What is Medical Negligence and How Can a Medical Malpractice Claim Help? We want to welcome you to our dental practice where our patients quickly become like family. 15 Adult Criminal Civil Family Court Probate County Adult Criminal County Civil 16 Adult Criminal Civil Family Court Probate County Adult Criminal County Civil 17 Adult Criminal Civil Family Court Probate County Adult Criminal County Civil 18 Adult Criminal Civil Family Court Probate County Adult Criminal County Civil 19 Adult Criminal Civil Family Court Probate County Adult Criminal County Civil 20 Adult Criminal Civil Family Court Probate County Adult Criminal County Civil Total 8,800 23,008 16,855 7,525 76,050 192,359 324,597 individual complaints (unrelated to the bellwether trials) and client retainers well before Cullan and Cullan have successfully handled many cases involving the failure to timely diagnose potentially dangerous conditions, such as heart attack, colorectal cancer, meningitis, internal bleeding, and fetal distress. In 2007, a jury demanded Physicians Clinic pay $4,000,000 in damages to the family of a man who died as a result of a delay in colorectal cancer diagnosis. Medical Law Solicitor Ceredo. Student Completed Dental Hygienist Degrees In Louisville 07/23/2013 - Ukrainian Pavlo Lapshyn faces court on Manchester terror murder charge Harnett, Lee and Johnston Counties Criminal Defense Attorneys A: I am sorry it took as long as it did to get back to you. I had a family emergency out of town. To A few years before his death, Dr. McKelway slipped on an icy pavement, fracturing his hip. This necessitated his retirement from active practice. He died in Trenton, April 23, 1877, at the age of ninety, and lies buried in Mercer Cemetery. Misdiagnosis: Misdiagnosis of cardiac arrest or heart attack, misdiagnosis of cancer, misdiagnosis resulting in a persistent vegetative state, lack of oxygen
June 17, 2016 Mississippi Auto Insurance Rates Poised To Rise Mississippi apparently has a perfect storm brewing with respect to auto insurance rates. The. Failure to respond to earlier incidents and inadequate evacuation plans: Although the event was advertised to occur rain or shine, the only evacuation plan was to send people into the tents. Several of the tents had already become loose on the previous Friday because of high winds, and severe weather was forecast for the Sunday of the fatal accident, but the event's organizers did nothing to prevent further blow-downs. Medicare and Medicaid usually pays for medical care in the event the injured person is eligible for Medicare or Medicaid assistance and is unable to pay their medical expenses. Medicaid and Medicare are secondary payers and will pay only after private insurance has been exhausted. Quickly log in to any Toolkit! Select a Toolkit from the list, then enter your Username and Password. 6. We can run your case with regular face-to-face meetings - or if you prefer, we are equally happy running your claim using mainly email, phone and Skype video 20+ years in ICBC injury disputes, experienced with traumatic brain injuries. Medical Malpractice. Employment Law. Lawyers Ceredo WV 25507
In a recent decision, the California Court of Appeals reversed a summary judgment order entered by the trial court against the plaintiff, thereby allowing the plaintiff to proceed with his personal injury action against a cable company. In Reis v. Time Warner N.Y. Cable, LLC (Cal. Ct. App. Feb. 18, 2016), the plaintiff brought suit against the defendant after he sustained injuries tripping over a cable that had emerged from the ground in his yard. The defendant moved for summary judgment before trial, which the lower court granted on the basis that the defendant did not install the cable at issue, and therefore the defendant had no duty of care to maintain it because it did not have actual or constructive notice of a dangerous condition. have emerged that can affect residents of San Antonio and greater Texas. Statistics specific to death cases were unavailable, said Kwon Miller, the association's research database manager. One Response to Denver Family Receives $150,000 Settlement for Medical Malpractice Death Lawyer for malpractice. Law firm recruiter. Joshua dressler understanding criminal law.
This chapter has set the stage for the more detailed empirical and other analyses presented in the following chapters. Malpractice coverage features a number of institutional reactions to the unique characteristics of medical malpractice insurance markets in particular and of the property-liability insurance industry of which malpractice insurance is a line. These features-single-line physician insurers, partly regulated entry and prices, and others-must be explained if the performance of medical malpractice insurers is to be understood. Issue - Labor & Employment - Whether the Average Weekly Wage of a sole proprietor who elects covered employment status under MD's Workers' Compensation Act should be calculated based upon gross profits/earnings and not net profits? Medical Law Solicitor Ceredo 25507 A medical malpractice claim is really another form of personal injury claim, and is based upon the same principles. In order to win in a medical malpractice action, the patient must prove that the doctor or other health care provider was negligent. A bad outcome in a surgical procedure does not necessarily mean that the doctor was negligent. In order to prove negligence, it must be proven that the outcome was not a reasonably foreseeable complication of the surgery or procedure. Proving negligence of a doctor requires another doctor to testify regarding the violation of the standard of care (the doctor's negligence). In addition, you must be able to prove that the doctor's negligence was the cause of the injury or death. Unfortunately, this process is expensive.
