Piriformis: Difference between revisions

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'''Original Editor '''- [[User:Lucas Villalta|Lucas Villalta]],
'''Original Editor ''' - [[User:Lucas Villalta|Lucas Villalta]]  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}};  
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}};  
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= Description<br> =
== Description ==
The piriformis is a thick, flat muscle and the most superficial muscle among the deep gluteal muscles. It is part of the lateral rotators of the hip ([[Obturator Internus|obturator internus]], [[Gemellus Superior|superior]] and [[Gemellus Inferior|inferior gemelli,]] [[Quadratus Femoris|quadratus femoris,]] [[Obturator Externus|obturator externus]], and [http://www.physio-pedia.com/Gluteus_Maximus gluteus maximus]). The muscle leaves the pelvis through the greater sciatic notch until it attaches to the superior margin of the greater trochanter.<ref name="Oatis">Oatis, C. A., (2009). Kinesiology : the mechanics and pathomechanics of human movement (2nd ed). Baltimore : Lippincott Williams &amp; Wilkins.</ref> Shaped like a pear, it lies nearly parallel to the posterior margin of the [http://www.physio-pedia.com/Gluteus_Medius gluteus medius]<ref name=":0">Chang C, Jeno SH, Varacallo M. [https://www.ncbi.nlm.nih.gov/books/NBK519497/ Anatomy, bony pelvis and lower limb, piriformis muscle]. InStatPearls [Internet] 2021 Oct 11. StatPearls Publishing.</ref>.


Piriformis is a flat muscle and the most superficial muscle of the deep gluteal muscles. It is part of the lateral rotators of the hip (obturator internus, superior and inferior gemelli, quadratus femoris, obturator externus, and [http://www.physio-pedia.com/Gluteus_Maximus gluteus maximus]). It leaves the pelvis through the greater sciatic notch, until its fixation reaches the superior margin of the greater trochanter.<ref name="Oatis">Oatis, C. A., (2009). Kinesiology : the mechanics and pathomechanics of human movement (2nd ed). Baltimore : Lippincott Williams &amp;amp;amp;amp;amp;amp; Wilkins.</ref> It has a piramidal shape that lies almost parallel with the posterior margin of the [http://www.physio-pedia.com/Gluteus_Medius gluteus medius].
[[File:Piriformis, gemmeli, obturator, quadratus femoris.PNG|center|thumb]]
<br>  


= Anatomy  =
== Anatomy<ref name="Oatis" /> ==


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=== Origin  ===
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In the second video the piriformis muscle will be discussed at 5:15.
*Anterior aspect of the [[sacrum]] at the level of about S2 through S4
=== Origin<ref name="Oatis" />  ===
*[[Sacrotuberous Ligament|Sacrotuberous]] ligament
*Periphery of the greater sciatic notch


*Anterior aspect of the sacrum at the level of about S2 through S4;
=== Insertion  ===
*Sacrotuberous ligament;
*Periphery of the greater sciatic notch.


=== Insertion<ref name="Oatis" />  ===
*Superior and medial aspects of the greater trochanter.


*Superior and medial aspects of the greater trochanter
=== Nerve  ===


=== Nerve<ref name="Oatis" /> ===
*Anterior Rami of '''S1''' and '''S2'''<ref name=":0" />


*Ventral rami of L5 and S1,2
=== Artery  ===


=== Artery<ref name="lowerlimb">http://lowerlimbanatomy.wikispaces.com/Piriformis</ref> ===
*The arterial supply is from the inferior gluteal, superior gluteal and internal pudendal arteries, all branches of the internal iliac artery<ref>Accessed from:https://www.kenhub.com/en/library/anatomy/piriformis-muscle on 14/08/18.</ref>.


*Inferior gluteal artery, the lateral sacral artery, internal pudendal and the superior gluteal artery
=== Function<ref name="Oatis" /><ref name="Moore">Moore, K. L., Dalley, A. F., Agur, A. M. R. (2014). Clinically oriented anatomy (7th ed).Philadelphia : Lippincott Williams &amp; Wilkins.</ref>  ===


=== Function<ref name="Moore">Moore, K. L., Dalley, A. F., Agur, A. M. R. (2014). Clinically oriented anatomy (7th ed).Philadelphia : Lippincott Williams &amp;amp;amp;amp; Wilkins.</ref><ref name="Oatis" />  ===
*Lateral rotation of the hip when it is extended (e.g. standing).
*Abduction of the hip when it is flexed.
*Aids slightly in tilting pelvis laterally.
*Also aids in tilting pelvis posteriorly by pulling the sacrum down towards the thigh<ref>Kendal, McCreary, Provance; Muscle Testing and Function with Posture and Pain;4th Edition; Piriformis muscle and its relationship to Sciatic Pain; Page No 365.</ref>.


