title: Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients.
abstract: OBJECTIVE
  Piriformis Muscle Syndrome (PMS) is caused by sciatic nerve compression in the infrapiriformis canal. However, the pathology is poorly understood and difficult to diagnose. This study aimed to devise a clinical assessment score for PMS diagnosis and to develop a treatment strategy.
  
  
  METHODS
  Two hundred and fifty patients versus 30 control patients with disco-radicular conflict, plus 30 healthy control subjects were enrolled. A range of tests was used to produce a diagnostic score for PMS and an optimum treatment strategy was proposed.
  
  
  RESULTS
  A 12-point clinical scoring system was devised and a diagnosis of PMS was considered 'probable' when greater or equal to 8. Sensitivity and specificity of the score were 96.4% and 100%, respectively, while the positive predictive value was 100% and negative predictive value was 86.9%. Combined medication and rehabilitation treatments had a cure rate of 51.2%. Hundred and twenty-two patients (48.8%) were unresponsive to treatment and received OnabotulinumtoxinA. Visual Analogue Scale (VAS) results were 'Very good/Good' in 77%, 'Average' in 7.4% and 'Poor' in 15.6%. Fifteen of 19 patients unresponsive to treatment underwent surgery with 'Very good/Good' results in 12 cases.
  
  
  CONCLUSIONS
  The proposed evaluation score may facilitate PMS diagnosis and treatment standardisation. Rehabilitation has a major role associated in half of the cases with botulinum toxin injections.
authors.affiliation: Department of Neuromuscular Examinations and Diseases, hôpital Jean-Minjoz, CHRU, 25000 Besançon, France. fmichel@chu-besancon.fr
authors.forename: F
authors.initials: F
authors.lastname: Michel
authors.forename: P
authors.initials: P
authors.lastname: Decavel
authors.forename: E
authors.initials: E
authors.lastname: Toussirot
authors.forename: L
authors.initials: L
authors.lastname: Tatu
authors.forename: E
authors.initials: E
authors.lastname: Aleton
authors.forename: G
authors.initials: G
authors.lastname: Monnier
authors.forename: P
authors.initials: P
authors.lastname: Garbuio
authors.forename: B
authors.initials: B
authors.lastname: Parratte
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D016022:Case-Control Studies; D004576:Electromyography; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008405:Massage; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009465:Neuromuscular Agents / Q000627:therapeutic use; D010808:Physical Examination; D055958:Piriformis Muscle Syndrome / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed
chemical_list: D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Diagnosis; Nerf ischiatique; OnabotulinumtoxinA (BoNTA); Piriformis Muscle Syndrome; Sciatic nerve; Syndrome du muscle piriforme; Évaluation clinique