AFFIRMED Board's ruling denying carrier's request to reopen PPD case even though claimant failed to respond to carrier's inquiries about a search for work. As the result of claimant's 2004 back injury, the parties in 2008 stipulated to a finding that claimant suffered a permanent partial disability with appropriate awards, with no further action planned. Failing to get a response to their August 2011 letter to claimant's counsel requesting documentation of claimant's search for work within his medical restrictions, the carrier filed a request for further action with the Board in September 2011, seeking a suspension of benefits on the basis that claimant had voluntarily removed himself from the labor market and/or was no longer attached to the labor market. If your dentist didn't clarify the risks or commitment required, and you're sad with the result, they may also help you declare dental compensation for future treatment. Their clinical negligence solicitors handle the case, from the preliminary dialog with yourselves to the ultimate settlement being forwarded to you. If this is the case then a declare for compensation for solicitors negligence may be made. Program for the Health of the People PO Box 160 Shiprock, NM 87420
Those members of the public who are defendants in traffic citations or criminal matters are important. They are innocent until proven guilty. Many of them are taxpayers who help pay our salaries. All of them are entitled to the rights guaranteed by the U.S. and Georgia Constitutions. We will afford them every courtesy we ourselves would expect if placed in their position. LOCUM TENENS/FLEXIBLE OPPORTUNITIES: Midwest Dental is seeking experienced dentists to fill daily/weekly/monthly locum tenens needs to cover leaves and extended vacations. Perfect for dentists wanting to pick up extra hours. We offer competitive pay and give you complete freedom to work as many locum sessions as you'd like! May involve travel with overnight stays. Typically includes 32-36 hours/week when needed. Opportunities are available at practices across the country. Contact Kayla Waller at ?612-214-5119 or kwaller@ We are available to handle cases involving Medical Negligence that resulted in brain injury , spine injury, serious injury or wrongful death of a family member. Some examples of cases we can handle include: Learn about medical malpractice at these Seattle-area Hospitals: Family practice Physician Chapel Medical Clinic 9739 California Avenue South Gate, CA 90280 Phone: 323-567-1212 -------------------- Ebenezer Chambi: Dialogue with an Adventist physician, health educator, and community leader Link Ebenezer Chambi MD - Chambi Ebenezer MD 9739 California Ave South Gate, CA 90280 Phones: (323) 564-2228 by Michael Peabody Born in Peru, Dr. Ebenezer Chambi developed early in his life a sense of community and an inclination to service. His family was active in the local church. Throughout his educational experience, he was guided by a commitment to help others. In 1970, he completed his pre-medical studies at Union College (now Peru Union University) located near Lima, the capital. Although he wanted to study medicine in his homeland, the then prevailing political situation made this virtually impossible. His older brothers had moved to Mexico to pursue their medical training; so did he. Completing his medical degree from the Autonomous University of Guadalajara, Mexico, in 1975, he did his residencies in Puerto Rico and Los Angeles, California. After completing the latter, Dr. Ebenezer Chambi joined a research team to study epilepsy. Currently, he is practicing general medicine at the Chapel Medical Clinic in South Gate, California. In addition to ensuring quality care to his patients, Dr. Ebenezer Chambi brings his Christian commitment to bear on his profession by continually promoting preventive care and healthful living. He is involved in his community through a variety of activities ranging from sponsoring folk music concerts to speaking to high school students on health. In recognition of his community service, he received in 1994 the La Sierra University Presidential Citation for Humanitarian Service. Ebenezer Chambi and his wife, Esther, have three children who are pursuing advanced studies: Esther Janet, Ebenezer Howard, and Eber Caleb. Dr. Ebenezer Chambi, what influences have shaped your life? Perhaps the same four major influences that shape all of us: family, education, community, and religion. The family teaches us how to care for each other. Parents care for children, children care for each other and their parents. In a good home, we learn to love people unconditionally. Education is one of the major ways to learn about ourselves and develop our talents and intellectual skills. It structures our personality. Community teaches us that we are not alone-no one is an island. We depend on other people and they depend on us. Christianity gives us inner strength, especially when we feel discouraged and don't have energy to keep going. There is a higher power, God, ready to help us. Religion gives us the powerful tool of confidence. It brings us strength and hope. It keeps us from giving up on life. At the end of the journey, it gives us the assurance of a better life. What type of research did you do in epilepsy? Epilepsy can be a very debilitating disease, and our team wanted to find its cause and determine whether it could be successfully treated or even cured. We studied a diverse population in the Los Angeles area, seeking ways of helping epilepsy victims. The results were rewarding. Some were cured. Many were able to live relatively normal lives and return to their vocations. Currently, what does your practice cover? I am involved in general practice. Beyond the regular treatment of patients, I focus on preventive medicine. I want to teach people how to live healthier, happier lives. In my practice, I see a lot of baby boomers. I'm one of them, so I know what they are like and how they live. Because they work so many hours and have so many activities, they often wait until the last possible moment to come to see me, knowing that a visit to the doctor takes time. They