*Lateral Rotation of the hip when it is extended;
== Clinical relevance  ==
*Abduction fo the hip when it is flexed.


= Clinical relevance  =
The piriformis muscle can be used to locate the [[Sciatic Nerve|sciatic nerve]]. The sciatic nerve enters the gluteal region inferiorly to the piriformis. If the lateral rotators of the hip are tight, they may exert pressure on the sciatic nerve, producing pain radiating into the lower extremity.<ref name="Oatis" /><ref name="teachmeanatomy">http://teachmeanatomy.info/lower-limb/muscles/gluteal-region/</ref> This is known as [http://www.physio-pedia.com/Piriformis_Syndrome#cite_note-x10-6 Piriformis Syndrome].


The piriformis muscle can be used to locate the scietic nerve. This nerve enters the gluteal region inferiorly to the piriformis.If the lateral rotators of the hip are tight they may exert pressure on the sciatic nerve, producing pain radiating into the lower extremity.<ref name="teachmeanatomy">http://teachmeanatomy.info/lower-limb/muscles/gluteal-region/</ref><ref name="Oatis" /> This is known as [http://www.physio-pedia.com/Piriformis_Syndrome#cite_note-x10-6 Piriformis Syndrome].
Piriformis also divides the gluteal region into a superior and inferior part. Therefore, it determines the name of the vessels and nerves that supply the area (e.g. the superior gluteal nerve and vessels emerge superiorly to the piriformis, and the inferior gluteal nerve and vessels emerge inferiorly to the piriformis).<ref name="teachmeanatomy" />  


Another importance of this muscle is that it divides the gluteal region into a superior and inferior part. Therefore, it determines the name of the vessels anf nerves that supply the area (e.g. the superior gluteal nerve and vessels emerge superiorly to the piriformis, and the inferior gluteal nerve and vessels emerge inferiorly to the piriformis).<ref name="teachmeanatomy" />
== Assessment  ==
 
<br>
 
= Assessment  =


=== Palpation  ===
=== Palpation  ===


It may be palpable indirectly by palpating through the gluteus maximus into the greater scietic notch.  
It may be palpable indirectly through the gluteus maximus into the greater sciatic notch.  


=== Test  ===
=== Test  ===
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[http://www.physio-pedia.com/Piriformis_Test Piriformis Test]  
[http://www.physio-pedia.com/Piriformis_Test Piriformis Test]  


=== Power ===
== Treatment  ==
 
=== Strengthening ===


=== Length  ===


= Treatment  =
{{#ev:youtube|9Gu7OjxbYKo}} <ref>Robert Kelty  Piriformis Strengthening Available fromhttps://[https://www.youtube.com/watch?v=9Gu7OjxbYKo&t=72s www.youtube.com/watch?time_continue=72&v=9Gu7OjxbYKo]</ref>


=== Strengthening  ===
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| {{#ev:youtube|9Gu7OjxbYKo|300}}
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=== Stretching  ===
=== Stretching  ===
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|-
| {{#ev:youtube|Yx1yOuPjVis|300}}
| {{#ev:youtube|1fbFMCyRDGs|300}}<ref>stoneclinicPT  Stretching: Piriformis Stretch Available from https://www.youtube.com/watch?time_continue=47&v=1fbFMCyRDGs</ref>
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=== Manual techniques  ===
=== Manual techniques  ===
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= Resources  =
{{#ev:youtube|f3vcmXWNJC0}}<ref>Brent Brookbush Piriformis Static Manual Release (Soft Tissue Mobilization) Available from https://www.youtube.com/watch?v=f3vcmXWNJC0</ref>


= See also  =


= Recent Related Research (from Pubmed)  =
== References  ==
<div class="researchbox"><rss>LINK HERE|charset=UTF-8|short|max=10</rss></div>
= References  =


<references />  
<references />  


[[Category:Anatomy]] [[Category:Muscles]]
[[Category:Anatomy]]  
[[Category:Hip]] 
[[Category:Muscles]]
[[Category:Hip - Muscles]]
[[Category:Musculoskeletal/Orthopaedics]]

