Overview of the anatomical basis of the piriformis syndrome‑dissection with magnetic resonance correlation

Goidescu,Ofelia-Costina; Enyedi,Mihaly; Tulin,Adrian-Daniel; Tulin,Raluca; Vacaroiu,Ileana Adela; Nica,Adriana Elena; Dragos,Dorin; Ionescu,Dorin; Georgescu,Dragos; Miron,Adrian; Filipoiu,Florin-Mihail

doi:10.3892/etm.2021.11036

February-2022 Volume 23 Issue 2

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February-2022 Volume 23 Issue 2

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Article Open Access

Overview of the anatomical basis of the piriformis syndrome‑dissection with magnetic resonance correlation

Authors:
- Ofelia-Costina Goidescu
- Mihaly Enyedi
- Adrian-Daniel Tulin
- Raluca Tulin
- Ileana Adela Vacaroiu
- Adriana Elena Nica
- Dorin Dragos
- Dorin Ionescu
- Dragos Georgescu
- Adrian Miron
- Florin-Mihail Filipoiu
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Affiliations: Doctoral School, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Morphological Sciences, Discipline of Anatomy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Nephrology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Orthopedics, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Discipline of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania

Copyright: © Goidescu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 113
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Published online on: December 3, 2021

https://doi.org/10.3892/etm.2021.11036
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Abstract

The piriformis syndrome is one of the most commonly misdiagnosed causes of lower back and gluteal pain caused by the compression of the sciatic nerve and the internal pudendal neurovascular bundle by the piriformis muscle. Although this syndrome was first suggested over 90 years ago, its diagnosis still represents a challenge for clinicians. In the present study, dissection was used to determine the intra‑ and extrapelvic anatomical course of the internal pudendal nerve and the data were compared with the information obtainable through MRI examination, in order to identify the piriformis syndrome and to differentiate it from other causes of internal pudendal neuralgia. Thorough dissections of the pelvis and deep gluteal region were conducted on female cadavers, which were correlated with MRI scans, in order to describe the course of the internal pudendal nerve in contact with the piriformis muscle. The dissection findings and MRI scans obtained allowed us to describe and demonstrate the compression points along the course of the sciatic nerve and the internal pudendal bundle, the anatomical correlations between the piriformis muscle and the nervous structures around it, emphasizing the areas most susceptible to possible nerve impingement syndromes. In the anatomic trajectory of the sciatic nerve and the internal pudendal bundle there are multiple contact points with anatomical structures that may lead to compression of the nerve structures, generating symptoms that comprise the piriformis syndrome. The present study sought to establish clear osseous landmarks that may help evaluate these associations and possible nerve compressions on pelvic MRI examination.

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1	Anbumani TL, Thamarai SA and Anthony AS: Sciatic nerve and its variations: An anatomical study. Int J Anat Res. 3:1121–1127. 2015.
2	Ripani M, Continenza MA, Cacchio A, Barile A, Parisi A and De Paulis F: The ischiatic region: Normal and MRI anatomy. J Sports Med Phys Fitness. 46:468–475. 2006.PubMed/NCBI
3	Chang C, Jeno SH and Varacallo M: Anatomy, bony pelvis and lower limb, piriformis muscle. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2021.
4	Hopayian K, Song F and Sambandan RRS: The clinical features of the piriformis syndrome: A systematic review. Eur Spine J. 19:2095–2109. 2010.PubMed/NCBI View Article : Google Scholar
5	Carro LP, Hernando MF, Cerezal L, Navarro IS, Fernandez AF and Castillo AO: Deep gluteal space problems: Piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J. 6:384–396. 2016.PubMed/NCBI View Article : Google Scholar
6	Beaton LE and Anson BJ: The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Rec. 70:1–5. 1937.
7	Pećina M: Contribution to the etiological explanation of the piriformis syndrome. Acta Anat (Basel). 105:181–187. 1979.PubMed/NCBI
8	Vij N, Kiernan H, Bisht R, Singleton I, Cornet EM, Kaye AD, Imani F, Varassi G, Pourbahiri M, Viswanath O and Urits I: Surgical and non-surgical treatment options for piriformis syndrome: A literature review. Anesth Pain Med. 11(e112825)2021.PubMed/NCBI View Article : Google Scholar
9	Yeoman W: The relation of arthritis of the sacro-iliac joint to sciatica, with an analysis of 100 cases. Lancet. 212:1119–1123. 1928.
10	Freiburg AH and Vinke TA: Sciatica and the sacroiliac joint. J Bone Joint Surg. 16:126–36. 1934.
11	Beaton LE and Anson BJ: The sciatic nerve and the piriformis muscle. Their interrelation a possible cause of coccygodynia. J Bone Joint Surg. 20:686–688. 1938.
12	Robinson D: Piriformis syndrome in relation to sciatic pain. Am J Surg. 73:356–358. 1947.PubMed/NCBI View Article : Google Scholar
13	Hopayian K and Danielyan A: Four symptoms define the piriformis syndrome: An updated systematic review of its clinical features. Eur J Orthop Surg Traumatol. 28:155–164. 2018.PubMed/NCBI View Article : Google Scholar
14	Papadopoulos EC and Khan SN: Piriformis syndrome and low back pain: A new classification and review of the literature. Orthop Clin North Am. 35:65–71. 2004.PubMed/NCBI View Article : Google Scholar
15	Hopayian K and Heathcote J: Deep gluteal syndrome: An overlooked cause of sciatica. Br J Gen Pract. 69:485–486. 2019.PubMed/NCBI View Article : Google Scholar
16	Martin HD, Kivlan BR, Palmer IJ and Martin RL: Diagnostic accuracy of clinical tests for sciatic nerve entrapment in the gluteal region. Knee Surg Sports Traumatol Arthrosc. 22:882–888. 2014.PubMed/NCBI View Article : Google Scholar
17	Martin HD, Shears SA, Johnson JC, Smathers AM and Palmer IJ: The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy. 27:172–181. 2011.PubMed/NCBI View Article : Google Scholar
18	Park JW, Lee YK, Lee YJ, Shin S, Kang Y and Koo KH: Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J. 102:556–557. 2020.PubMed/NCBI View Article : Google Scholar
19	Kim YJ and Kim DH: Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve. Yeungnam Univ J Med. 38:148–151. 2021.PubMed/NCBI View Article : Google Scholar

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Overview of the anatomical basis of the piriformis syndrome‑dissection with magnetic resonance correlation

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