Piriformis syndrome - Knowledge (XXG)

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NSAIDs only (32%), and 9 improved with NSAIDs and physical therapy (22%). In a study of 14 patients, all (100%) saw improvement with physical therapy and/or injections. Of these patients, 9 (64%) improved with physical therapy alone. The remaining 5 (36%) improved with injections (steroids or ozone). However, 6 months after the end of treatment, only 5/14 patients (36%) had complete resolution of pain. In a study of 250 patients, medication and physical therapy led to complete pain relief in 51% of patients. Of those who did not see improvement with physical therapy, botox injections led to greater than 50% pain relief in 77% of patients. Of those who also did not see improvement with injections, surgery led to greater than 50% pain relief in 79% of patients. Some caution should be applied in interpreting these results as therapy is usually not compared to an untreated

584:, such secondary causes are considered preventable, especially those occurring in daily activities: according to this theory, periods of prolonged sitting, especially on hard surfaces, produce minor stress that can be relieved with bouts of standing. An individual's environment, including lifestyle factors and physical activity, determine susceptibility to trauma of any given type. Although empirical research findings on the subject have never been published, many believe that taking sensible precautions during high-impact sports and when working in physically demanding conditions may decrease the risk of experiencing piriformis syndrome, either by forestalling injury to the muscle itself or injury to the nerve root that causes it to spasm. In this vein, proper safety and padded equipment should be worn for protection during any type of regular, firm contact (e.g. 839:, quadriceps pain, lower leg pain, and buttock pain. These symptoms include tenderness, tingling and numbness initiating in low back and buttock area and then radiating down to the thigh and to the leg. A precise test for piriformis syndrome has not yet been developed and thus hard to diagnose this pain. The pain is often initiated by sitting and walking for a longer period. In 2012, one study found that 17.2% of low back pain patients met a clinical diagnosis for piriformis syndrome. Piriformis syndrome does not occur in children, and is mostly seen in women of age between thirty and forty. This is due to 588:). In the workplace, individuals are encouraged to make regular assessments of their surroundings and attempt to recognize those things in their routine that may produce micro or macro traumas. No research has substantiated the effectiveness of any such routine, however, and participation in one may do nothing but heighten an individual's sense of worry over physical minutiae while have no effect in reducing the likeliness of experiencing or re-experiencing piriformis syndrome. 716: 763:. Comparing local anesthetic with corticosteroids against Botulinum toxin is difficult because existing studies tend to lack controls which means that the effect of the treatment under observation is confounded with the natural history of the disease (patients with piriformis syndrome often see their symptoms resolve even without treatment). When comparative studies exist, Botulinum toxin is found to be more effective and local anesthetic with corticosteroids. 619: 683:(to massage the piriformis below it), lumbosacral stabilization (e.g. abdominal muscle exercises, spine stretching), hip strengthening/stretching, and the correction of biomechanical errors. Direct application of heat and ultrasound (which generates heat) and are often suggested before physical therapy. Heat will enhance muscle elasticity and blood flow, which helps with increase the efficacy of stretching. Piriformis 39: 560:

relieve the symptoms. If successful, there should be a complete or near-complete relief of pain for 4-6 hours. Needle guidance can be done with fluoroscopy, ultrasound, CT, or MRI. Ultrasound is a popular choice due to its low cost, lack of radiation, and accessibility, but lacks the spatial resolution of CT/MRI. While there is no gold standard test to diagnose piriformis syndrome, in

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anesthesia, antibiotics, electrophysiology, imaging, image-guided injections, and surgery have revived interest around piriformis syndrome. Recently, advances in endoscopic surgery led to discoveries suggesting a broader classification was necessary to describe all the causes of sciatic nerve entrapment in the deep gluteal space. This broader classification is now called

855:. In 2011, out of 263 patients between the ages of 45 to 84 treated for piriformis syndrome, 53.3% were female. Females are two times more likely to develop piriformis syndrome than males. Moreover, females had longer stay in hospital during 2011 due to high prevalence of the pain in females. The average cost of treatment was $ 29,070 for hospitalizing average 4 days. 756:. In addition to helping break the cycle of chronic muscle spasms, it reverses piriformis hypertrophy where the muscle is enlarged and presses on the sciatic nerve. Though the piriformis muscle becomes inactivated for months, the loss of piriformis muscle function does not cause any deficit in strength or gait as the surrounding muscles quickly take over its role. 652:, especially piriformis stretching, is often done concomitantly while treating pain. For patients who have failed physical therapy, injections into the piriformis muscle using some combination of anesthetic/steroids/botox may be considered. In refractory cases, surgery may be indicated where the sciatic nerve is dissected or the piriformis muscle/tendon is cut. 535:

a number of maneuvers that can be done in an attempt to provoke sciatic nerve compression. These tests either stretch the piriformis or cause the piriformis to contract. The most common tests used are the Freiberg test, FAIR test (flexion, adduction, internal rotation), Beatty test, Pace test, seated piriformis stretch test, and

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syndrome. However, magnetic resonance neurography is considered "investigational/not medically necessary" by some insurance companies. Neurography can determine whether or not a patient has a split sciatic nerve or a split piriformis muscle – this may be important in getting a good result from injections or surgery.

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piriformis muscle at the greater sciatic notch. However, the incidence of atypical anatomic variations (types B-F) has not been found to differ significantly between piriformis syndrome patients and cadavers, leading to doubt about the importance of this anatomic variation in the development of piriformis syndrome.

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Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, McBride DQ, Tsuruda JS, Morisoli B, Batzdorf U, Johnson JP (February 2005). "Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome

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femoris muscle angle in the os coxae. Between the years of 1991–1994, self-selecting patients seeking piriformis syndrome treatment from a group of American physicians had the following distribution: 75% were in New York, Connecticut, New Jersey, Pennsylvania; 20% in other American urban centers; and

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Hip adduction is a strengthening exercise for the piriformis muscle. A cable attached at the ankle can be used to adduct the hip, bringing the leg in toward the opposite side of the body. The same equipment can also be used for hip abduction, where the leg starts beside the opposing leg and moves out

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Today piriformis syndrome is in the same place herniated disk once were - there is a link between the pathophysiology and the symptoms (it's clear why the most studied treatments work), but piriformis syndrome does not have a clear set of diagnostic criteria and a known prevalence. Controlled trials

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In one study, the cure rate of physiotherapy for 250 piriformis syndrome patients was found to be approximately 50% after 3 months. However, this study did not use a control group for physiotherapy and so this may simply reflect the natural history of the syndrome. In other words, patients may often

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diffusion of water to assess structural and functional properties of nerves. Both MRN and DTI can localize nerve lesions, their extension, and their spatial distribution due to conditions such as entrapment. MRN and DTI have also been used to visualize sciatic nerve lesions to diagnose of piriformis

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Diagnostic modalities such as EMG, x-rays, ultrasound, CT, MRI is mostly used to exclude other conditions. For example, and MRI of the spine can rule out conditions like radiculopathy and spinal stenosis. MRI of the pelvis can rule out conditions like pelvic tumors. MRI and ultrasound can be used to

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In a physical exam the piriformis can be palpated externally though it is so deep that it may not be possible to assess tenderness. If the piriformis can be located it may feel cord-like. Internal palpation is also possible which allows better access to assess piriformis muscle tenderness. There are

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Piriformis syndrome does not yet have a validated set of diagnostic criteria, however the diagnosis is primarily clinical, involving a physical examination and an evaluation of patient history. Imaging can assist in excluding other conditions with similar symptoms, such as lumbar disc herniation and

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The clinical signs may involve unilateral or bilateral buttocks pain that fluctuates throughout the day, the absence of lower back pain, buttocks or sciatica pain when in the sitting position (especially for prolonged periods), sciatic pain with fluctuating periods without pain through out the day,

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The largest and most bulky nerve in the human body is the sciatic nerve. Starting at its origin it is 2 cm wide and 0.5 cm thick. The sciatic nerve forms the roots of L4-S3 segments of the lumbosacral plexus. The nerve will pass inferiorly to the piriformis muscle, in the direction of the

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cited an incident for PS. A separate study showed 6% of 750 patients with the same incidence. About 6–8% of low back pain occurrences were attributed to PS, though other reports concluded about 5–36%. In a survey conducted on the general population, 12.2–27% included a lifetime occurrence of PS,

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Image-guided injections into the piriformis muscle can assist in the diagnosis. Injections usually involve delivering anesthetic to the piriformis muscle to paralyze it. In the event of a piriformis muscle spasm causing sciatic nerve compression, paralyzing the piriformis muscle will temporarily

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Injections are part of multi-modal therapy and can be therapeutic. They may be used with conservative treatments like physical therapy or after the failure of conservative treatments. Injections deliver medication directly to the piriformis muscle through a needle. The needle is placed into the

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Data on treatment outcomes is very limited. In a study of 42 patients with clinically suspected piriformis syndrome with normal MRI/CT imaging findings, 41 saw complete resolution of symptoms within 36 days. Of those 41 patients, 19 had spontaneous resolution of symptoms (46%), 13 improved with

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may cause crowding around the greater sciatic foramen. Both the piriformis and sciatic nerve pass through the greater sciatic foramen and the deep gluteal space. An enlarged (hypertrophic) piriformis muscle may place pressure on nearby structures. The empirical evidence supporting this is that

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Anatomic variations which might cause piriformis syndrome have been reported (e.g. sciatic nerve branching, bipartite piriformis muscle, etc), however comprehensive anatomic data on the piriformis morphology is lacking. In other words, patients with piriformis syndrome sometimes have anatomic

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as a cause of sciatica shifted attention to the spine. Although the concept of piriformis syndrome was conceptualized as early as 1928, the incompletely understood pathology and lack of clear diagnostic criteria made this syndrome highly controversial. Advancements in medical technology like

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A heavily scrutinized anatomic variation involves sciatic nerve branching around the piriformis using the 6 category classification first described by Beaton and Anson. In this classification, the normal anatomy (type A) seen in about 80% of people is where the sciatic nerve passes under the

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Piriformis syndrome surgery is still in the preliminary stages and so there are no randomized, prospective trials or cross-sectional studies. Existing evidence is largely retrospective studies and systematic reviews of those studies. Surgical outcomes are typically assessed by

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Hilal FM, Bashawyah A, Allam AE, Lam KH, El Oumri AA, Galluccio F, AlKharabsheh A, Kaye AD, Salti A, Varrassi G (August 2022). "Efficacy of Botulinum Toxin, Local Anesthetics, and Corticosteroids in Patients With Piriformis Syndrome: A Systematic Review and Meta-analysis".

