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CONDITION/DISORDER SYNONYMS

  • Deep gluteal syndrome

  • Fat wallet syndrome

  • Hip lateral rotator tendinitis

  • Hip lateral rotator tendinosis

  • Sciatic nerve impingement with (out) inflammation

  • Wallet sciatica

ICD-9-CM CODE

  • 355.0 Lesion of sciatic nerve

ICD-10-CM CODE

  • G57.00 Lesion of sciatic nerve, unspecified lower limb

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation

PATIENT PRESENTATION

A 27-year-old woman presenting with complaints of left ischial/hip pain with sciatic radiation of the pain. She reports that the pain has been present for approximately 5 months with onset following a 13-mile run in older running shoes. Since the onset of symptoms, the ischial/hip pain has not decreased in intensity. The sciatic pain radiation has also not improved, however has not progressed or moved further distally.

Since the onset of symptoms she has had extensive medical workup, including an MRI and CT scan that were both negative for lumbar radiculopathy. Her primary complaints of pain are with sitting (especially while driving) or prolonged standing. There is relief of symptoms when lying down. She has modified but continued her daily workouts including 30 minutes on the stair master and runs of 6 miles or less, despite her persistent pain. She admits poor or absent stretching habits and frequently returns to her sedentary work routine immediately following exercise. Observation of lower extremity alignment reveals excessive femoral external rotation, lateral tibial torsion, and excessive pronation of both feet. There is tenderness in the left buttock region between the sacrum and the greater trochanter. Active range of motion (AROM) is within normal limits (WNL) for the lumbar spine. Hip AROM is limited in internal rotation.

KEY FEATURES

Description

  • Neuropathic pain from compression of the sciatic nerve as it courses through the piriformis muscle or myofascial pain from a tight, hypertrophic, and tender piriformis without nerve entrapment

  • Major muscles at the posterior hip function together based on how much the hip is flexed

    • Gluteals

    • Piriformis

    • Gemelli

    • Obturator internus

    • Quadratus femoris

  • These muscles are usually involved whenever there is low back pain or a lower extremity problem that requires compensation of motion

  • The sciatic nerve may even pass through the piriformis (17% of an assumed normal population)

FIGURE 136-1

Proximity of the piriformis muscle and the sciatic nerve. (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ. Emergency Orthopedics, The Extremities. 5th ed. © 2007, McGraw-Hill Inc., New York.)

FIGURE 136-2

Deeper muscles of the posterior hip. (Reproduced, with permission, from Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. McGraw-Hill, 2011.)

Essentials of Diagnosis

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