysfunction. As a result, patients are exposed to unnecessary and ineffective treatments, even surgery. The main problems in the PS diagnosis are the absence of objective physical examination findings, radiological findings, and a clear etiology. When the pathophysiology and etiology of PS are considered, there is no identifiable cause in most patients. Previous studies suggest that trauma, anatomical variations, and the trigger point in the muscle may cause PS. No study in the literature radiologically examined the pelvis or hip bone morphological features in PS to the best of our knowledge. This study aims to determine whether pelvic or hip bone morphology features pose a risk for PS in this study.

Official Title
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The Importance of Pelvic Morphometric Measurements in Piriformis Syndrome: A Case-control Study

Conditions
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Piriformis Muscle Syndrome, Anthropometry

Intervention / Treatment
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* Diagnostic Test: Ultrasound guided diagnostic injection


Participation Criteria
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Eligibility Criteria
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For Piriformis syndrome group (study group); Inclusion Criteria: A dramatic relief of pain following piriformis muscle local anesthetic injection Exclusion Criteria: Having a neurological deficiency Having lumbar, sacroiliac, hip, and thoracolumbar pathology (inflammatory or degenerative) Operation history at the lumbar and hip region Being in the gestational or lactational period Body mass index of greater than 35 History of inflammatory or infectious disease Active psychiatric illness, severe systemic, vascular or malign disease For the control group Inclusion criteria: -Having Anteroposterior pelvic radiographs for other medical reasons Exclusion criteria: Having a present piriformis syndrome or a history of piriformis syndrome Having a neurological deficiency Having lumbar, sacroiliac, hip, and thoracolumbar pathology (inflammatory or degenerative) Operation history at the lumbar and hip region Being in the gestational or lactational period Body mass index of greater than 35 History of inflammatory or infectious disease Active psychiatric illness, severe systemic, vascular or malign disease

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Piriformis syndrome group<br>Patients who were diagnosed as PS by diagnostic injection with ultrasound guidance | Diagnostic Test: Ultrasound guided diagnostic injection<br>* 4 cc lidocaine %2 injection into the piriformis muscle was performed for the diagnosis of piriformis syndrome. It was performed by the ultrasound-guidance to increase the accuracy of the injection.<br>|
| Age and sex match control group<br>Patients who were excluded from the diagnosis of PS and had anteroposterior (AP) direct radiographic imaging | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Femoral Neck-Shaft Angle (NSA) | The NSA, also called caput collum-diaphyseal angle or inclination angle, defined as the angle between the longitudinal femoral shaft axis and femoral head-neck axis. | The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken. | 
| Posterior Superior Iliac Spine (PSIS)- Trochanter Major (TM) | The distance between the posterior superior iliac spine and the greater trochanter | The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken. | 
| PSIS-Ischial Tuberosity (IT) | The distance between the posterior superior iliac spine and the apex of the ischial tuberosity | The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken. | 
| IT-TM | The distance between the apex of the ischial tuberosity and the greater trochanter | The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken. | 
| Sacrum-TM | The distance between the sacrum and the greater trochanter | The measurement was evaluated by two different investigators immediately after the pelvis anteroposterior radiography was taken. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anthropometry, Pelvic Bones, Muscle Syndrome, Piriformis, Prospective Studies, Case-Control Studies, femur neck / pathology