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observe side-to-side differences, a common finding where the symptomatic side often exhibits increased piriformis size measured as increased thickness and cross-sectional area. Specialized sequences and protocols of MRI can be used for sciatic nerve imaging, namely MRN (

317:, and exits the greater sciatic foramen just underneath the piriformis. A number of anatomic variations exist in the branching pattern of sciatic nerve around the piriformis, such as passing over, through, or under the piriformis, as well as early branching into the 801:

Failure may in part be due to an incorrect diagnosis. Piriformis syndrome does not have well-validated diagnostic criteria and consequently some patients being treated for piriformis syndrome may have a different underlying condition with a similar symptom profile.

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Wada K, Hashimoto T, Miyagi R, Sakai T, Sairyo K (March 2017). "Diffusion tensor imaging and tractography of the sciatic nerve: assessment of fractional anisotropy and apparent diffusion coefficient values relative to the piriformis muscle, a preliminary study".

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For surgery, results typically show that at least 80% of patients see improvement. When VAS scores (pain scores) are measured, patients typically have severe pain (>7.5) before surgery and at most mild pain (< 3.5) after surgery. A systematic review of

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Ruiz-Arranz J, Alfonso-Venzalá I, Villalón-Ogayar J (2008). "Síndrome del músculo piramidal. Diagnóstico y tratamiento. Presentación de 14 casos" [Piriformis muscle syndrome. Diagnosis and treatment. Presentation of 14 cases].

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effects. The duration is unclear but somewhere between 1 week and 3 months. Botulinum Toxin will paralyze a muscle with a much longer duration than local anesthetics, up to 3 months. By paralyzing a muscle for so long the muscle will

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5% in North and South America, Europe, Asia, Africa and Australia. The common ages of occurrence happen between thirty and forty, and are scarcely found in patients younger than twenty; this has been known to affect all lifestyles.

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Saltychev M, Mattie R, McCormick Z, Laimi K (July 2020). "The Magnitude and Duration of the Effect of Intra-articular Corticosteroid Injections on Pain Severity in Knee Osteoarthritis: A Systematic Review and Meta-Analysis".

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for piriformis syndrome follows general rehabilitation principles for musculoskeletal conditions. The goals of physical therapy are to reduce piriformis muscle tightness, improve spine/hip/pelvis mobility, and restore normal

782:. While there is no difference seen in outcomes between open and endoscopic surgery, the endoscopic approach has a lower complication rate and is significantly less invasive (open surgery can involve a 10 cm incision). 2860:

Park MS, Jeong SY, Yoon SJ (May 2019). "Endoscopic Sciatic Nerve Decompression After Fracture or Reconstructive Surgery of the Acetabulum in Comparison With Endoscopic Treatments in Idiopathic Deep Gluteal Syndrome".

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Misirlioglu TO, Akgun K, Palamar D, Erden MG, Erbilir T (2015). "Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study".

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Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE (December 2014). "Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain".

695:. Strengthening abdominal muscles (part of core stabilization) is to improve spine stability and to avoid compensatory tension on the hip and buttocks. Stretching the spine and hip muscles is meant to increase 724:

piriformis muscle with image guidance such as fluoroscopy, ultrasound, CT, or MRI. Ultrasound is a popular choice due to a balance of accuracy, accessibility, lack of radiation exposure, and affordability.

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Michel F, Decavel P, Toussirot E, Tatu L, Aleton E, Monnier G, Garbuio P, Parratte B (July 2013). "Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients".

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Wong LF, Mullers S, McGuinness E, Meaney J, O'Connell MP, Fitzpatrick C (August 2012). "Piriformis pyomyositis, an unusual presentation of leg pain post partum--case report and review of literature".

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Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, Ayeni OR (December 2017). "Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review".

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injections may be used in those who do not improve. Surgery is not typically recommended. The frequency of the condition is unknown, with different groups arguing it is more or less common.

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Wada K, Goto T, Takasago T, Hamada D, Sairyo K (October 2017). "Piriformis muscle syndrome with assessment of sciatic nerve using diffusion tensor imaging and tractography: a case report".

441:. The empirical evidence supporting this is that patients can often see immediate and permanent relief from local anesthetic and the effectiveness of Botox injections as a muscle relaxer. 1435:

Chang A, Ly N, Varacallo M. Piriformis Injection. . In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448193/

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Hernando MF, Cerezal L, Pérez-Carro L, Abascal F, Canga A (July 2015). "Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space".

599:, though these are often suggested for helping treat or prevent any physical injury and are not piriformis-specific in their approach As with any type of exercise, it is thought that 719:

Ultrasound scan (left) and ultrasound-guided injection (right) of the piriformis muscle. Gmax = gluteus maximus; Pm = piriformis muscle; sn = sciatic nerve; S = sacrum; H = hip bone.

660:(patients sometimes get better on their own without treatment), and the diagnosis of piriformis syndrome isn't validated (meaning different studies can select patients differently). 4673: 591:

Other suggestions from some researchers and physical therapists have included prevention strategies including warming up before physical activity, practising correct exercise form,

418:. The pathophysiology of piriformis syndrome is not completely understood. There are several mechanisms by which the piriformis muscle is thought to be capable of compressing the 2068:

Fishman LM, Wilkins AN, Rosner B (August 2017). "Electrophysiologically identified piriformis syndrome is successfully treated with incobotulinum toxin a and physical therapy".

790:(numerical pain scores) and various questionnaires (e.g. Oswestry Disability Index), potentially with a follow up of up to 2 years, however no validated outcome measure exists. 774:

Surgical intervention may be considered when conservative treatments fail. Surgery for piriformis syndrome involves resection of the piriformis tendon (or muscle) and a sciatic

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and range of motion. The purpose of correcting poor biomechanics in the hip/pelvis/spine is that they move in coordination, so a biomechanical error may have cascading effects.

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Hodgens A, Sharman T. Corticosteroids. . In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554612/

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Porta M (March 2000). "A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm".

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Fritz J, Chhabra A, Wang KC, Carrino JA (February 2014). "Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome".

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A complete exam of low back, pelvis, buttocks, lower extremities may be necessary to rule out differential diagnoses. Sciatica secondary to conditions to be ruled out include

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Vassalou EE, Katonis P, Karantanas AH (February 2018). "Piriformis muscle syndrome: A cross-sectional imaging study in 116 patients and evaluation of therapeutic outcome".

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are unlikely to proceed without a sufficiently high prevalence and reliable diagnosis, however the prevalence cannot be determined without a reliable method of diagnosis.

564:, the generalization of extra-spinal sciatica in the deep gluteal space, diagnostic blocks are considered the gold standard for differentiating alternate sources of pain. 4705: 309:

is the largest peripheral nerve in the body and innervates significant portions of the skin and muscles of the thigh, leg, and foot. The sciatic nerve originates from

207:. Few cases in athletics, however, have been described. Diagnosis is difficult as there is no definitive test. A number of physical exam maneuvers can be supportive. 4336: 471:

The piriformis may be capable of dynamically compressing the sciatic nerve with certain hip movements. The empirical evidence supporting this is the presence of

739:(Botox, BTX), which may be used together or in combination. Local anesthetic will temporarily paralyze a muscle in the hope that it breaks the cycle of chronic 527:

are other conditions that present with pain in the low back and hip regions, which may radiate down along the back of the thigh, rarely going down below knee.

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are extremely limited. However, physiotherapy is safe and relatively inexpensive, so it is often recommended before more invasive and expensive treatments.

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The initial treatments are often focused on avoiding/relieving pain such as activity modification (e.g. avoidance of activities that cause pain), heat/ice,

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Yoon SJ, Ho J, Kang HY, Lee SH, Kim KI, Shin WG, Oh JM (May 2007). "Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome".

743:. The duration is in hours and consequently doesn't lead to long lasting relief from the direct action of the anesthetic. Corticosteroids is used for its 4329: 3958:

Kean Chen C, Nizar AJ (April 2013). "Prevalence of piriformis syndrome in chronic low back pain patients. A clinical diagnosis with modified FAIR test".

