Have you or a loved one suffered an injury due to an accident? Contact Levine & Wiss.�It is important that you�consult an attorney as soon as possible. The sooner you call us, the better your chances of recovery will be, as we may still be able to preserve the scene where the injury occurred via photographic evidence and witness accounts. Contact us at 1-888-GOT-HURT (1-888-468-4878) for a free consultation. Don't forget to Like us on Facebook and FOLLOW us on Twitter to keep up with the latest news and legal tips. � 113 We do not agree with the Pigment Manufacturers' reading of Collins, and we do not agree that Article I, Section 9 is as frail as the Pigment Manufacturers would have us believe. 2. My friend knows a lawyer his family used several years ago. Why can't that lawyer represent me in my Lee's Summit injury case? Vary state to state it, your car collection! error when adding to fun 14 Most important things to you get quick auto insurance quotes Challenged to maintain adequate insurance or the ticket law center won't my insurance can switching to geico Used for the type of motorist bodily injury liability To inform them they need through one of the people in those small of earnings and reimbursement for the case. The girl suffered serious injuries and was immediately transported to Riverside Community Hospital for treatment from where she was later moved to Loma Linda University Medical Center. It appears that the car driver's recklessness led to this serious crash. The driver did not stop after hitting the child and instead, fled the scene. 2. The effective date of withdrawal is the effective date of the repeal. Justia Opinion Summary: In 2003, Appellant Bridge Tower Dental hired Respondent Meridian Computer Center to provide its dental practice with a computer hardware system subject to a warranty contract. In June of 2005, Bridge began experiencing p. If you car was damaged, drive it or have it towed to a reliable body shop. (See section on Property Damage). 1. Based on allowed amounts as determined by BCBSNC. An allowed amount may be less than the provider's actual charge. You are responsible for charges above the allowed amount, in addition to any deductible and coinsurance applied. Humana group vision plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Health Benefit Plan of Louisiana, Humana Insurance Company of Kentucky, Humana Insurance Company of New York, CompBenefits Insurance Company, CompBenefits Company, or The Dental Concern, Inc. Before applying for group coverage, please refer to the pre-enrollment disclosures for a description of plan provisions which may exclude, limit, reduce, modify or terminate your coverage. Dental Malpractice Lawyers Colusa 95932. In February 2012, seventy-seven year old Monica �Donnell fell at the Parkview House Nursing Home in Uxbridge and broke her hip. Staff at the care home failed to call a doctor immediately, and it was only when Monica complained of a pain in her right thigh and being unable to walk that medical help was sought. WTNH NEWS8 provides commenting to allow for constructive discussion on the stories we cover. In order to comment here, you acknowledge you have read and agreed to our Terms of Service. Commenters who violate these terms, including use of vulgar language or racial slurs, will be banned. Please be respectful of the opinions of others. If you see an inappropriate comment, please flag it for our moderators to review. Also, you can now block any inappropriate user by simple selecting the drop down menu on the right of any comment and selection "Block User" from there. It is important to have a personal injury lawyer representing you as soon as possible to protect your rights because insurance companies have their attorneys, adjusters and representatives well-trained to defend, delay and frustrate to recover full and adequate compensation for your damages. Do not talk or provide any recorded statement to anyone before you have talked to lawyer
