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Syndrome of a pear-shaped muscle


The syndrome of a pear-shaped muscle is a pain syndrome which is localized in a rump with possible return (irradiation) in an upper part of a hip, shin and inguinal area.
The syndrome of a pear-shaped muscle occurs not less than at 50% of patients with discogenic lumbosacral radiculitis. Reflex tension in a muscle and neurotrophic processes in it are caused, as a rule, by irritation not of the fifth lumbar, but the first sacral root. If this diagnosis is made to the patient, the assumption of existence of a syndrome of a pear-shaped muscle can arise in the presence of the persistent pains on the course of a sciatic nerve which are not decreasing at drug treatment. It is much more difficult to define existence of this syndrome if there is only pain in a buttock having limited character and connected with certain provisions (movements) of a basin or when walking.

Анатомия грушевидной мышцы

Anatomy of a pear-shaped muscle

Reasons of a syndrome of a pear-shaped muscle:

The syndrome of a pear-shaped muscle is familiar to general practitioners long ago, it can be both a complication of lumbar osteochondrosis, and a symptom of diseases of bodies of a small pelvis, and the investigation of an overload of a pear-shaped muscle, muscles and a linking of a girdle of inferior extremity.
Primary damage of a pear-shaped muscle is observed at a myofascial pain syndrome; can be proximate causes of its emergence:
- stretching
- overcooling
- muscle overtraining
- injury lumbosacral and rumps
- an unsuccessful injection of medicines to the area of a pear-shaped muscle
- ossifying miositis
- long stay in an antalgichesky pose
The secondary syndrome of a pear-shaped muscle can arise at:
- diseases of a sacroiliac joint
- diseases of a small pelvis, in particular at gynecologic diseases.
At vertebrogenny pathology there can be a reflex spasm of a muscle. The syndrome of a pear-shaped muscle which develops according to this scheme (not radicular) with muscular and tonic manifestations is the most frequent option of lumbar and femoral pains. The pathological tension of a pear-shaped muscle in the form of a spasm are observed at discogenic radiculopathies with defeat of spinal roots. In these cases there will be a clinical combination as radicular and reflex mechanisms with emergence of neurologic displays of vertebrogenny pathology.
So, it became clear that the reasons of a syndrome of a pear-shaped muscle can be both vertebrogenny, and nevertebrogenny.

Symptoms of a syndrome of a pear-shaped muscle:

The clinical picture of a syndrome of a pear-shaped muscle consists from:
- local symptoms
- symptoms of a prelum of a sciatic nerve
- symptoms of a prelum of the lower buttock artery and vessels of the most sciatic nerve.
Local symptoms:
- aching, pulling, buttock, sacroiliac and coxofemoral joints pain which amplifies when walking, in a standing position, at reduction of a hip, and also in a semi-squat on cards;
- pain abates in a prone position a little and sitting with divorced legs;
- at good relaxation of a big gluteus under it it is probed dense and painful at a tension (Bonnet-Bobrovnikova's symptom);
- at percussion in a point of a pear-shaped muscle pain on the back surface of a leg - Vilenkin's symptom develops;
- morbidity of a sciatic awn comes to light: the feeling finger intensively sliding medially up from a sciatic hillock will come across it;
- quite often tonic tension of a pear-shaped muscle is combined with a similar condition of other muscles of a pelvic bottom, coccygeal, internal locking, the anus levator, etc. in such cases speak about a syndrome of a pelvic bottom;
- at a syndrome of a pear-shaped muscle there are almost always easy sphincteric disturbances: a small pause before an urination.