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just get better on their own without any particular treatment. The exact benefits of physiotherapy for piriformis syndrome are unclear as well-designed,

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Nakano J, Yamabayashi C, Scott A, Reid WD (August 2012). "The effect of heat applied with stretch to increase range of motion: a systematic review".

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Zeren B, Canbek U, Oztekin HH, İmerci A, Akgün U (December 2015). "Bilateral piriformis syndrome in two elite soccer players: Report of two cases".

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variations suggesting a cause, but it's not known if these anatomic variations actually occur more frequently in patients with piriformis syndrome.

4645: 4044: 3284:"Hip-spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain" 1143:

Hopayian K, Danielyan A (23 August 2017). "Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features".

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Typically the combination of therapies is local anesthetics with corticosteroids (LA+CS), or Botulinum toxin (BTX). Both are more effective than

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while 2.2–19.5% showed an annual occurrence. However further studies show that the proportion of the sciatica, in terms of PS, is about 0.1% in

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Le Bihan D, Mangin JF, Poupon C, Clark CA, Pappata S, Molko N, Chabriat H (April 2001). "Diffusion tensor imaging: concepts and applications".

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buttocks pain near the piriformis. The pain may be exacerbated with any activity that causes flexion of the hip such as stooping or lifting.

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spinal stenosis. Diagnostic injections of anesthetic into the piriformis may be used to confirm the diagnosis. Often piriformis syndrome is a

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Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH (May 2020). "Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain".

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Piriformis syndrome (PS) data is often confused with other conditions due to differences in definitions, survey methods and whether or not

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is meant to reduce muscle tightness and lengthen the muscle which may relieve pressure on the sciatic nerve. Massage is meant to break up

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Fishman LM, Dombi GW, Michaelsen C, et al. (March 2002). "Piriformis syndrome: diagnosis, treatment, and outcome--a 10-year study".

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Windisch G, Braun EM, Anderhuber F (February 2007). "Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome".

633: 612: 401: 479:) of the sciatic nerve during the FAIR test, as well as the improvement of these electrophysiology results after successful treatment. 4846: 1092: 3839:

Papadopoulos EC, Khan SN (January 2004). "Piriformis syndrome and low back pain: a new classification and review of the literature".

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There are also some reports of gluteal atrophy on the same side as the symptoms for chronic cases, but this is less commonly seen.

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Papadopoulos ES, Mani R (December 2020). "The Role of Ultrasound Therapy in the Management of Musculoskeletal Soft Tissue Pain".

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or general population are surveyed. This causes a lack of group harmony about the diagnosis and treatment of PS, affecting its

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Probst D, Stout A, Hunt D (August 2019). "Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment".

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Athletes and weightlifters overtraining or acquiring a repetitive strain injury, causing piriformis irritation or hypertrophy

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Jankovic D, Peng P, van Zundert A (October 2013). "Brief review: piriformis syndrome: etiology, diagnosis, and management".

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As the piriformis muscle spasms, it shortens and becomes harder, applying greater pressure on the sciatic nerve against the

798:(of which piriformis syndrome is a major cause) found consistently positive results for surgeries in the included studies. 4668: 2634:"Anatomical variation of piriformis muscle as a cause of deep gluteal pain: diagnosis using MR neurography and treatment" 1827:

Fishman LM, Anderson C, Rosner B (December 2002). "BOTOX and physical therapy in the treatment of piriformis syndrome".

657: 576:. Large injuries include trauma to the buttocks while "micro traumas" result from small repeated bouts of stress on the 520: 4658: 1963:

Benson ER, Schutzer SF (July 1999). "Posttraumatic piriformis syndrome: diagnosis and results of operative treatment".

4678: 3728:"Endoscopic Treatment of Piriformis Syndrome Results in a Significant Improvement in Pain Visual Analog Scale Scores" 2790:

Wadhwa V, Scott KM, Rozen S, Starr AJ, Chhabra A (2016). "CT-guided Perineural Injections for Chronic Pelvic Pain".

2399: 4807: 899: 411: 169: 3235:"A Systematic Review of the Effectiveness of Core Stability Exercises in Patients with Non-Specific Low Back Pain" 766:

Injections may be more or less curative (with no return to pain), or may have limited timespans of effectiveness.

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lower limb where it divides into common tibial and fibular nerves. Symptoms may include pain and numbness in the

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Smoll NR (January 2010). "Variations of the piriformis and sciatic nerve with clinical consequence: A review".

688: 548: 4565: 4459: 438: 291: 4802: 4727: 4633: 4557: 4529: 4511: 4482: 4416: 4393: 2534:"Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries" 1227:

that is presumed to be a compression neuropathy of the sciatic nerve at the level of the piriformis muscle

868: 551:). MRN can assess changes in the path, thickness, and signal intensity of the sciatic nerve. DTI uses the 496: 489: 449:

ipsilateral (same-side) piriformis hypertrophy is a common image finding in piriformis syndrome, and that

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Piriformis syndrome is often left undiagnosed and mistaken with other pains due to similar symptoms with

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The most common etiology of piriformis syndrome is that resulting from a specific previous injury due to

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Durrani Z, Winnie AP (August 1991). "Piriformis muscle syndrome: an underdiagnosed cause of sciatica".

4321: 200: 116: 460:, making the tissue tougher and tighter, applying greater pressure on the sciatic nerve against the 4547: 4469: 4269: 811: 775: 715: 295: 279: 271: 4856: 4398: 4026: 3983: 3937: 2430: 2235: 1701: 1317: 1260: 1168: 1055: 536: 359: 299: 67: 827:

practice. This is more common in women with a ratio of 3 to 1 and most likely due to the wider

4449: 4421: 4214: 4179: 4141: 4092: 4065: 4018: 3975: 3929: 3894: 3856: 3793: 3757: 3703: 3649: 3609: 3543: 3508: 3473: 3438: 3407: 3362: 3313: 3264: 3215: 3170: 3105: 3099: 3080: 3022: 2981: 2930: 2878: 2842: 2807: 2772: 2734: 2698: 2663: 2614: 2565: 2514: 2479: 2422: 2380: 2331: 2284: 2227: 2165: 2085: 2050: 2015: 1980: 1945: 1905: 1899: 1880: 1844: 1802: 1741: 1693: 1658: 1623: 1588: 1553: 1526: 1491: 1413: 1367: 1342: 1309: 1301: 1280:"Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?" 1252: 1218: 1160: 1047: 965: 904: 744: 596: 585: 577: 472: 259: 247: 177: 93: 51: 1248: 4206: 4171: 4131: 4123: 4010: 3967: 3921: 3886: 3848: 3785: 3747: 3739: 3693: 3685: 3641: 3599: 3591: 3535: 3500: 3465: 3399: 3352: 3344: 3303: 3295: 3254: 3246: 3205: 3197: 3162: 3135: 3072: 3012: 2971: 2961: 2920: 2870: 2834: 2799: 2764: 2726: 2690: 2653: 2645: 2604: 2596: 2555: 2545: 2506: 2469: 2461: 2414: 2370: 2362: 2323: 2274: 2266: 2219: 2210:

Kirschner JS, Foye PM, Cole JL (July 2009). "Piriformis syndrome, diagnosis and treatment".

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Barbosa AB, Santos PV, Targino VA, Silva Nd, Silva YC, Gomes FB, Assis Td (September 2019).

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itself. To the extent that piriformis syndrome is the result of some type of trauma and not

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might restrict normal movement of the sciatic nerve as it passes by the piriformis muscle.

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Siddiq MA, Hossain MS, Uddin MM, Jahan I, Khasru MR, Haider NM, Rasker JJ (February 2017).

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Fishman LM, Zybert PA (April 1992). "Electrophysiologic evidence of piriformis syndrome".

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The history of piriformis syndrome is interrelated to advances in understanding causes of

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Trauma to the hip or buttock area such as a fall is the most common precipitating factor.

4309: 4136: 4111: 3357: 3332: 2351:"Ultrasound appears to be a reliable technique for the diagnosis of piriformis syndrome" 4663: 4629: 4477: 4366: 3752: 3727: 3698: 3673: 3604: 3579: 3308: 3283: 3259: 3234: 3076: 3017: 3000: 2976: 2949: 2658: 2633: 2609: 2584: 2560: 2533: 2474: 2449: 2375: 2350: 2279: 2254: 1737: 1724:

Halpin RJ, Ganju A (October 2009). "Piriformis syndrome: a real pain in the buttock?".

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Kuncewicz E, Gajewska E, Sobieska M, Samborski W (2006). "Piriformis muscle syndrome".

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Fishman LM, Schaefer MP (November 2003). "The piriformis syndrome is underdiagnosed".

4840: 4715: 4575: 4539: 3971: 2046: 1976: 1840: 1584: 1409: 1321: 1264: 909: 819: 753: 508: 504: 419: 407: 341: 314: 306: 253: 223: 173: 112: 3987: 3941: 3040: 2400:"Piriformis syndrome: a case series of 31 Bangladeshi people with literature review" 2239: 1705: 1172: 1145:

European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie

1059: 4742: 4688: 4521: 4441: 4385: 4030: 2434: 914: 815: 740: 679:

The rehabilitative protocol usually involves piriformis stretching, gluteal muscle

673: 608: 524: 456:

A single injury, or many smaller injuries, may predispose the piriformis muscle to

453:

injections reduce symptoms (by paralyzing a muscle for months the muscle shrinks).