usually don't come in when they have a slight cold or a stomach ache. They visit my office only when they sense that they are in serious trouble and need help. We do a complete check-up, including blood and urine tests. Most of the time we find that they have high cholesterol levels; they are not eating right and not exercising. Most of the common problems can be prevented, and I emphasize that. How do you convince busy people to live healthier lives? The key is behavior modification. We can give objective explanations of why a person should exercise more or spend some time relaxing rather than overworking, but it is challenging to convince people that they need to make fundamental changes in how they live. At times a physician needs to be quite direct, even blunt, to persuade patients to radically alter their lifestyle. A while back, a man, suffering from exhaustion, came to my office. He was working at two jobs so he could buy a new house every year. His wife told me that he worked too many hours a day and did not take time to relax and enjoy life. She told me that they already owned three homes and that he wanted to buy another one. I told her, "Don't worry. The more he works, the more houses he will leave to you when he dies!" He got the message and changed his habits. Do you also utilize the media to educate the public? When I was doing my residence in Puerto Rico, I started a radio program on health prevention and promotion. Then here, in the Los Angeles area, I hosted for ten years a weekly radio forum called El M�dico Habla (The Physician Speaks) that was quite popular. We have also prepared several short video programs on health that I make available to pastors and TV cable stations. Does the emphasis on exercise and nutrition in the popular media help in having people change their lifestyle? Yes. Ten or 15 years ago, it was more difficult to convince people that they needed to exercise and eat well. But now, the media's coverage of prevention and health has made my job easier in terms of education. The problem is that many people who understand the principles of healthful living aren't putting them into practice. They still eat too much fast food and stay up too late watching the late shows. Fortunately, people are beginning to see the light. The city where I practice has a park where you can see more people running, walking, and doing other exercises than in any other park in the nearby cities. I like to think this has something to do with our emphasis on exercise. The hamburger place that is near our office now also sells vegetarian burgers. I think that shows some of the positive influence we've had on people who are trying to eat more healthful foods. How can people who are not involved in the health-care profession effectively spread the message of healthful living? All of us exert an influence and convey a silent message wherever we go. People are searching for a better life, and they look up to good role models. If we spend time with people, we can influence them positively by your example. I've found it effective not to preach at people, but rather to lead by example. We can encourage others to see that there's a better life. It's easy to become so focused on our own studies or profession that we forget that we are part of a larger community outside our walls. How can a person who has become so insulated begin to interact with the larger community beyond their family or church? Before I became active in the community, it was easy to be critical of those outside my circle. But after I became involved, I discovered how much good I could do and how much I enjoyed it. Get to know other people, especially those with whom we would not normally associate. It will help with your social and intellectual development. You will also learn how your community works and how you can help. Becoming involved begins with something as simple as the way you greet people. Start with a solid and sincere, "Good morning. How are you?" Speak words of encouragement. Learn to listen. Meet with the people who are having problems in your area of expertise who don't know where to look for help. Focus on relieving their suffering. A few years ago, an earthquake hit the Los Angeles area. When people asked me why I left my office to volunteer in the relief efforts, I told them that I was just paying part of my debt to my community. The community has given me a lot and I want to give back. It's a two-way street. And don't forget to have fun! One of the things I do is organize folk-music concerts. And though lots of people enjoy them, I enjoy them the most! How do you apply this involvement in your church? I love my church like a family. I do things not to be recognized or rewarded, but because I want to do something for Christ and my church. If you start a project with the goal of being recognized for your efforts, you miss the point. Instead, do the job because it is important and necessary. As a successful physician, a health educator, and community leader, what would your counsel be to people who are just entering their careers? Learn from successful people by watching how they live, how they get along with others, and how they maintain their emotional balance. Emulate their good traits. If I retrace my journey, being active in the church and in the community were the most important factors that kept me on track. Those of us who have been blessed by talents and education can do much good. Put yourself where God can use your skills. Take the initiative to help the community and make people's lives better. That is a worthwhile goal in life. Interview by Michael Peabody. Michael Peabody is a third year law student at Pepperdine University in Malibu, California. E-mail: mdpeabod@ Dr. Ebenezer Chambi's address: 9739 California Ave.; South Gate, California 90280; U.S.A. -------------------- Orthopedics Link Information about diagnosis and treatment of piriformis syndrome What is piriformis syndrome? Good question! No one really knows