Symptoms of a prelum of vessels and sciatic nerve in subpear-shaped space:
- pains at a compression of a sciatic nerve have stupid character with the expressed vegetative coloring (feeling of a chill, burning, an odereveneniye)
- irradiation of pain on all leg or it is preferential on a zone of an innervation of tibial and fibular nerves
- provocative factors are heat, a weather changing, stressful situations
- sometimes the reflex, superficial sensitivity decrease akhill
- at preferential involvement of fibers from which the tibial nerve forms pain is localized in back group of muscles of a shin - in them pains when walking develop, at test of Lasega; palpatorno morbidity in kambalovidny and sural muscles is noted

Symptoms of a prelum of the lower buttock artery and vessels of the most sciatic nerve:
- sharp passing with a leg vasospasm, leading to the alternating lameness - the patient is forced when walking to stop, sit down or lay down; leg skin at the same time turns pale; after rest of the patient can continue walking, but soon it repeats the same attack.

Important diagnostic test podtverdayushchy the leading role in formation of a clinical picture of a grusheviny muscle - is its infiltration (a pear-shaped muscle) novocaine with assessment of the positive shifts arising at the same time.
Certain manual tests help to distinguish a syndrome of a pear-shaped muscle:
- morbidity at a palpation of verkhnevnutrenny area of a big spit of a femur (the place of an attachment of a pear-shaped muscle)
- morbidity at a palpation of a lower part of a sacroiliac joint - a projection of the place of an attachment of a pear-shaped muscle
- reproduction of pain at passive reduction of a hip with its simultaneous rotation inside (Bonnet-Bobrovnikova's symptom)
- the test for a research of a sacral and awned sheaf allowing to diagnose at the same time a condition of sacral and awned and iliosacral sheaves
- effleurage on a buttock (from the sick party) - at the same time arises the pain extending on the back surface of a hip
- Grossman's symptom - at blow by a hammer or the put fingers on nizhnepoyasnichny or verkhnekresttsovy acanthas occurs reduction of gluteuses.

Treatment of a syndrome of a pear-shaped muscle:

In most cases correction is demanded by primary state which caused formation of a muscular and tonic syndrome. At elimination of primary source of a painful impulsation the reflex muscular and tonic syndrome can regress. When muscular and tonic disturbances become the main or independent source of pain, apply both local, and general influences. Stretching, massage of the interested muscle, influence by the warming physiotherapy, the methods of manual therapy directed on mobilization of the struck vertebral motive segment are carried out. Correction of a motive stereotype, avoiding of provocative loadings and poses is reasonable. In the absence of a sanogenetichesky role of a muscular and tonic syndrome purpose of NPVP and muscle relaxants having analgetic properties, for example, of a tizanidin is possible.
As the painful tension of a pear-shaped muscle is most often connected with an irritation of the first sacral root, it is reasonable to carry out serially novocainic blockade of this root and novocainization of a pear-shaped muscle. Trying to relax a pear-shaped muscle, it is necessary to use previously blockade, the weakening massage of buttock muscles at simultaneous intensive processing of adductors.

Blockade of a pear-shaped muscle. The point of infiltration of a pear-shaped muscle is found as follows. Mark a big spit of a hip, an upper back awn of an ileal bone and a sciatic hillock, Connect these points and from an upper back awn on the basis of this triangle carry out bisectrix. The required point is located on border of the lower and middle part of this bisectrix. Here enter a needle vertically on depth of 6 - 8 cm and infiltrirut a muscle of 0,5% novocaine solution in number of not less than 10 ml.

Gymnastic exercises which are recommended for relaxation of a pear-shaped muscle and activation of her antagonists can be carried out in the following order. In situation on spin with halfbent legs, the leaning soles about a couch, the patient makes the smooth movements of connection and cultivation of knees. Then, having connected halfbent legs, the patient vigorously pushes with one knee another during 3-5 pages. The following exercise - "cradle", is carried out whenever possible without hands at active bending of hips. Then in a sitting position widely place soles, connect knees and, leaning against a couch a palm of an outstretched arm, begin to rise with a couch. By the time of when the palm comes off a couch, offer other hand to the instructor helping to complete straightening of a body. By this moment the connected knees freely separate. When the state improves, at a stage of regressing and during remission, it is recommended often (but not long) to cross in situation "the legs".

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