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or rotation of the hip. Stretching increases range of motion, while strengthening

4285: 4210: 3925: 3645: 3539: 3403: 2925: 2908: 2874: 1042: 1025: 4408: 4084: 2465: 2327: 1361: 1336: 824: 692: 445: 56: 3789: 3743: 3201: 2649: 2600: 2585:"Magnetic Resonance Neurography: Improved Diagnosis of Peripheral Neuropathies" 1876: 1619: 274:, such as standing, the piriformis rotates the thigh outwards. When the hip is 4719: 4454: 4431: 4259: 4175: 3595: 2838: 2730: 2694: 2418: 1941: 1798: 1654: 1522: 1477: 1296: 1279: 1213: 1196: 1156: 828: 684: 592: 552: 219: 135: 127: 3166: 2550: 1396:

ROBINSON DR (March 1947). "Pyriformis syndrome in relation to sciatic pain".

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Jassal NS (2017). "Piriformis Muscle Syndrome". In Pope JE, Deer TR (eds.).

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Under certain conditions, the piriformis muscle is believed to compress the

383:

Sitting for prolonged periods (office workers, taxi drivers, bicycle riders)

266:(closer to the center of the body). The function of the piriformis is as an 4183: 4145: 4127: 4096: 4022: 4001:

Dere K, Akbas M, Luleci N (2009). "A rare cause of a piriformis syndrome".

3979: 3933: 3898: 3860: 3797: 3761: 3707: 3674:"Endoscopic release of the piriformis tendon and sciatic nerve exploration" 3653: 3613: 3512: 3477: 3442: 3411: 3366: 3317: 3299: 3268: 3219: 3174: 3084: 3026: 2985: 2934: 2882: 2846: 2811: 2776: 2738: 2702: 2667: 2618: 2569: 2518: 2483: 2426: 2384: 2335: 2288: 2231: 2169: 2089: 2019: 1984: 1949: 1884: 1848: 1806: 1745: 1697: 1662: 1627: 1557: 1530: 1495: 1417: 1371: 1346: 1313: 1256: 1222: 1164: 1051: 969: 333:

Patients with piriformis syndrome may have some of the following symptoms:

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is typically normal. Other conditions that may present similarly include a

4069: 4014: 3689: 3504: 2966: 2909:"Diagnosis and management of piriformis syndrome: an osteopathic approach" 2803: 2054: 1592: 951: 3672:

Ilizaliturri VM, Arriaga R, Villalobos FE, Suarez-Ahedo C (August 2018).

2950:"Anatomical, clinical and electrical observations in piriformis syndrome" 894: 864: 516: 476: 465: 457: 415: 337: 3250: 2907:

Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP (November 2008).

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Pope T, Bloem HL, Beltran J, Morrison WB, Wilson DJ (3 November 2014).

1462:"The clinical features of the piriformis syndrome: a systematic review" 840: 760: 749: 680: 604: 464:

at the greater sciatic foramen. Or the formation of scar tissue from a

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and down the leg. Often symptoms are worsened with sitting or running.

189: 4242: 2510: 2366: 2223: 2081: 2011: 1197:"The diagnosis and management of Piriformis Syndrome: myths and facts" 4254: 1689: 848: 752:(shrink in size), reducing pressure on nearby structures such as the 615:

theoretically allows the piriformis to tolerate trauma more readily.

600: 573: 287: 262:

is a flat, pear-shaped muscle. The thicker side of the piriformis is

227: 140: 2532:

Martín Noguerol T, Barousse R, Socolovsky M, Luna A (August 2017).

851:, including piriformis muscles, tense up to stabilize the area for 4112:"Looking beyond Piriformis Syndrome: Is It Really the Piriformis?" 2755:

Lemke KA, Dawson SD (July 2000). "Local and regional anesthesia".

852: 714: 617: 2632:

Polesello GC, Queiroz MC, Linhares JP, Amaral DT, Ono NK (2013).

3333:"Spinopelvic Motion: A Simplified Approach to a Complex Subject" 3331:

Pagan CA, Karasavvidis T, Vigdorchik JM, DeCook CA (June 2024).

2902: 2900: 2898: 2896: 2894: 2892: 2450:"Sciatic neuropathy: findings on magnetic resonance neurography" 4779: 4627: 4364: 4325: 218:

Treatment may include avoiding activities that cause symptoms,

3534:, Cham: Springer International Publishing, pp. 255–267, 2448:

Agnollitto PM, Chu MW, Simão MN, Nogueira-Barbosa MH (2017).

352:

pain on any maneuver that increases piriformis muscle tension

3812:

Physical Medicine and Rehabilitation for Piriformis Syndrome

3098:

Hayek SM, Shah BJ, Desai MJ, Chelimsky TC (16 April 2015).

2407:

European Journal of Orthopaedic Surgery & Traumatology

2255:"Wallet Neuritis – An Example of Peripheral Sensitization" 1460:

Hopayian K, Song F, Riera R, Sambandan S (December 2010).

1026:"Piriformis syndrome: a cause of nondiscogenic sciatica" 340:, or pain felt in the leg along the distribution of the 3282:

Khoury AN, Hatem M, Bowler J, Martin HD (August 2020).

3101:

Pain Medicine: An Interdisciplinary Case-Based Approach

4674:

Hereditary neuropathy with liability to pressure palsy

3128:

Revista Española de Cirugía Ortopédica y Traumatología

1360:

Giuffre BA, Black AC, Jeanmonod R (16 November 2023).

1338:

Anatomy, Bony Pelvis and Lower Limb: Piriformis Muscle

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Siddiq MA, Jahan I, Masihuzzaman S (December 2018).

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Causes of piriformis syndrome include the following

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The Journal of Maternal-Fetal and Neonatal Medicine

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The Journal of the American Osteopathic Association