exactly what causes piriformis syndrome, or if it really exists. Some physicians believe that piriformis syndrome is the name given to hip/buttock pain that cannot be otherwise diagnosed. Others believe that piriformis syndrome is a very real cause of pain and disability. What is the piriformis muscle? The piriformis is a muscle that travels behind the hip joint. The piriformis muscle is small compared to other muscles around the hip and thigh, and it aids in external rotation (turning out) of the hip joint. The piriformis muscle and its tendon have an intimate relationship to the sciatic nerve-the largest nerve in the body-which supplies the lower extremities with motor and sensory function. The piriformis tendon and sciatic nerve cross each other behind the hip joint, in the deep buttock. Both structures are about one centimeter in diameter. What do people think happens in piriformis syndrome? It is thought that the piriformis muscle tendon may be tethering the sciatic nerve, and causing an irritation to the nerve. While it has not be proven, the theory supported by some physicians is that when the piriformis muscle and its tendon are too tight, the sciatic nerve is choked. This may decrease the blood flow to the nerve and irritate the nerve because of pressure. What else may be causing this pain? Sometimes referred to as "deep buttock pain," other causes of this type of pain include spine problems (including herniated discs, spinal stenosis, etc.), sciatica, and tendonitis. The diagnosis of piriformis syndrome is often given when all of these diagnoses are eliminated as possible causes of pain. Other signs of piriformis syndrome include examination maneuvers that attempt to isolate the function of this muscle, and the finding of pain directly over the tendon of the piriformis muscle. Is there any treatment for piriformis syndrome? Unfortunately, the treatment of piriformis syndrome is quite general, and often this is a difficult problem to recover from. Some treatment suggestions are: 1. Physical Therapy - Emphasis on stretching and strengthening the hip rotator muscles 2. Rest - Avoid the activities that cause symptoms for at least a few weeks 3. Anti-Inflammatory Medication - To decrease inflammation around the tendon 4. Deep Massage - Advocated by some physicians 5. On some occasions, when these treatments fail, patients have surgery to release, or loosen, the piriformis muscle tendon. This surgery is not a small procedure, and generally considered the last resort if a lengthy period of conservative treatment does not solve the problem. ============================================================================= eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions Link Piriformis Syndrome Last Updated: June 14, 2004 Rate this Article Email to a Colleague Synonyms and related keywords: hip socket neuropathy, pseudosciatica, wallet sciatica, deep gluteal syndrome, piriformis syndrome AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Miscellaneous Pictures Bibliography Author: Milton J Klein, DO, Consulting Staff, Department of Physical Medicine and Rehabilitation, Sewickley Valley Hospital and Ohio Valley General Hospital Milton J Klein, DO, is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Association of Electrodiagnostic Medicine, American Medical Association, American Osteopathic Association, and American Osteopathic College of Physical Medicine and Rehabilitation Editor(s): Rajesh R Yadav, MD, Assistant Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas at Houston; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, Pharmacy, eMedicine; Michael T Andary, MD, MS, Residency Program Director, Associate Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine; Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center; and Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center INTRODUCTION Section 2 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Miscellaneous Pictures Bibliography Background: Piriformis syndrome has remained a controversial diagnosis since its initial description in 1928. Piriformis syndrome usually is caused by neuritis of the proximal sciatic nerve. The piriformis muscle can either irritate or compress the proximal sciatic nerve due to spasm and/or contracture, and this problem can mimic discogenic sciatica (pseudosciatica). Pathophysiology: The piriformis muscle is flat, pyramid-shaped, and oblique. This muscle originates to the anterior of the S2-S4 vertebrae, the sacrotuberous ligament, and the upper margin of the greater sciatic foramen (see Image 1). This muscle passes through the greater sciatic notch and inserts on the superior surface of the greater trochanter of the femur. With the hip extended, the piriformis muscle is the primary external rotator; however, with the hip flexed, the piriformis muscle itself becomes a hip abductor. This muscle is innervated by branches from L5, S1, and S2. A lower lumbar radiculopathy also may cause secondary irritation of the piriformis muscle, which may complicate the diagnosis and hinder patient progress. Many developmental variations of the relationship between the sciatic nerve in the pelvis and piriformis muscle have been observed. In approximately 20% of the population, the muscle belly is split with one or more parts of the sciatica nerve dividing the muscle belly itself. In 10% of the population, the tibial/peroneal divisions are not enclosed in a common sheath. Usually, the peroneal portion splits the piriformis muscle belly; the tibial division rarely splits the muscle belly. Involvement of the superior gluteal nerve usually is not seen in cases of piriformis syndrome. This nerve leaves the sciatic nerve trunk and passes through the canal above the piriformis muscle. Blunt injury may cause hematoma formation and subsequent scarring between the sciatic nerve and short external rotators. Nerve injury can occur with prolonged pressure on the nerve or vasa nervorum. Etiology can be subdivided into a few categories as