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Radiological Comparison of Femoral Neck–Shaft Angle in Piriformis Syndrome: A Case–Control Study

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Abstract

Introduction

Variations in osseous, neural and muscular anatomical structures in the gluteal region have been investigated for their role in causing deep gluteal pain syndromes including piriformis syndrome. This study aimed to radiologically determine whether the femoral neck–shaft angle (NSA) in piriformis syndrome differs from that in a healthy population.

Methods

Two groups of participants comprising 23 piriformis syndrome patients and 22 healthy controls were included in the present study. Piriformis syndrome was diagnosed based on clinical findings and the diagnosis was confirmed by intramuscular local anaesthetic injection. Femoral NSAs were measured from the anteroposterior pelvic radiographs and compared between the control and piriformis syndrome-affected groups.

Results

The age, height, body weight, body mass index and gender distribution differences between the two groups (control and piriformis) were not statistically significant. The femur NSA was significantly lower in the piriformis group than in the control group. The receiver operating characteristic analysis revealed that the area under the curve, sensitivity and specificity for predicting the risk of piriformis syndrome (PS) were 0.946%, 100% and 86.36%, respectively, at an NSA cut-off of 127°.

Conclusions

Reduced femoral NSA is related to PS. However, studies with a larger study sample are needed to further substantiate this finding.

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References

  1. Hernando, M. F., Cerezal, L., Pérez-Carro, L., Abascal, F., & Canga, A. (2015). Deep gluteal syndrome: Anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiology, 44(7), 919–934.

    Article  Google Scholar 

  2. Park, J. W., Lee, Y. K., Lee, Y. J., Shin, S., Kang, Y., & Koo, K. H. (2020). Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. The Bone & Joint Journal, 102B(5), 556–567.

    Article  Google Scholar 

  3. Kizaki, K., Uchida, S., Shanmugaraj, A., Aquino, C. C., Duong, A., Simunovic, N., Martin, H. D., & Ayeni, O. R. (2020). Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), 3354–3364.

    Article  Google Scholar 

  4. Chang, A., Ly, N., & Varacallo, M. (2022). Piriformis injection. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448193/.

  5. Jankovic, D., Peng, P., & van Zundert, A. (2013). Brief review: Piriformis syndrome: Etiology, diagnosis, and management. Canadian Journal of Anaesthesia, 60(10), 1003–1012.

    Article  Google Scholar 

  6. Hicks, B. L., Lam, J. C., & Varacallo, M. (2022). Piriformis syndrome. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/ Accessed 15 Jan 22

  7. Michel, F., Decavel, P., Toussirot, E., Tatu, L., Aleton, E., Monnier, G., Garbuio, P., & Parratte, B. (2013). The piriformis muscle syndrome: An exploration of anatomical context, pathophysiological hypotheses and diagnostic criteria. Annals of Physical and Rehabilitation Medicine, 56(4), 300–311.

    Article  CAS  Google Scholar 

  8. Haładaj, R., Pingot, M., Polguj, M., Wysiadecki, G., & Topol, M. (2015). Anthropometric study of the piriformis muscle and sciatic nerve: A morphological analysis in a Polish population. Medical Science Monitor, 21, 3760–3768.

    Article  Google Scholar 

  9. Hintze, J.L. (2011). PASS 11. NCSS, LLC. Kaysville, Utah, USA. www.ncss.com Accessed 9 Aug 2021.

  10. Probst, D., Stout, A., & Hunt, D. (2019). Piriformis syndrome: A narrative review of the anatomy, diagnosis, and treatment. PM & R, 11(1), 54–63.

    Google Scholar 

  11. Freiberg, A. H., & Vinke, T. H. (1934). Sciatica and the sacro-iliac joint. Journal of Bone and Joint Surgery., 16(1), 126–136.

    Google Scholar 

  12. Solheim, L. F., Siewers, P., & Paus, B. (1981). The piriformis muscle syndrome. Sciatic nerve entrapment treated with section of the piriformis muscle. Acta Orthopaedica Scandinavica, 52(1), 73–75.

    Article  CAS  Google Scholar 

  13. Beatty, R. A. (1994). The piriformis muscle syndrome: A simple diagnostic maneuver. Neurosurgery, 34(3), 512–514.

    Article  CAS  Google Scholar 

  14. Palamar, D., & Akgun, K. (2019). Pelvic ınjections. In L. Ozcakar, K. V. Chang, E. Gürçay, G. Park, F. Franchignomi, & V. Ricci (Eds.), Ultrasound imaging and guidance for musculoskeletal interventions in physical and rehabilitation medicine (pp. 287–289). Milan: Edi Ermes.