422:, and these mechanisms are not mutually exclusive. 155: 134: 122: 102: 92: 84: 76: 66: 50: 28: 23: 4003:Journal of Back and Musculoskeletal Rehabilitation 3528:"Botulinum Toxin Treatment of Piriformis Syndrome" 3063:Lo JK, Robinson LR (2024). "Piriformis syndrome". 2205: 2203: 2201: 2199: 1335:Chang C, Jeno SH, Varacallo M (13 November 2023). 346:external tenderness near the greater sciatic notch 4706:Chronic inflammatory demyelinating polyneuropathy 4110:Sharma S, Kaur H, Verma N, Adhya B (March 2023). 2197: 2195: 2193: 2191: 2189: 2187: 2185: 2183: 2181: 2179: 843:changes throughout their life, especially during 313:L4-S3. It forms in the pelvis from nerves of the 3879:Archives of Physical Medicine and Rehabilitation 3001:"Conservative management of piriformis syndrome" 1455: 1453: 1451: 1449: 1447: 1445: 1443: 1441: 778:. This surgery can be done with open surgery or 168:is a condition which is believed to result from 3872: 3870: 1366:. Treasure Island (FL): StatPearls Publishing. 1341:. Treasure Island (FL): StatPearls Publishing. 1195:Miller TA, White KP, Ross DC (September 2012). 934:Martin HD, Reddy M, Gómez-Hoyos J (July 2015). 691:, increase blood circulation, and lengthen the 507:, wallet neuritis (sitting on a thick wallet), 46:Location of piriformis syndrome within the body 4337: 4056:Brunori A, De Caro GM, Giuffrè R (1998). "". 3953: 3951: 3578:Han SK, Kim YS, Kim TH, Kang SH (June 2017). 1201:The Canadian Journal of Neurological Sciences 876:, of which piriformis syndrome is one cause. 282:the hip (spreading the legs). The piriformis 8: 2349:Zhang W, Luo F, Sun H, Ding H (April 2019). 1087: 1085: 1083: 1081: 1079: 1077: 1075: 1073: 1071: 1069: 519:. Pathology in the sacroiliac joint region, 3580:"Surgical Treatment of Piriformis Syndrome" 3532:Botulinum Toxin Treatment of Pain Disorders 2954:Journal of Orthopaedic Surgery and Research 4787: 4776: 4641: 4624: 4499: 4381: 4374: 4361: 4344: 4330: 4322: 4233: 3726:Vanermen F, Van Melkebeek J (April 2022). 1138: 1136: 1134: 1019: 1017: 1015: 1013: 1011: 1009: 1007: 1005: 1003: 1001: 999: 818:. In a study, 0.33% of 1293 patients with 37: 20: 4135: 3751: 3697: 3603: 3356: 3307: 3258: 3209: 3016: 2975: 2965: 2924: 2657: 2608: 2559: 2549: 2473: 2374: 2278: 1904:. Elsevier Health Sciences. p. 507. 1485: 1295: 1212: 1190: 1188: 1186: 1184: 1182: 1132: 1130: 1128: 1126: 1124: 1122: 1120: 1118: 1116: 1114: 1041: 997: 995: 993: 991: 989: 987: 985: 983: 981: 979: 959: 126:Avoiding activities that cause symptoms, 3104:. Oxford University Press. p. 240. 2948:Jawish RM, Assoum HA, Khamis CF (2010). 1249:10.1302/0301-620X.102B5.BJJ-2019-1212.R1 603:will decrease the risk of injury during 4045:Healthcare Cost and Utilization Project 3841:The Orthopedic Clinics of North America 3233:Smrcina Z, Woelfel S, Burcal C (2022). 926: 72:Buttock pain that is worse with sitting 4157: 4155: 3423: 3421: 2750: 2748: 2583:Kollmer J, Bendszus M (October 2021). 2308: 2306: 2304: 2302: 2300: 2298: 2143: 2141: 2139: 2137: 2135: 2133: 2131: 2129: 2127: 2125: 2123: 2121: 2119: 1923: 1921: 1822: 1820: 1818: 1816: 1779: 1777: 1775: 1431: 1429: 1427: 3721: 3719: 3717: 3667: 3665: 3663: 3627: 3625: 3623: 3573: 3571: 3569: 3567: 3565: 3058: 3056: 3054: 3052: 3050: 2117: 2115: 2113: 2111: 2109: 2107: 2105: 2103: 2101: 2099: 1773: 1771: 1769: 1767: 1765: 1763: 1761: 1759: 1757: 1755: 1719: 1717: 1715: 1546:Annales Academiae Medicae Stetinensis 1391: 1389: 1387: 1385: 1383: 1381: 7: 4203:Treatment of Chronic Pain Conditions 4852:Peripheral nervous system disorders 4083:Chang A, Ly N, Varacallo M (2021). 940:Journal of Hip Preservation Surgery 402:Pathophysiology of nerve entrapment 199:, spasms of the piriformis muscle, 3077:10.1016/B978-0-323-90108-6.00002-8 2757:Vet Clin North Am Small Anim Pract 1738:10.1227/01.NEU.0000335788.45495.0C 1097:Merck Manuals Professional Edition 278:, such as sitting, the piriformis 14: 2999:Keskula DR, Tamburello M (1992). 2271:10.2174/1573397113666170310100851 195:Causes may include trauma to the 4504:lateral cutaneous nerve of thigh 3972:10.1111/j.1533-2500.2012.00585.x 1977:10.2106/00004623-199907000-00006 1841:10.1097/00002060-200212000-00009 623:to the side, away from the body. 1785:study of resulting treatment". 1030:Current Sports Medicine Reports 731:(e.g. lidocaine, bupivacaine), 475:testing abnormalities (delayed 325:before passing the piriformis. 286:at the anterior surface of the 4798:Complex regional pain syndrome 4607:Template:Cranial nerve disease 4043:Hcupnet.ahrq.gov (2010, 2011) 3043:. Everkinetic. 19 August 2019. 545:magnetic resonance neurography 515:, and inferior gluteal artery 429:may compress the sciatic nerve 88:Trauma, spasms, overuse injury 1: 4669:Hereditary spastic paraplegia 3853:10.1016/S0030-5898(03)00105-6 3470:10.1016/s0304-3959(99)00264-x 3140:10.1016/S1988-8856(08)70122-6 2769:10.1016/s0195-5616(08)70010-x 1552:(3): 99–101, discussion 101. 1284:Arquivos de Neuro-Psiquiatria 727:The medications injected are 4211:10.1007/978-1-4939-6976-0_78 3926:10.3109/14767058.2011.636098 3646:10.1016/j.arthro.2017.06.041 3540:10.1007/978-3-030-99650-5_13 3404:10.1097/PHM.0000000000001384 3005:Journal of Athletic Training 2926:10.7556/jaoa.2008.108.11.657 2875:10.1097/JSM.0000000000000504 2259:Current Rheumatology Reviews 2047:10.1016/0003-9993(92)90010-t 1585:10.1016/0885-3924(91)90029-4 1410:10.1016/0002-9610(47)90345-0 1043:10.1249/JSR.0000000000000110 521:Sacroiliac joint dysfunction 4679:Familial amyloid neuropathy 4654:Charcot–Marie–Tooth disease 3732:Arthrosc Sports Med Rehabil 2466:10.1590/0100-3984.2015.0205 2328:10.1016/j.rehab.2013.04.003 867:. In 1933, the proposal of 847:, where muscles around the 180:. It is a specific case of 4873: 4808:Nerve compression syndrome 3790:10.1016/j.pain.2014.09.014 3744:10.1016/j.asmr.2021.10.002 3202:10.1016/j.ptsp.2011.11.003 2650:10.1016/j.rboe.2012.09.001 2601:10.1007/s13311-021-01166-8 1620:10.1016/j.otsr.2015.07.022 900:nerve compression syndrome 399: 355:pain aggravated on sitting 251: 245: 4847:Musculoskeletal disorders 4786: 4775: 4733:Pectoralis minor syndrome 4640: 4623: 4373: 4360: 4354:peripheral nervous system 4352:Diseases relating to the 4176:10.1007/s00256-015-2124-6 4091:. StatPearls Publishing. 3596:10.4055/cios.2017.9.2.136 2839:10.1016/j.nic.2013.03.028 2731:10.1007/s00256-016-2557-6 2695:10.1007/s00256-017-2690-x 2419:10.1007/s00590-016-1853-0 1942:10.1007/s00330-017-4982-x 1799:10.3171/spi.2005.2.2.0099 1655:10.1007/s00276-006-0169-x 1608:Orthop Traumatol Surg Res 1523:10.1007/s12630-013-0009-5 1478:10.1007/s00586-010-1504-9 1297:10.1590/0004-282x20190093 1214:10.1017/s0317167100015298 1157:10.1007/s00590-017-2031-8 676:to the spine/hip/pelvis. 511:, pelvic tumors, gluteal 226:, and medication such as 45: 36: 4759:Alcoholic polyneuropathy 4738:Thoracic outlet syndrome 3167:10.1177/1534734620948343 2551:10.21037/qims.2017.08.01 1877:10.36076/ppj/2015.18.163 1024:Cass SP (January 2015). 