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Piriformis syndrome: Diagnosis, treatment, and outcome—a 10-year study

  • Loren M. Fishman
    Affiliations
    Department of Physical Medicine and Rehabilitation, New York Flushing Hospital and New York–Presbyterian Medical Center, New York, NY (Fishman); University of Detroit, Detroit, MI (Dombi); Department of Orthopedic Surgery, New York–Presbyterian Medical Center, New York, NY (Michaelsen); Department of Orthopedic Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Ringel); Department of Orthopedic Surgery, Beth Israel Medical Center, New York, NY (Rozbruch); Department of Biostatistics, Deaconess and Brigham & Women's Hospital, Harvard Medical School, Boston, MA (Rosner); and Department of Medical and Surgical Neurology, Texas Tech University, Lubbock, TX (Weber)
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  • George W. Dombi
    Affiliations
    Department of Physical Medicine and Rehabilitation, New York Flushing Hospital and New York–Presbyterian Medical Center, New York, NY (Fishman); University of Detroit, Detroit, MI (Dombi); Department of Orthopedic Surgery, New York–Presbyterian Medical Center, New York, NY (Michaelsen); Department of Orthopedic Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Ringel); Department of Orthopedic Surgery, Beth Israel Medical Center, New York, NY (Rozbruch); Department of Biostatistics, Deaconess and Brigham & Women's Hospital, Harvard Medical School, Boston, MA (Rosner); and Department of Medical and Surgical Neurology, Texas Tech University, Lubbock, TX (Weber)
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  • Christopher Michaelsen
    Affiliations
    Department of Physical Medicine and Rehabilitation, New York Flushing Hospital and New York–Presbyterian Medical Center, New York, NY (Fishman); University of Detroit, Detroit, MI (Dombi); Department of Orthopedic Surgery, New York–Presbyterian Medical Center, New York, NY (Michaelsen); Department of Orthopedic Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Ringel); Department of Orthopedic Surgery, Beth Israel Medical Center, New York, NY (Rozbruch); Department of Biostatistics, Deaconess and Brigham & Women's Hospital, Harvard Medical School, Boston, MA (Rosner); and Department of Medical and Surgical Neurology, Texas Tech University, Lubbock, TX (Weber)
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  • Stephen Ringel
    Affiliations
    Department of Physical Medicine and Rehabilitation, New York Flushing Hospital and New York–Presbyterian Medical Center, New York, NY (Fishman); University of Detroit, Detroit, MI (Dombi); Department of Orthopedic Surgery, New York–Presbyterian Medical Center, New York, NY (Michaelsen); Department of Orthopedic Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Ringel); Department of Orthopedic Surgery, Beth Israel Medical Center, New York, NY (Rozbruch); Department of Biostatistics, Deaconess and Brigham & Women's Hospital, Harvard Medical School, Boston, MA (Rosner); and Department of Medical and Surgical Neurology, Texas Tech University, Lubbock, TX (Weber)
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  • Jacob Rozbruch
    Affiliations
    Department of Physical Medicine and Rehabilitation, New York Flushing Hospital and New York–Presbyterian Medical Center, New York, NY (Fishman); University of Detroit, Detroit, MI (Dombi); Department of Orthopedic Surgery, New York–Presbyterian Medical Center, New York, NY (Michaelsen); Department of Orthopedic Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Ringel); Department of Orthopedic Surgery, Beth Israel Medical Center, New York, NY (Rozbruch); Department of Biostatistics, Deaconess and Brigham & Women's Hospital, Harvard Medical School, Boston, MA (Rosner); and Department of Medical and Surgical Neurology, Texas Tech University, Lubbock, TX (Weber)
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  • Bernard Rosner
    Affiliations
    Department of Physical Medicine and Rehabilitation, New York Flushing Hospital and New York–Presbyterian Medical Center, New York, NY (Fishman); University of Detroit, Detroit, MI (Dombi); Department of Orthopedic Surgery, New York–Presbyterian Medical Center, New York, NY (Michaelsen); Department of Orthopedic Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Ringel); Department of Orthopedic Surgery, Beth Israel Medical Center, New York, NY (Rozbruch); Department of Biostatistics, Deaconess and Brigham & Women's Hospital, Harvard Medical School, Boston, MA (Rosner); and Department of Medical and Surgical Neurology, Texas Tech University, Lubbock, TX (Weber)
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  • Cheryl Weber
    Affiliations
    Department of Physical Medicine and Rehabilitation, New York Flushing Hospital and New York–Presbyterian Medical Center, New York, NY (Fishman); University of Detroit, Detroit, MI (Dombi); Department of Orthopedic Surgery, New York–Presbyterian Medical Center, New York, NY (Michaelsen); Department of Orthopedic Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Ringel); Department of Orthopedic Surgery, Beth Israel Medical Center, New York, NY (Rozbruch); Department of Biostatistics, Deaconess and Brigham & Women's Hospital, Harvard Medical School, Boston, MA (Rosner); and Department of Medical and Surgical Neurology, Texas Tech University, Lubbock, TX (Weber)
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      Abstract

      Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 2002;83:295-301. Objectives: To validate an operational definition of piriformis syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of piriformis syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat piriformis syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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