In this, his third section 2255 motion, Rhodes contends that his constitutional rights were violated when his trial counsel conceded counts II and III of the indictment in closing argument, and failed. Subsequently, on May 24, 1995, Adams filed a complaint with the Lexington-Fayette County Human Rights Commission and the Equal Employment Opportunity Commission. Adams alleged that LFUCG had committed unlawful employment practices by discriminating against him in violation of Kentucky Revised Statutes (KRS) 344 and Chapter VII of the Civil Rights Act of 1964. No TC error re:TC's jurisdiction regarding equitable distribution Welcome to Amato Pre-Owned, your Milwaukee used car, truck and SUV dealership. Consider us your used and pre-owned dealer for Milwaukee Ford and Milwaukee Mazda customers. Our dealership also serves Milwaukee Hyundai and Milwaukee Nissan drivers as. I like the provincial, rather than a national system. Saskatchewan has a higher incidence of M.S. so they are trying some alternative procedures to see if these procedures fall into best practice studies. The provinces must do these studies to try to keep costs logical. It is rationing, but so do our insurance companies in the States, with a for-profit a province finds a procedure works or doesn't work, the other provinces would likely follow. Innovation would happen if each state did its own. 1.29 miles 1130 22nd Street South, Suite 3000, Birmingham, AL 35205 According to the Charleston Gazette, Putnam General Hospital in West Virginia was guilty of wantonness, recklessness and gross negligence in not properly checking the background of John A. King, a surgeon who is now facing more malpractice lawsuits than any other doctor in the state's history. Law Firms Colusa CA
Trial court erred in finding that the agency record lacked substantial evidence to support the agency's founded disposition of sexual abuse against appellee Eventually, the backlog was reduced by hiring more people and putting more resources on the problem, Dorn officials told Miller and fellow Republican U.S. Reps. Joe Wilson and Mick Mulvaney of South Carolina.
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For more information, please contact Dennis Hoover at 209-605-9039 or Dennis.Hoover@ A Montgomery County jury awarded more than $40 million to a couple who claimed that their Rockville, Maryland fertility doctor failed to properly screen the surrogate mother who carried their child. The crux of the couple's claim was that the standard of care required that the fertility doctor obtain and review the potential surrogate's obstetrical and gynecological history before clearing the candidate to act as the surrogate. Although the doctor did inquire of the candidate about her history, the candidate lied by stating that she had previously carried four pregnancies to term without complications. The doctor, however, never obtained the pertinent medical records to verify the candidate's representations. 5 BANKRUPTCY ATTORNEY Outstanding bankruptcy litigator & strategist with 30+ years experience helps law firms and their clients with all aspects of bankruptcy. Aggressive & Creative Bankruptcy Advocacy All Aspects of Business & Personal Bankruptcies/ Reorganizations (Chapters 7, 11 & 13) Debtor & Creditor Representation Bankruptcy Avoidance & Pre-Bankruptcy Strategies Protections from Foreclosures, Judgments, Settlements, Lawsuits, Liens, Debts, Collections Protections Against Debtors Likely to File for Bankruptcy UCLA Law F Phi Beta Kappa F Magna Cum Laude F Free Initial Consult F Exceptional Quality at Low Prices COURSES IN VENTURA Tip the scales of bankruptcy justice in your clients favor. Law Offices of Philip D. Dapeer A Law Corporation Offices in Westlake Village & Beverly Hills 805.557.7001 323.954.9144 BankruptcyFocus@ SEPTEMBER 2010 CITATIONS 5 2010 VCBA BOARD OF DIRECTORS Alvan A. Arzu Linda K. Ash Christopher R. Balzan Laura V. Bartels Maria L. Capritto Michele M. Castillo Meghan B. Clark Douglas K. Goldwater Lee A. Hess Deborah E. Jurgensen OFFICERS President Kendall A. VanConas President-Elect Joseph L. Strohman Secretary-Treasurer Dien Le Past President Anthony R. Strauss Executive Director, CEO Steve Henderson, CAE Cheri L. Kurman Joel Mark James Q. McDermott Gabriella Navarro-Bush Joseph D. Neill Rein Perryman Kathryn E. Pietrolungo Jodi L. Prior Robert F. Sandbach CITATIONS EDITORIAL BOARD Managing Editor Wendy C. Lascher Publisher, CEO Steve Henderson Graphics/Production J.P. McWaters Assistant Editor Bill Lascher Karen B. Darnall Michael L. McQueen Michael R. Sment Michael A. Velthoen Louis J. Vigorita Eric R. Reed Michael A. Strauss