549:diffusion tensor imaging 410:, also known as sciatic 4701:Guillain–Barré syndrome 4659:Dejerine–Sottas disease 4460:Cheiralgia paresthetica 3891:10.1053/apmr.2002.30622 3349:10.5371/hp.2024.36.2.77 3155:Int J Low Extrem Wounds 1901:Musculoskeletal Imaging 936:"Deep gluteal syndrome" 439:greater sciatic foramen 292:greater sciatic foramen 4803:Mononeuritis multiplex 4728:Brachial plexus injury 4634:Polyradiculoneuropathy 4558:superior gluteal nerve 4530:Tarsal tunnel syndrome 4512:Meralgia paraesthetica 4417:Ulnar nerve entrapment 4394:Carpal tunnel syndrome 4128:10.5371/hp.2023.35.1.1 4085:"Piriformis Injection" 3239:Int J Sports Phys Ther 2827:Neuroimaging Clin N Am 2538:Quant Imaging Med Surg 1466:European Spine Journal 1363:Anatomy, Sciatic Nerve 1243:. 102-B (5): 556–567. 720: 644:, and medications for 624: 497:spinal disc herniation 490:diagnosis of exclusion 268:external thigh rotator 104:Differential diagnosis 4818:Peripheral neuropathy 4693:demyelinating disease 4427:Ulnar tunnel syndrome 4015:10.3233/BMR-2009-0213 3505:10.1592/phco.27.5.657 3392:Am J Phys Med Rehabil 2967:10.1186/1749-799X-5-3 2804:10.1148/rg.2016150263 2035:Arch Phys Med Rehabil 1829:Am J Phys Med Rehabil 1732:(4 Suppl): A197–202. 1573:J Pain Symptom Manage 1093:"Piriformis Syndrome" 890:deep gluteal syndrome 874:deep gluteal syndrome 796:deep gluteal syndrome 718: 621: 562:deep gluteal syndrome 499:, facet arthropathy, 323:common peroneal nerve 290:, passes through the 182:deep gluteal syndrome 32:Deep gluteal syndrome 4566:Trendelenburg's sign 3640:(12): 2263–2278.e1. 3300:10.1093/jhps/hnaa054 2499:J Magn Reson Imaging 2316:Ann Phys Rehabil Med 2156:(Suppl 1): S54–S63. 1965:J Bone Joint Surg Am 201:anatomical variation 117:SI joint dysfunction 4584:Piriformis syndrome 4470:long thoracic nerve 4205:. pp. 269–71. 3690:10.1093/jhps/hny018 3251:10.26603/001c.37251 952:10.1093/jhps/hnv029 812:occupational groups 776:nerve decompression 166:Piriformis syndrome 24:Piriformis syndrome 4399:Ape hand deformity 4296:External resources 3678:J Hip Preserv Surg 3526:Jabbari B (2022), 3288:J Hip Preserv Surg 2355:Muscle & Nerve 2212:Muscle & Nerve 2162:10.1002/pmrj.12189 721: 625: 537:straight leg raise 444:Piriformis muscle 360:straight leg raise 358:limitation of the 329:Signs and symptoms 300:greater trochanter 270:. When the hip is 4834: 4833: 4830: 4829: 4826: 4825: 4771: 4770: 4767: 4766: 4619: 4618: 4615: 4614: 4592: 4591: 4491: 4490: 4450:Radial neuropathy 4319: 4318: 4220:978-1-4939-6974-6 3784:(12): 2545–2550. 3549:978-3-030-99649-9 3111:978-0-19-939081-6 3065:Handb Clin Neurol 2689:(10): 1399–1404. 2589:Neurotherapeutics 2511:10.1002/jmri.1076 2367:10.1002/mus.26418 2224:10.1002/mus.21318 2082:10.1002/mus.25504 2012:10.1002/mus.10482 1911:978-0-323-27818-8 1787:J Neurosurg Spine 905:piriformis muscle 745:anti-inflammatory 729:local anesthetics 705:randomized trials 597:strength training 586:American football 578:piriformis muscle 473:electrophysiology 248:Piriformis muscle 178:piriformis muscle 170:nerve compression 163: 162: 98:Based on symptoms 94:Diagnostic method 18:Medical condition 4864: 4788: 4777: 4664:Refsum's disease 4642: 4625: 4548:Morton's neuroma 4500: 4382: 4375: 4362: 4346: 4339: 4332: 4323: 4234: 4224: 4188: 4187: 4159: 4150: 4149: 4139: 4107: 4101: 4100: 4080: 4074: 4073: 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4534: 4516: 4487: 4464: 4436: 4403: 4369: 4356: 4350: 4320: 4315: 4314: 4291: 4290: 4245: 4231: 4221: 4200: 4197: 4195:Further reading 4192: 4191: 4164:Skeletal Radiol 4161: 4160: 4153: 4109: 4108: 4104: 4082: 4081: 4077: 4055: 4054: 4050: 4042: 4038: 4000: 3999: 3995: 3957: 3956: 3949: 3911: 3910: 3906: 3876: 3875: 3868: 3838: 3837: 3822: 3809: 3805: 3774: 3773: 3769: 3725: 3724: 3715: 3671: 3670: 3661: 3631: 3630: 3621: 3577: 3576: 3563: 3554: 3552: 3550: 3525: 3524: 3520: 3493:Pharmacotherapy 3490: 3489: 3485: 3455: 3454: 3450: 3427: 3426: 3419: 3388: 3387: 3383: 3378: 3374: 3330: 3329: 3325: 3281: 3280: 3276: 3232: 3231: 3227: 3190:Phys Ther Sport 3187: 3186: 3182: 3152: 3151: 3147: 3124: 3123: 3119: 3112: 3097: 3096: 3092: 3062: 3061: 3048: 3041:"Hip Adduction" 3039: 3038: 3034: 2998: 2997: 2993: 2947: 2946: 2942: 2906: 2905: 2890: 2859: 2858: 2854: 2824: 2823: 2819: 2789: 2788: 2784: 2754: 2753: 2746: 2719:Skeletal Radiol 2715: 2714: 2710: 2683:Skeletal Radiol 2680: 2679: 2675: 2631: 2630: 2626: 2582: 2581: 2577: 2531: 2530: 2526: 2496: 2495: 2491: 2447: 2446: 2442: 2402: 2397: 2396: 2392: 2348: 2347: 2343: 2312: 2311: 2296: 2252: 2251: 2247: 2209: 2208: 2177: 2147: 2146: 2097: 2067: 2066: 2062: 2032: 2031: 2027: 1997: 1996: 1992: 1962: 1961: 1957: 1927: 1926: 1919: 1912: 1897: 1896: 1892: 1861: 1860: 1856: 1826: 1825: 1814: 1783: 1782: 1753: 1723: 1722: 1713: 1675: 1674: 1670: 1640: 1639: 1635: 1605: 1604: 1600: 1570: 1569: 1565: 1543: 1542: 1538: 1517:(10): 1003–12. 1508: 1507: 1503: 1459: 1458: 1439: 1434: 1425: 1395: 1394: 1379: 1359: 1358: 1354: 1334: 1333: 1329: 1277: 1276: 1272: 1238: 1237: 1233: 1194: 1193: 1180: 1142: 1141: 1112: 1102: 1100: 1091: 1090: 1067: 1023: 1022: 977: 933: 932: 928: 923: 886: 869:disc herniation 861: 808: 772: 737:Botulinum toxin 733:corticosteroids 713: 666: 630: 570: 501:spinal stenosis 485: 404: 398: 396:Pathophysiology 371: 331: 256: 250: 244: 236:botulinum toxin 209:Medical imaging 149:botulinum toxin 61:sports medicine 19: 12: 11: 5: 4870: 4868: 4860: 4859: 4854: 4849: 4839: 4838: 4832: 4831: 4828: 4827: 4824: 4823: 4821: 4820: 4815: 4810: 4805: 4800: 4794: 4792: 4784: 4783: 4780: 4773: 4772: 4769: 4768: 4765: 4764: 4762: 4761: 4755: 4753: 4749: 4748: 4746: 4745: 4740: 4735: 4730: 4724: 4722: 4712: 4711: 4709: 4708: 4703: 4697: 4695: 4685: 4684: 4682: 4681: 4676: 4671: 4666: 4661: 4656: 4650: 4648: 4638: 4637: 4630:Polyneuropathy 4628: 4621: 4620: 4617: 4616: 4613: 4612: 4610: 4609: 4602: 4600: 4598:Cranial nerves 4594: 4593: 4590: 4589: 4587: 4586: 4580: 4578: 4572: 4571: 4569: 4568: 4562: 4560: 4554: 4553: 4551: 4550: 4544: 4542: 4536: 4535: 4533: 4532: 4526: 4524: 4518: 4517: 4515: 4514: 4508: 4506: 4497: 4493: 4492: 4489: 4488: 4486: 4485: 4483:Backpack palsy 4480: 4478:Winged scapula 4474: 4472: 4466: 4465: 4463: 4462: 4457: 4452: 4446: 4444: 4438: 4437: 4435: 4434: 4429: 4424: 4422:Froment's sign 4419: 4413: 4411: 4405: 4404: 4402: 4401: 4396: 4390: 4388: 4379: 4371: 4370: 4367:Mononeuropathy 4365: 4358: 4357: 4351: 4349: 4348: 4341: 4334: 4326: 4317: 4316: 4313: 4312: 4300: 4299: 4297: 4293: 4292: 4289: 4288: 4277: 4262: 4246: 4241: 4240: 4238: 4237:Classification 4230: 4229:External links 4227: 4226: 4225: 4219: 4196: 4193: 4190: 4189: 4151: 4102: 4075: 4060:(in Italian). 4048: 4036: 3993: 3947: 3904: 3885:(3): 295–301. 3866: 3820: 3803: 3767: 3713: 3684:(3): 301–306. 3659: 3619: 3590:(2): 136–144. 3561: 3548: 3518: 3483: 3464:(1–2): 101–5. 3448: 3437:(5): 325–337. 3431:Pain Physician 3417: 3398:(7): 617–625. 