follows: Hyperlordosis Muscle anomalies with hypertrophy Fibrosis (due to trauma) Partial or total nerve anatomical abnormalities Other causes can include the following: Pseudo aneurysms of the inferior gluteal artery adjacent to the piriformis syndrome Bilateral piriformis syndrome due to prolonged sitting during an extended neurosurgical procedure Cerebral palsy Total hip arthroplasty Myositis ossificans Vigorous physical activity This syndrome remains controversial because, in most cases, the diagnosis is clinical, and no confirmatory tests exist to support the clinical findings. Frequency: In the US: Given the lack of agreement on exactly how to diagnose this condition, estimates of frequency of sciatica caused by piriformis syndrome vary from rare to approximately 6% of sciatica cases seen in a general family practice. Approximately 90% of adults have had at least one episode of disabling LBP in their lifetime. Mortality/Morbidity: Piriformis syndrome is not life-threatening, but it can have significant associated morbidity. The total cost of low back pain (LBP) and sciatica is significant, exceeding $16 billion in both direct and indirect costs. Sex: Some reports suggest a 6:1 female-to-male predominance. CLINICAL Section 3 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Miscellaneous Pictures Bibliography History: Piriformis syndrome often is not recognized as a cause of LBP and associated sciatica. This clinical syndrome is due to a compression of the sciatic nerve by the piriformis muscle. This condition is identical in clinical presentation to LBP with associated L5, S1 radiculopathy due to discogenic and/or lower lumbar facet arthropathy with foraminal narrowing. Not uncommonly, patients demonstrate both of these clinical entities simultaneously. This diagnostic dilemma highlights the need for patients with LBP and associated radicular pain to undergo a complete history and physical examination, including a digital rectal examination. Many cases of refractory trochanteric bursitis are observed to have an underlying occult piriformis syndrome due to the insertion of the piriformis muscle on the greater trochanter of the hip. If both the trochanteric bursitis and the piriformis syndrome are treated inadequately, both conditions remain resistant to medical management. Physical: Examination findings may include the following: Piriformis muscle spasm often is detected by careful deep palpation. Digital rectal examination may reveal tenderness on lateral pelvic wall that reproduces symptoms. Reproduction of sciatica type pain with weakness is noted by resisted abduction/external rotation (Pace test). The Freiberg test is another diagnostic sign that elicits pain upon forced internal rotation of the extended thigh. The Beatty maneuver reproduces buttock pain by selectively contracting the piriformis muscle. The patient lies on the uninvolved side and abducts the involved thigh upward; this activates the ipsilateral piriformis muscle, which is both a hip external rotator and abductor with the hip flexed. A painful point may be present at the lateral margin of the sacrum. Shortening of the involved lower extremity may be seen. The patient may have difficulty sitting due to an intolerance of weight bearing on the buttock. The patient may have the tendency to demonstrate a splayed foot on the involved side when in the supine position. Piriformis syndrome alone is rarely a cause of a focal neuromuscular impairment; either a sciatic mononeuropathy or an L5-S1 radiculopathy can mimic both of these conditions, obscuring diagnosis of piriformis syndrome. A Morton foot may predispose the patient to developing piriformis syndrome. The prominent second metatarsal head destabilizes the foot during the push-off phase of the gait cycle, causing foot pronation and internal rotation of the lower limb. The piriformis muscle (external hip rotator) reactively contracts repetitively during each push-off phase of the gait cycle as a compensatory mechanism, leading to piriformis syndrome. Causes: Approximately 50% of patients with piriformis syndrome have a history of trauma, with either a direct buttock contusion or hip/lower back torsional injury. The remaining 50% of cases are of spontaneous onset, so the treating physician must have a high index of suspicion for this problem, lest it be overlooked. DIFFERENTIALS Section 4 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Miscellaneous Pictures Bibliography Lumbar Degenerative Disc Disease Lumbar Facet Arthropathy Lumbar Spondylolysis and Spondylolisthesis Myofascial Pain Trochanteric Bursitis Other Problems to be Considered: Lumbosacral radiculopathy Buttock pain Ischial tuberosity bursitis Sciatica Check the Internet for Related Articles: Lumbar Degenerative Disc Disease Lumbar Facet Arthropathy Lumbar Spondylolysis and Spondylolisthesis Myofascial Pain Trochanteric Bursitis Continuing Education CME available for this topic. Click here to take this CME. WORKUP Section 5 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Lab Studies: Laboratory studies generally are not indicated in diagnosing piriformis syndrome. Imaging Studies: Diagnostic imaging of the lumbar spine is mandatory to exclude associated discogenic and/or osteoarthritic contributing pathology. Reports in the literature on piriformis muscle describe imaging by nuclear diagnostic studies and MRI of the pelvis, but these tests are neither practical nor reliable diagnostic approaches to this problem. The history and clinical diagnostic examination provide the greatest and most specific diagnostic yield for this problem. Other Tests: Results of electrodiagnostic testing for piriformis syndrome usually are normal. Reports of positional H-reflex abnormalities can be found in the literature; however, such findings have not been widely accepted or reproduced. TREATMENT Section 6 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Rehabilitation Program: Physical Therapy: Because a definitive method to accurately