    Google Scholar 

  15. Misirlioglu, T. O., Akgun, K., Palamar, D., Erden, M. G., & Erbilir, T. (2015). Piriformis syndrome: Comparison of the effectiveness of local anesthetic and corticosteroid injections: A double-blinded, randomized controlled study. Pain Physician, 18(2), 163–171.

    Article  Google Scholar 

  16. Fischer, C. S., Kühn, J. P., Völzke, H., Ittermann, T., Gümbel, D., Kasch, R., Haralambiev, L., Laqua, R., Hinz, P., & Lange, J. (2020). The Neck–Shaft angle: An update on reference values and associated factors. Acta Orthopaedica, 91(1), 53–57.

    Article  Google Scholar 

  17. Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology, 143(1), 29–36.

    Article  CAS  Google Scholar 

  18. Hopayian, K., & Danielyan, A. (2018). Four symptoms define the piriformis syndrome: An updated systematic review of its clinical features. European Journal of Orthopaedic Surgery & Traumatology, 28(2), 155–164.

    Article  Google Scholar 

  19. Parziale, J. R., Hudgins, T. H., & Fishman, L. M. (1996). The piriformis syndrome. American Journal of Orthopedics, 25(12), 819–823.

    CAS  PubMed  Google Scholar 

  20. Hopayian, K., Song, F., Riera, R., & Sambandan, S. (2010). The clinical features of the piriformis syndrome: A systematic review. European Spine Journal, 19(12), 2095–2109.

    Article  Google Scholar 

  21. Benzon, H. T., Katz, J. A., Benzon, H. A., & Iqbal, M. S. (2003). Piriformis syndrome: Anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology, 98(6), 1442–1448.

    Article  Google Scholar 

  22. Barbosa, A., Santos, P., Targino, V. A., Silva, N. A., Silva, Y., Gomes, F. B., & Assis, T. O. (2019). Sciatic nerve and its variations: Is it possible to associate them with piriformis syndrome? Arquivos de Neuro-Psiquiatria, 77(9), 646–653.

    Article  Google Scholar 

  23. Poutoglidou, F., Piagkou, M., Totlis, T., Tzika, M., & Natsis, K. (2020). Sciatic nerve variants and the piriformis muscle: A systematic review and meta-analysis. Cureus, 12(11), e11531.

    PubMed  PubMed Central  Google Scholar 

  24. Leite, M. J., Pinho, A. R., Silva, M. R., Lixa, J. C., Maderia, M. D., & Pereira, P. G. (2020). Deep gluteal space anatomy and its relationship with deep gluteal pain syndromes. Hip International, 32, 1120700020966255.

    Google Scholar 

  25. Fearon, A., Stephens, S., Cook, J., Smith, P., Neeman, T., Cormick, W., & Scarvell, J. (2012). The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. British Journal of Sports Medicine, 46(12), 888–892.

    Article  Google Scholar 

  26. Torriani, M., Souto, S. C., Thomas, B. J., Ouellette, H., & Bredella, M. A. (2009). Ischiofemoral impingement syndrome: An entity with hip pain and abnormalities of the quadratus femoris muscle. AJR American Journal of Roentgenology, 193(1), 186–190.

    Article  Google Scholar 

  27. Tosun, O., Algin, O., Yalcin, N., Cay, N., Ocakoglu, G., & Karaoglanoglu, M. (2012). Ischiofemoral impingement: Evaluation with new MRI parameters and assessment of their reliability. Skeletal Radiology, 41(5), 575–587.

    Article  Google Scholar 

  28. Bredella, M. A., Azevedo, D. C., Oliveira, A. L., Simeone, F. J., Chang, C. Y., Stubbs, A. J., & Torriani, M. (2015). Pelvic morphology in ischiofemoral impingement. Skeletal Radiology, 44(2), 249–253.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Assoc. Prof. Can Ateş for his contribution to the statistical analysis in this study.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, E 5 Karayolu üstü, İçerenköy, Istanbul, Turkey

    Gamze G. Güleç, İlknur Aktaş & Feyza Ü. Özkan

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  1. Gamze G. Güleç
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  2. İlknur Aktaş
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  3. Feyza Ü. Özkan
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Contributions

Conceived and designed the analysis: FUO, İA, and GGG. Data collection: GGG, İA, and FÜÖ. Contributed data/analysis tools: GGG and FÜÖ. Performed the analysis: GGG, İA, and FÜÖ. Wrote the paper: GGG and İA. Revision of the paper: İA and FUO.

Corresponding author

Correspondence to Gamze G. Güleç.

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Güleç, G.G., Aktaş, İ. & Ü. Özkan, F. Radiological Comparison of Femoral Neck–Shaft Angle in Piriformis Syndrome: A Case–Control Study. JOIO 56, 1950–1957 (2022). https://doi.org/10.1007/s43465-022-00736-y

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  • DOI: https://doi.org/10.1007/s43465-022-00736-y

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