3381: 3372: 3323: 3294:(3): 390–400. 3274: 3245:(5): 766–774. 3225: 3180: 3161:(4): 350–358. 3145: 3130:(in Spanish). 3117: 3110: 3090: 3046: 3032: 2991: 2940: 2919:(11): 657–64. 2888: 2869:(3): 203–208. 2852: 2817: 2798:(5): 1408–25. 2782: 2744: 2725:(3): 309–314. 2708: 2673: 2644:(1): 114–117. 2638:Rev Bras Ortop 2624: 2575: 2544:(4): 398–421. 2524: 2489: 2460:(3): 190–196. 2440: 2413:(2): 193–203. 2390: 2361:(4): 411–416. 2341: 2294: 2265:(3): 279–283. 2245: 2175: 2095: 2076:(2): 258–263. 2060: 2025: 1990: 1955: 1936:(2): 447–458. 1917: 1910: 1890: 1865:Pain Physician 1854: 1835:(12): 936–42. 1812: 1751: 1711: 1668: 1633: 1598: 1563: 1536: 1501: 1437: 1423: 1377: 1352: 1327: 1290:(9): 646–653. 1270: 1231: 1178: 1151:(2): 155–164. 1110: 1099:. October 2014 1065: 975: 925: 924: 922: 919: 918: 917: 912: 907: 902: 897: 892: 885: 882: 860: 857: 807: 804: 780:endoscopically 771: 768: 712: 709: 689:trigger points 665: 662: 629: 626: 569: 566: 484: 481: 397: 394: 393: 392: 388: 384: 381: 378: 370: 367: 363: 362: 356: 353: 350: 347: 344: 330: 327: 243: 240: 213:herniated disc 205:overuse injury 197:gluteal muscle 161: 160: 159:Unknown (2017) 157: 153: 152: 138: 132: 131: 124: 120: 119: 109:Herniated disc 106: 100: 99: 96: 90: 89: 86: 82: 81: 78: 74: 73: 70: 64: 63: 54: 48: 47: 43: 42: 34: 33: 30: 26: 25: 17: 13: 10: 9: 6: 4: 3: 2: 4869: 4858: 4855: 4853: 4850: 4848: 4845: 4844: 4842: 4819: 4816: 4814: 4811: 4809: 4806: 4804: 4801: 4799: 4796: 4795: 4793: 4789: 4785: 4778: 4774: 4760: 4757: 4756: 4754: 4750: 4744: 4741: 4739: 4736: 4734: 4731: 4729: 4726: 4725: 4723: 4721: 4717: 4716:Radiculopathy 4713: 4707: 4704: 4702: 4699: 4698: 4696: 4694: 4690: 4686: 4680: 4677: 4675: 4672: 4670: 4667: 4665: 4662: 4660: 4657: 4655: 4652: 4651: 4649: 4647: 4643: 4639: 4635: 4631: 4626: 4622: 4608: 4604: 4603: 4601: 4599: 4595: 4585: 4582: 4581: 4579: 4577: 4576:sciatic nerve 4573: 4567: 4564: 4563: 4561: 4559: 4555: 4549: 4546: 4545: 4543: 4541: 4540:plantar nerve 4537: 4531: 4528: 4527: 4525: 4523: 4519: 4513: 4510: 4509: 4507: 4505: 4501: 4498: 4494: 4484: 4481: 4479: 4476: 4475: 4473: 4471: 4467: 4461: 4458: 4456: 4453: 4451: 4448: 4447: 4445: 4443: 4439: 4433: 4430: 4428: 4425: 4423: 4420: 4418: 4415: 4414: 4412: 4410: 4406: 4400: 4397: 4395: 4392: 4391: 4389: 4387: 4383: 4380: 4376: 4372: 4368: 4363: 4359: 4355: 4347: 4342: 4340: 4335: 4333: 4328: 4327: 4324: 4311: 4310:article/87545 4307: 4306: 4302: 4301: 4298: 4294: 4287: 4283: 4282: 4278: 4276: 4272: 4271: 4267: 4263: 4261: 4257: 4256: 4252: 4248: 4247: 4244: 4239: 4235: 4228: 4222: 4216: 4212: 4208: 4204: 4199: 4198: 4194: 4185: 4181: 4177: 4173: 4170:(7): 919–34. 4169: 4165: 4158: 4156: 4152: 4147: 4143: 4138: 4133: 4129: 4125: 4121: 4117: 4113: 4106: 4103: 4098: 4094: 4090: 4086: 4079: 4076: 4071: 4067: 4064:(3): 285–93. 4063: 4059: 4058:Ann Ital Chir 4052: 4049: 4046: 4040: 4037: 4032: 4028: 4024: 4020: 4016: 4012: 4008: 4004: 3997: 3994: 3989: 3985: 3981: 3977: 3973: 3969: 3966:(4): 276–81. 3965: 3961: 3960:Pain Practice 3954: 3952: 3948: 3943: 3939: 3935: 3931: 3927: 3923: 3920:(8): 1505–7. 3919: 3915: 3908: 3905: 3900: 3896: 3892: 3888: 3884: 3880: 3873: 3871: 3867: 3862: 3858: 3854: 3850: 3846: 3842: 3835: 3833: 3831: 3829: 3827: 3825: 3821: 3818: 3814: 3813: 3807: 3804: 3799: 3795: 3791: 3787: 3783: 3779: 3771: 3768: 3763: 3759: 3754: 3749: 3745: 3741: 3737: 3733: 3729: 3722: 3720: 3718: 3714: 3709: 3705: 3700: 3695: 3691: 3687: 3683: 3679: 3675: 3668: 3666: 3664: 3660: 3655: 3651: 3647: 3643: 3639: 3635: 3628: 3626: 3624: 3620: 3615: 3611: 3606: 3601: 3597: 3593: 3589: 3585: 3581: 3574: 3572: 3570: 3568: 3566: 3562: 3551: 3545: 3541: 3537: 3533: 3529: 3522: 3519: 3514: 3510: 3506: 3502: 3499:(5): 657–65. 3498: 3494: 3487: 3484: 3479: 3475: 3471: 3467: 3463: 3459: 3452: 3449: 3444: 3440: 3436: 3432: 3424: 3422: 3418: 3413: 3409: 3405: 3401: 3397: 3393: 3385: 3382: 3376: 3373: 3368: 3364: 3359: 3354: 3350: 3346: 3342: 3338: 3334: 3327: 3324: 3319: 3315: 3310: 3305: 3301: 3297: 3293: 3289: 3285: 3278: 3275: 3270: 3266: 3261: 3256: 3252: 3248: 3244: 3240: 3236: 3229: 3226: 3221: 3217: 3212: 3207: 3203: 3199: 3195: 3191: 3184: 3181: 3176: 3172: 3168: 3164: 3160: 3156: 3149: 3146: 3141: 3137: 3134:(6): 359–65. 3133: 3129: 3121: 3118: 3113: 3107: 3103: 3102: 3094: 3091: 3086: 3082: 3078: 3074: 3070: 3066: 3059: 3057: 3055: 3053: 3051: 3047: 3042: 3036: 3033: 3028: 3024: 3019: 3014: 3011:(2): 102–10. 3010: 3006: 3002: 2995: 2992: 2987: 2983: 2978: 2973: 2968: 2963: 2959: 2955: 2951: 2944: 2941: 2936: 2932: 2927: 2922: 2918: 2914: 2910: 2903: 2901: 2899: 2897: 2895: 2893: 2889: 2884: 2880: 2876: 2872: 2868: 2864: 2856: 2853: 2848: 2844: 2840: 2836: 2833:(1): 211–34. 2832: 2828: 2821: 2818: 2813: 2809: 2805: 2801: 2797: 2793: 2792:Radiographics 2786: 2783: 2778: 2774: 2770: 2766: 2763:(4): 839–57. 2762: 2758: 2751: 2749: 2745: 2740: 2736: 2732: 2728: 2724: 2720: 2712: 2709: 2704: 2700: 2696: 2692: 2688: 2684: 2677: 2674: 2669: 2665: 2660: 2655: 2651: 2647: 2643: 2639: 2635: 2628: 2625: 2620: 2616: 2611: 2606: 2602: 2598: 2594: 2590: 2586: 2579: 2576: 2571: 2567: 2562: 2557: 2552: 2547: 2543: 2539: 2535: 2528: 2525: 2520: 2516: 2512: 2508: 2505:(4): 534–46. 2504: 2500: 2493: 2490: 2485: 2481: 2476: 2471: 2467: 2463: 2459: 2455: 2451: 2444: 2441: 2436: 2432: 2428: 2424: 2420: 2416: 2412: 2408: 2401: 2394: 2391: 2386: 2382: 2377: 2372: 2368: 2364: 2360: 2356: 2352: 2345: 2342: 2337: 2333: 2329: 2325: 2322:(5): 371–83. 2321: 2317: 2309: 2307: 2305: 2303: 2301: 2299: 2295: 2290: 2286: 2281: 2276: 2272: 2268: 2264: 2260: 2256: 2249: 2246: 2241: 2237: 2233: 2229: 2225: 2221: 2217: 2213: 2206: 2204: 2202: 2200: 2198: 2196: 2194: 2192: 2190: 2188: 2186: 2184: 2182: 2180: 2176: 2171: 2167: 2163: 2159: 2155: 2151: 2144: 2142: 2140: 2138: 2136: 2134: 2132: 2130: 2128: 2126: 2124: 2122: 2120: 2118: 2116: 2114: 2112: 2110: 2108: 2106: 2104: 2102: 2100: 2096: 2091: 2087: 2083: 2079: 2075: 2071: 2064: 2061: 2056: 2052: 2048: 2044: 2041:(4): 359–64. 2040: 2036: 2029: 2026: 2021: 2017: 2013: 2009: 2005: 2001: 1994: 1991: 1986: 1982: 1978: 1974: 1970: 1966: 1959: 1956: 1951: 1947: 1943: 1939: 1935: 1931: 1924: 1922: 1918: 1913: 1907: 1903: 1902: 1894: 1891: 1886: 1882: 1878: 1874: 1871:(2): 163–71. 1870: 1866: 1858: 1855: 1850: 1846: 1842: 1838: 1834: 1830: 1823: 1821: 1819: 1817: 1813: 1808: 1804: 1800: 1796: 1793:(2): 99–115. 1792: 1788: 1780: 1778: 1776: 1774: 1772: 1770: 1768: 1766: 1764: 1762: 1760: 1758: 1756: 1752: 1747: 1743: 1739: 1735: 1731: 1727: 1720: 1718: 1716: 1712: 1707: 1703: 1699: 1695: 1691: 1687: 1683: 1679: 1672: 1669: 1664: 1660: 1656: 1652: 1648: 1644: 1637: 1634: 1629: 1625: 1621: 1617: 1614:(8): 987–90. 