diagnose this problem is not available, treatment regimens are controversial and have not been subjected to randomized blind clinical trials. Despite this fact, numerous treatment strategies exist for patients with piriformis syndrome. Functional biomechanical deficits may include the following: Tight piriformis muscle Tight hip external rotators and adductors Hip abductor weakness Lower lumbar spine dysfunction Sacroiliac joint hypomobility Functional adaptations to these deficits include the following: Ambulation with thigh in external rotation Functional limb length shortening Shortened stride length Once the diagnosis has been made, these underlying perpetuating biomechanical factors must be corrected. Consider the use of ultrasound and other heat modalities prior to physical therapy sessions. Prior to performing piriformis stretches, the hip joint capsule should be mobilized anteriorly and posteriorly to allow for more effective stretching. Soft tissue therapies of the piriformis muscle can be helpful, including longitudinal gliding with passive internal hip rotation, as well as transverse gliding and sustained longitudinal release with the patient lying on his/her side. Addressing sacroiliac joint and low back dysfunction also is important. A home stretching program should be provided to the patient. These stretches are an essential component of the treatment program. During the acute phase of treatment, stretching every 2-3 hours (while awake) is a key to the success of non operative treatment. Prolonged stretching of the piriformis muscle is accomplished in either a supine or orthostatic position with the involved hip flexed and passively adducted/ internally rotated. Medical Issues/Complications: No consensus exists on overall treatment of piriformis syndrome due to lack of objective clinical trials. Conservative treatment (eg, stretching, manual techniques, injections, activity modifications, modalities like heat or ultrasound, natural healing) is successful in most cases. Injection therapy can be incorporated if the situation is refractory to the aforementioned treatment program. For effective injection, the piriformis muscle must be localized manually by digital rectal examination. Then the piriformis muscle is injected using a 3.5-inch (8.9-cm) spinal needle. Care must be taken to avoid direct injection of the sciatic nerve. Surgical Intervention: Surgical management is the treatment of last resort. Surgery for this condition involves resection of the muscle itself or the muscle tendon near its insertion at the superior aspect of the greater trochanter of the femur (as described by Mizuguchi). These surgical procedures are described as effective, and they do not cause any associated superimposed postoperative disability. Consultations: Because of the enigmatic nature of piriformis syndrome, initial consultation obtained from an orthopedic surgeon or similar specialist usually is nonspecific. This disorder is considered to be a soft tissue problem that presents as low back or buttock pain with sciatica. After all differential diagnoses have been excluded, consider piriformis syndrome. Due to the traumatic etiology of most cases, piriformis syndrome usually is associated with other more proximal causes of LBP, sciatica, and buttock pain (thereby further clouding the diagnosis). Other Treatment (injection, manipulation, etc.): The Spray N' Stretch myofascial treatment and ultrasound modality preceding physical therapy sessions are useful. Manual muscle medicine, including facilitated positional release, may be helpful. Injections with steroids, local anesthetics, and botulinum toxin have been reported in the literature for this condition. No single technique is universally accepted. Localization techniques include manual localization of muscle with fluoroscopic and electromyographic guidance. The piriformis muscle, after localization with a digital rectal examination, can be injected with a 3.5-inch (8.9-cm) spinal needle. Care should be taken to avoid direct injection of the sciatic nerve. FOLLOW-UP Section 7 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Miscellaneous Further Inpatient Care: Inpatient care would be necessary only if surgical intervention is warranted. Surgery is the last resort treatment for severe cases of piriformis syndrome. Further Outpatient Care: Piriformis syndrome usually is treated effectively with conservative measures. Please refer to the Treatment section for a discussion of treatment recommendations. Deterrence/Prevention: No method has been demonstrated to prevent piriformis syndrome. The best prevention is to maintain biomechanical balance by restoration of a more physiologic weight bearing distribution with a level pelvis/sacral base and equal leg lengths, achieved by heel lift therapy if necessary. This treatment approach also prevents recurrences of piriformis syndrome, especially if the underlying etiology is a leg-length discrepancy. The patient also must engage in a general stretching program that includes bilateral piriformis muscles. Complications: The most significant complication is failure to recognize, diagnose, and treat this disabling condition. If left untreated, a patient may undergo unsuccessful back surgery for a disc herniation; however, a coexisting occult piriformis syndrome can result in a failed back syndrome. Another complication is inadvertent direct injection of the sciatic nerve, which usually results in a non disabling and temporary sciatic mononeuropathy. Prognosis: The prognosis depends upon early recognition and treatment. As this is a soft tissue syndrome, it has a tendency to be chronic, usually due to late diagnosis and treatment and has a less favorable prognosis. Patient Education: For conservative measures to be effective, the patient must be educated with an aggressive home-based stretching program to maintain piriformis muscle flexibility. He or she must comply with the program even beyond the point of discontinuation of formal medical