Latest revision as of 05:46, 30 January 2024

Original Editor - Lucas Villalta

Top Contributors - Lucas Villalta, Vidya Acharya, Kim Jackson, Candace Goh, 127.0.0.1, Laura Ritchie, Evan Thomas, WikiSysop and Wendy Snyders;

Description[edit | edit source]

The piriformis is a thick, flat muscle and the most superficial muscle among the deep gluteal muscles. It is part of the lateral rotators of the hip (obturator internus, superior and inferior gemelli, quadratus femoris, obturator externus, and gluteus maximus). The muscle leaves the pelvis through the greater sciatic notch until it attaches to the superior margin of the greater trochanter.[1] Shaped like a pear, it lies nearly parallel to the posterior margin of the gluteus medius[2].

Piriformis, gemmeli, obturator, quadratus femoris.PNG


Anatomy[1][edit | edit source]

Origin[edit | edit source]

  • Anterior aspect of the sacrum at the level of about S2 through S4
  • Sacrotuberous ligament
  • Periphery of the greater sciatic notch

Insertion[edit | edit source]

  • Superior and medial aspects of the greater trochanter.

Nerve[edit | edit source]

  • Anterior Rami of S1 and S2[2]

Artery[edit | edit source]

  • The arterial supply is from the inferior gluteal, superior gluteal and internal pudendal arteries, all branches of the internal iliac artery[3].

Function[1][4][edit | edit source]

  • Lateral rotation of the hip when it is extended (e.g. standing).
  • Abduction of the hip when it is flexed.
  • Aids slightly in tilting pelvis laterally.
  • Also aids in tilting pelvis posteriorly by pulling the sacrum down towards the thigh[5].

Clinical relevance[edit | edit source]

The piriformis muscle can be used to locate the sciatic nerve. The sciatic nerve enters the gluteal region inferiorly to the piriformis. If the lateral rotators of the hip are tight, they may exert pressure on the sciatic nerve, producing pain radiating into the lower extremity.[1][6] This is known as Piriformis Syndrome.

Piriformis also divides the gluteal region into a superior and inferior part. Therefore, it determines the name of the vessels and nerves that supply the area (e.g. the superior gluteal nerve and vessels emerge superiorly to the piriformis, and the inferior gluteal nerve and vessels emerge inferiorly to the piriformis).[6]

Assessment[edit | edit source]

Palpation[edit | edit source]

It may be palpable indirectly through the gluteus maximus into the greater sciatic notch.

Test[edit | edit source]

Piriformis Test

Treatment[edit | edit source]

Strengthening[edit | edit source]

[7]


Stretching[edit | edit source]

[8]

Manual techniques[edit | edit source]

[9]


References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Oatis, C. A., (2009). Kinesiology : the mechanics and pathomechanics of human movement (2nd ed). Baltimore : Lippincott Williams & Wilkins.
  2. ↑ 2.0 2.1 Chang C, Jeno SH, Varacallo M. Anatomy, bony pelvis and lower limb, piriformis muscle. InStatPearls [Internet] 2021 Oct 11. StatPearls Publishing.
  3. ↑ Accessed from:https://www.kenhub.com/en/library/anatomy/piriformis-muscle on 14/08/18.
  4. ↑ Moore, K. L., Dalley, A. F., Agur, A. M. R. (2014). Clinically oriented anatomy (7th ed).Philadelphia : Lippincott Williams & Wilkins.
  5. ↑ Kendal, McCreary, Provance; Muscle Testing and Function with Posture and Pain;4th Edition; Piriformis muscle and its relationship to Sciatic Pain; Page No 365.
  6. ↑ 6.0 6.1 http://teachmeanatomy.info/lower-limb/muscles/gluteal-region/
  7. ↑ Robert Kelty Piriformis Strengthening Available fromhttps://www.youtube.com/watch?time_continue=72&v=9Gu7OjxbYKo
  8. ↑ stoneclinicPT Stretching: Piriformis Stretch Available from https://www.youtube.com/watch?time_continue=47&v=1fbFMCyRDGs
  9. ↑ Brent Brookbush Piriformis Static Manual Release (Soft Tissue Mobilization) Available from https://www.youtube.com/watch?v=f3vcmXWNJC0
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