1613: 1609: 1602: 1599: 1594: 1590: 1586: 1582: 1578: 1574: 1567: 1564: 1559: 1555: 1551: 1547: 1540: 1537: 1532: 1528: 1524: 1520: 1516: 1512: 1511:Can J Anaesth 1505: 1502: 1497: 1493: 1488: 1483: 1479: 1475: 1471: 1467: 1463: 1456: 1454: 1452: 1450: 1448: 1446: 1444: 1442: 1438: 1432: 1430: 1428: 1424: 1419: 1415: 1411: 1407: 1403: 1399: 1392: 1390: 1388: 1386: 1384: 1382: 1378: 1373: 1369: 1365: 1364: 1356: 1353: 1348: 1344: 1340: 1339: 1331: 1328: 1323: 1319: 1315: 1311: 1307: 1303: 1298: 1293: 1289: 1285: 1281: 1274: 1271: 1266: 1262: 1258: 1254: 1250: 1246: 1242: 1235: 1232: 1228: 1224: 1220: 1215: 1210: 1207:(5): 577–83. 1206: 1202: 1198: 1191: 1189: 1187: 1185: 1183: 1179: 1174: 1170: 1166: 1162: 1158: 1154: 1150: 1146: 1139: 1137: 1135: 1133: 1131: 1129: 1127: 1125: 1123: 1121: 1119: 1117: 1115: 1111: 1098: 1094: 1088: 1086: 1084: 1082: 1080: 1078: 1076: 1074: 1072: 1070: 1066: 1061: 1057: 1053: 1049: 1044: 1039: 1035: 1031: 1027: 1020: 1018: 1016: 1014: 1012: 1010: 1008: 1006: 1004: 1002: 1000: 998: 996: 994: 992: 990: 988: 986: 984: 982: 980: 976: 971: 967: 962: 957: 953: 949: 946:(2): 99–107. 945: 941: 937: 930: 927: 920: 916: 913: 911: 910:sciatic nerve 908: 906: 903: 901: 898: 896: 893: 891: 888: 887: 883: 881: 877: 875: 870: 866: 858: 856: 854: 850: 846: 842: 838: 833: 830: 826: 821: 820:low back pain 817: 813: 805: 803: 799: 797: 791: 789: 783: 781: 777: 769: 767: 764: 762: 757: 755: 754:sciatic nerve 751: 746: 742: 738: 734: 730: 725: 717: 710: 708: 706: 700: 698: 694: 693:muscle fibers 690: 686: 682: 677: 675: 670: 663: 661: 659: 658:control group 653: 651: 647: 643: 639: 635: 627: 620: 616: 614: 610: 609:hip adductors 606: 602: 598: 594: 589: 587: 583: 579: 575: 567: 565: 563: 557: 554: 550: 546: 540: 538: 532: 528: 526: 522: 518: 514: 510: 509:endometriosis 506: 505:muscle strain 502: 498: 493: 491: 482: 480: 478: 474: 469: 467: 463: 459: 454: 452: 447: 442: 440: 436: 432: 428: 423: 421: 420:sciatic nerve 417: 413: 409: 408:sciatic nerve 403: 395: 389: 385: 382: 379: 376: 375: 374: 368: 366: 361: 357: 354: 351: 348: 345: 343: 342:sciatic nerve 339: 336: 335: 334: 328: 326: 324: 320: 316: 315:sacral plexus 312: 311:spinal nerves 308: 307:sciatic nerve 303: 301: 297: 293: 289: 285: 281: 277: 273: 269: 265: 261: 255: 254:Sciatic nerve 249: 241: 239: 237: 233: 229: 225: 224:physiotherapy 221: 216: 214: 210: 206: 202: 198: 193: 191: 185: 183: 179: 175: 174:sciatic nerve 171: 167: 158: 154: 150: 146: 142: 139: 137: 133: 130:, medications 129: 125: 121: 118: 114: 113:kidney stones 110: 107: 105: 101: 97: 95: 91: 87: 83: 79: 75: 71: 69: 65: 62: 58: 55: 53: 49: 44: 40: 35: 31: 27: 22: 16: 4743:Phantom limb 4583: 4522:tibial nerve 4442:radial nerve 4386:median nerve 4303: 4279: 4264: 4249: 4202: 4167: 4163: 4119: 4115: 4105: 4088: 4078: 4061: 4057: 4051: 4039: 4006: 4002: 3996: 3963: 3959: 3917: 3913: 3907: 3882: 3878: 3847:(1): 65–71. 3844: 3840: 3810: 3806: 3781: 3777: 3770: 3735: 3731: 3681: 3677: 3637: 3633: 3587: 3583: 3553:, retrieved 3531: 3521: 3496: 3492: 3486: 3461: 3457: 3451: 3434: 3430: 3395: 3391: 3384: 3375: 3343:(2): 77–86. 3340: 3336: 3326: 3291: 3287: 3277: 3242: 3238: 3228: 3196:(3): 180–8. 3193: 3189: 3183: 3158: 3154: 3148: 3131: 3127: 3120: 3100: 3093: 3068: 3064: 3035: 3008: 3004: 2994: 2957: 2953: 2943: 2916: 2912: 2866: 2862: 2855: 2830: 2826: 2820: 2795: 2791: 2785: 2760: 2756: 2722: 2718: 2711: 2686: 2682: 2676: 2641: 2637: 2627: 2592: 2588: 2578: 2541: 2537: 2527: 2502: 2498: 2492: 2457: 2453: 2443: 2410: 2406: 2393: 2358: 2354: 2344: 2319: 2315: 2262: 2258: 2248: 2215: 2211: 2153: 2149: 2073: 2070:Muscle Nerve 2069: 2063: 2038: 2034: 2028: 2006:(5): 646–9. 2003: 2000:Muscle Nerve 1999: 1993: 1971:(7): 941–9. 1968: 1964: 1958: 1933: 1929: 1900: 1893: 1868: 1864: 1857: 1832: 1828: 1790: 1786: 1729: 1726:Neurosurgery 1725: 1681: 1677: 1671: 1649:(1): 37–45. 1646: 1642: 1636: 1611: 1607: 1601: 1579:(6): 374–9. 1576: 1572: 1566: 1549: 1545: 1539: 1514: 1510: 1504: 1469: 1465: 1404:(3): 355–8. 1401: 1397: 1362: 1355: 1337: 1330: 1287: 1283: 1273: 1241:Bone Joint J 1240: 1234: 1226: 1204: 1200: 1148: 1144: 1101:. Retrieved 1096: 1033: 1029: 943: 939: 929: 915:muscle spasm 878: 862: 834: 816:epidemiology 809: 806:Epidemiology 800: 792: 784: 773: 765: 758: 741:muscle spasm 726: 722: 701: 678: 674:biomechanics 667: 654: 631: 590: 571: 558: 541: 533: 529: 525:Sacroiliitis 513:varicosities 494: 486: 470: 455: 443: 430: 427:muscle spasm 424: 405: 372: 364: 349:buttock pain 332: 319:tibial nerve 304: 257: 217: 194: 186: 165: 164: 15: 4409:ulnar nerve 4009:(1): 55–8. 3634:Arthroscopy 3211:10069/29869 3071:: 203–226. 2454:Radiol Bras 2218:(1): 10–8. 1684:(1): 8–17. 1103:30 December 1036:(1): 41–4. 825:orthopaedic 697:flexibility 553:anisotropic 547:) and DTI ( 446:hypertrophy 425:Piriformis 57:Orthopedics 29:Other names 4841:Categories 4720:plexopathy 4689:Autoimmune 4455:Wrist drop 4432:Ulnar claw 4122:(1): 1–5. 4116:Hip Pelvis 4089:StatPearls 3337:Hip Pelvis 1930:Eur Radiol 921:References 829:quadriceps 788:VAS scores 685:stretching 638:analgesics 595:and doing 593:stretching 582:neuropathy 568:Prevention 414:, causing 400:See also: 284:originates 260:piriformis 252:See also: 246:See also: 220:stretching 151:injections 136:Medication 128:stretching 4857:Syndromes 4813:Neuralgia 4305:eMedicine 3817:eMedicine 1398:Am J Surg 1322:202761655 1306:1678-4227 1265:217593533 845:pregnancy 837:back pain 628:Treatment 613:abductors 517:aneuyrism 503:, lumbar 483:Diagnosis 156:Frequency 123:Treatment 80:Long-term 52:Specialty 4184:25739706 4146:36937215 4137:10020728 4097:28846327 4023:20023365 3988:22560882 3980:22863240 3942:39280671 3934:22082187 3899:11887107 3861:15062719 3798:25239073 3762:35494270 3708:30393558 3654:28866346 3614:28567214 3555:28 March 3513:17461700 3478:10692608 3443:35901473 3412:31972612 3367:38825817 3358:11162876 3318:33948195 3269:35949382 3220:22814453 3175:32856521 3085:38697742 3027:16558144 2986:20180984 2935:19011229 2883:31033613 2847:24210321 2812:27618322 2777:10932828 2739:28028573 2703:28616638 2668:31304122 2619:34859380 2570:28932698 2519:11276097 2484:28670031 2427:27644428 2385:30663080 2336:23684470 2289:28294069 2240:19857216 2232:19466717 2170:31102324 2150:PM&R 2090:27935076 2020:14571472 1985:10428125 1950:28786005 1885:25794202 1849:12447093 1807:15739520 1746:19927068 1706:23677435 1698:19998490 1663:17216293 1628:26522381 1558:17385355 1531:23893704 1496:20596735 1418:20289074 1372:29494038 1347:30137781 1314:31553395 1257:32349600 1223:22931697 1173:19275213 1165:28836092 1060:10621104 1052:25574881 970:27011826 895:sciatica 884:See also 865:sciatica 477:H reflex 466:hematoma 458:fibrosis 416:sciatica 369:Etiology 338:sciatica 272:extended 203:, or an 190:buttocks 145:steroids 77:Duration 68:Symptoms 4791:General 4286:D055958 4070:9835099 4031:9937192 3753:9042772 3699:6206698 3605:5435650 3309:8081421 3260:9340836 3018:1317145 2977:2828977 2659:6565897 2610:8804110 2561:5594015 2475:5487234 2435:7024313 2376:6594076 2280:6204659 2055:1554310 1593:1880438 1487:2997212 961:4718497 859:History 841:hormone 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