treatment. MISCELLANEOUS Section 8 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Miscellaneous Pictures Bibliography Medical/Legal Pitfalls: The greatest medical/legal concern is either misdiagnosis or failure to diagnose piriformis syndrome. In most cases, the diagnosis is one of exclusion. Therefore, if piriformis syndrome is not in the differential diagnosis list, it may be overlooked. The patient becomes a chronic pain patient doomed to a lifetime of disability and chronic management with medication. Because the diagnosis usually is elusive, missing the diagnosis does not constitute malicious negligence and, therefore, rarely would be sufficient grounds alone for a medical malpractice lawsuit. Piriformis syndrome may be a secondary perpetuating factor underlying chronic posttraumatic intractable LBP. Negligent misdiagnosis or delayed diagnosis of this condition has caused a significant degree of unnecessary disability and financial loss. Special Concerns: In female patients, piriformis syndrome may be a cause of dyspareunia, but, again, this connection becomes impossible to prove. Diagnosis of piriformis syndrome requires a high index of suspicion by either the primary care physician or the obstetric/ gynecologic specialist/surgeon. A bimanual simultaneous vaginal-rectal examination of female patients to determine this soft tissue diagnosis helps the physician to prescribe appropriate treatment. Although it is a misdiagnosed etiology of LBP/sciatica, piriformis syndrome can be a significant cause of soft tissue pain and disability. This problem requires a skillful, attentive physician to conduct a thorough history/physical examination that provides an accurate diagnosis. Once the clinical diagnosis has been made, a specific treatment can be formulated to provide the best outcome with a minimal degree of long-term disability. Author Information Introduction Clinical Differentials Workup Treatment Follow-up Miscellaneous Pictures Bibliography Nerve irritation in the herniated disk occurs at the root (sciatic radiculitis). In the piriformis syndrome, the irritation extends to the full thickness of the nerve (sciatic neuritis). BIBLIOGRAPHY Section 10 of 10 Author Information Introduction Clinical Differentials Workup Treatment Follow-up Barton PM: Piriformis syndrome: a rational approach to management. Pain 1991 Dec; 47(3): 345-52Medline. Beatty RA: The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurgery 1994; 34: 512-514Medline. Beauchesne RP, Schutzer SF: Myositis ossificans of the piriformis muscle: an unusual cause of piriformis syndrome. A case report. J Bone Joint Surg Am 1997 Jun; 79(6): 906-10Medline. Brown JA, Braun MA, Namey TC: Piriformis syndrome in a 10-year-old boy as a complication of operation with the patient in the sitting position. Neurosurgery 1988 Jul; 23(1): 117-9Medline. Durrani Z, Winnie AP: Piriformis muscle syndrome: an under diagnosed cause of sciatica. J Pain Symptom Manage 1991 Aug; 6(6): 374-9Medline. Fishman LM, Zybert PA: Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil 1992 Apr; 73(4): 359-64Medline. Freidberg AH: Sciatic pain and its relief by operation on muscle and fascia. Arch Surg 1937; 34: 337-349. Frymoyer JW: Back pain and sciatica. N Engl J Med 1988 Feb 4; 318(5): 291-300Medline. Jankiewicz JJ, Hennrikus WL, Houkom JA: The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature. Clin Orthop 1991 Jan; (262): 205-9Medline. Karl RD Jr, Yedinak MA, Hartshorne MF: Scintigraphic appearance of the piriformis muscle syndrome. Clin Nucl Med 1985 May; 10(5): 361-3Medline. Mizuguchi T: Division of the piriformis muscle for the treatment of sciatica. Postlaminectomy syndrome and osteoarthritis of the spine. Arch Surg 1976 Jun; 111(6): 719-22Medline. Noftal F: The Piriformis Syndrome. Can J Surg 1988 Jul; 31(4): 210Medline. Pace JB, Nagle D: Piriformis syndrome. West J Med 1976 Jun; 124(6): 435-9Medline. Papadopoulos SM, McGillicuddy JE, Albers JW: Unusual cause of "piriformis muscle syndrome". Arch Neurol 1990 Oct; 47(10): 1144-6Medline. Parziale JR, Hudgins TH, Fishman LM: The piriformis syndrome. Am J Orthop 1996 Dec; 25(12): 819-23Medline. Rask MR: Superior gluteal nerve entrapment syndrome. Muscle Nerve 1980 Jul-Aug; 3(4): 304-7Medline. Retzlaff EW, Berry AH, Haight AS: The piriformis muscle syndrome. J Am Osteopath Assoc 1974 Jun; 73(10): 799-807Medline. Robinson D: Piriformis syndrome in relation to sciatic pain. Am J Surg 1947; 73: 355-358. Schiowitz S: Facilitated positional release. J Am Osteopath Assoc 1990 Feb; 90(2): 145-6, 151-5Medline. Steiner C, Staubs C, Ganon M: Piriformis syndrome: pathogenesis, diagnosis, and treatment. J Am Osteopath Assoc 1987 Apr; 87(4): 318-23Medline. TePoorten BA: The piriformis muscle. J Am Osteopath Assoc 1969 Oct; 69(2): 150-60Medline. Thiele GH: Tonic spasm of the levator ani, coccygeus and piriformis muscles. Trans Am Proct Soc 1936; 37: 145-155. Uchio Y, Nishikawa U, Ochi M: Bilateral Piriformis Syndrome after Total Hip Arthroplasty. Arch Orthop Trauma Surg 1988; 117: 177-179. Yeoman W: The relation of arthritis of the sacroiliac joint to sciatica. Lancet 1928; ii: 1119-1122. NOTE: Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. - : Arch Surg. 1976 Jun;111(6):719-22. Related Articles, Link Division of the piriformis muscle for the treatment of sciatica. Postlaminectomy syndrome and osteoarthritis of the spine. Mizuguchi T. Division of the piriformis muscle at its tendinous insertion was employed for the treatment of sciatica in 14 patients with post laminectomy syndrome and osteoarthritis of the spine. Of these patients, 85% had satisfactory results. It is logical that the piriformis muscle can play an important role in the production of sciatic associated with intraspinal lesions. Tension on the sciatic nerve, which passes in close approximation to the piriformis muscle anteriorly, can be relieved by division of the piriformis muscle. - 1: Neurosurgery. 1994 Mar;34(3):512-4; discussion 514. Related Articles, Link Comment in: Neurosurgery. 1994 Sep;35(3):545. The piriformis muscle syndrome: a simple diagnostic maneuver. Beatty RA. Department of Neurosurgery, University of Illinois, College of Medicine, Chicago. Current maneuvers to diagnose the piriformis syndrome are less than ideal. Freiberg's maneuver of forceful internal rotation of the extended thigh elicits buttock pain by stretching the piriformis muscle, and Pace's maneuver elicits pain by having the patient abduct the legs in the seated position, which causes a contraction of the piriformis muscle. This report describes a maneuver performed by the patient lying with the painful side up, the painful leg flexed, and the knee resting on the table. Buttock pain is produced when the patient lifts and holds the knee several inches off the table. The maneuver produced deep buttock pain in three patients with piriformis syndrome. In 100 consecutive patients with surgically documented herniated lumbar discs, the maneuver often produced lumbar and leg pain but not deep buttock pain. In 27 patients with primary hip abnormalities, pain was often produced in the trochanteric area but not in the buttock. he maneuver described in this report was helpful in diagnosing the piriformis syndrome. It relies on contraction of the muscle, rather than stretching, which the author believes better reproduces the actual syndrome. Publication Types: Case Reports PMID: 8190228 PubMed - indexed for MEDLINE - Muscle Nerve. 1980 Jul-Aug;3(4):304-7. Related Articles, Link Superior gluteal nerve entrapment syndrome. Rask MR. Entrapment of the superior gluteal nerve can occur as a result of compression by anterior-superior tendinous fibers of the piriformis muscle and cause aching claudication -type buttock pain, weakness of abduction of the affected hip with a waddling gait, and tenderness to palpation in the area of the buttock super lateral to the greater sciatic notch. Instilling anesthetic into the point of entrapment may relieve the pain completely but superior gluteal neurolysis may be required to effect a permanent cure. Publication Types: Case Reports PMID: 7412775 PubMed - indexed for MEDLINE -------------------- 1: Clin Nucl Med. 1985 May;10(5):361-3. Related Articles, Link Scintigraphic appearance of the piriformis muscle syndrome. Karl RD Jr, Yedinak MA, Hartshorne MF, Cawthon MA, Bauman JM, Howard WH, Bunker SR. This is the first report in the nuclear medicine literature of the scintigraphic appearance of the piriformis muscle syndrome. This syndrome previously has been thought to be a purely clinical diagnosis and imaging modalities have been ignored. However, its confusing clinical presentation can lead to unnecessary surgical exploration This case is presented to illustrate the characteristic scintigraphic pattern and suggest the role of nuclear medicine scanning in establishing the diagnosis. Publication Types: Case Reports PMID: 3160520 PubMed - indexed for MEDLINE -------------------- 1: Arch Surg. 1976 Jun;111(6):719-22. Related Articles, Link Division of the piriformis muscle for the treatment of sciatica. Post laminectomy syndrome and osteoarthritis of the spine. Mizuguchi T. Division of the piriformis muscle at its tendinous insertion was employed for the treatment of sciatica in 14 patients with post laminectomy syndrome and osteoarthritis of the spine. Of these patients, 85% had satisfactory results. It is logical that the piriformis muscle can play an important role in the production of sciatic associated with intraspinal lesions. Tension on the sciatic nerve, which passes in close approximation to the piriformis muscle anteriorly, can be relieved by division of the piriformis muscle. PMID: 1275705 PubMed - indexed for MEDLINE - Link Science for the Brain - Related Articles: The nation's leading supporter of biomedical research on disorders of the brain and nervous system More about Piriformis Syndrome Studies with patients Research literature Press releases Search NINDS. NINDS is part of the National Institutes of Health: You are here: Home > Disorders > Piriformis Syndrome NINDS Piriformis Syndrome Information Page Organizations What is Piriformis Syndrome? Piriformis syndrome is a rare neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve-the largest nerve in the body. The piriformis muscle is a narrow muscle located in the buttocks. Compression of the sciatic nerve causes pain-frequently described as tingling or numbness-in the buttocks and along the nerve, often down to the leg. The pain may worsen as a result of sitting for a long period of time, climbing stairs, walking, or running. Is there any treatment? Generally, treatment for the disorder begins with stretching exercises and massage. Anti-inflammatory drugs may be prescribed. Cessation of running, bicycling, or similar activities may be advised. A corticosteroid injection near where the piriformis muscle and the sciatic nerve meet may provide temporary relief. In some cases, surgery is recommended. What is the prognosis? The prognosis for most individuals with piriformis syndrome is good. Once symptoms of the disorder are addressed, individuals can usually resume their normal activities. In some cases, exercise regimens may need to be modified in order to reduce the likelihood of recurrence or worsening. What research is being done? Within the NINDS research programs, piriformis syndrome is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as piriformis syndrome. - Piriformis Syndrome: Link New minimal access, outpatient surgery developed at INM greatly improves outcome and reduces recovery time $ 3 million for an electrician injured in tractor-trailer accident Rudin contends that the district court erred in applying the manifest necessity standard to her March 15, 2001, motion for mistrial based on Amador's alleged lack of preparation. We agree, but we conclude that the district court nonetheless reached the correct result in denying Rudin's motion. 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