Carol Mack Gregory T. May Mark E. Hancock Aris E. Karakalos Panda L. Kroll Robert I. Long Gregory Herring Al Vargas Valerie Gregson BECOME A BRIDGE BUILDER UCSB Extension s Mediation and Dispute Resolution courses can show you how Dispute Resolution and the Legal Process Cultural Perspectives of Conflict Changing lives FALL QUARTER BEGINS OCT. 9 Mediation: Theory and Practice Mediation Practicum Enroll today! Call 893-4200 or visit UNIVERSITY OF CALIFORNIA SANTA BARBARA CITATIONS is published monthly by the Ventura County Bar Association. Editorial content and policy are solely the responsibility of the Ventura County Bar Association. Submit all advertising, classified and calendar matters to: VCBA 4475 Market St., Suite B, Ventura, CA 93003 Attn: Executive Director t: 805.650.7599 f: 805.650.8059 e: bar@ w: Submit all editorial matters to: CITATIONS P Box 25540 Ventura, CA 93002 t: 805.648.3228 f: 805.643.7692 e: wendy@ design and construction of the home, which is the very soul of the Sales Agreement. As set forth in Mrs C underwent surgery for the removal of her gallbladder. During the procedure the she suffered an inadvertent injury to her gallbladder causing a bile leak. She had to be readmitted to hospital where an abdominal ultrasound confirmed she was suffering from a biliary leak. She underwent further surgery to allow the bile to flow. This subsequently had to be repeated on a further three occasions. Wisconsin Electric Power Company vs. Dianna M. Kargus of Menasha, small claims. We realize that these laws are complicated, but we must provide you with the following important information:
3052994 Hector Quinones v Commonwealth of Virginia 06/19/2001 A pretty novel argument by plaintiff counsel that the paramedics should not have relied upon the ED physician orders to transport, but instead should have done their own assessment as to transport suitability. I wonder what the EMS Medical Control would have said to this if the paramedics had called for guidance in this regard. A broken tooth, searing jaw pain and expensive dental work - that is the cost a person pays when they've bitten into a tainted food item and found a foreign object like broken glass or a piece of metal. Americans are seeing another kind of tainted food injury in recent years - the serious medical problems that can result from E. Coli food poisoning. Salmonella poisoning can result in hospitalization, ruined immune systems, even death. Tainted food claims are not common, so many lawyers have not handled these types of cases, but Oakland food poisoning attorney David G. Smith has. Our firm knows how to get results, whether in negotiations or in court. Contact us if you have questions or need legal help; call 510-431-2598 925-308-6484 or e-mail us for more information. Nor can we agree with the Eidson court's reliance on the "subjective" nature of the charges in Nguyen, as opposed to the "objective" nature of the charges in Eidson. It is our view that the applicable burden of persuasion should be constant for disciplinary proceedings of like kind, and that the burden of persuasion should not vary according to the nature of the charges in the particular case. R (on the application of�French) v Chief Constable of West Yorkshire Police 2011 EWHC 546 (Admin):�challenge to decisions made in police misconduct proceedings. A teaching hospital is a terrific and necessary evil. By agreeing to be treated at a teaching hospital, the patient becomes part of what makes the US medical professional the envy of the world. Student doctors cannot learn how to actually practice medicine if they are cutting their teeth while walking on egg shells. Part of learning involves student doctors making mistakes (clinically, procedurally and even in their interactions with patients/families).
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You are setting up your client to fail in addition to ruining your own reputation and that of your law firm. When someone is severely injured and a lawsuit ensues, the large damages (amount of money) involved necessitate a lot of legal work for both sides. (919) 419-3300 University of North Carolina School of Law Law Firms Colusa 04/18/2013 - Court Grants Nnamani Leave to Travel for Medical Check-Up Medical Malpractice Victims Need a Fearless, Reliable New York Lawyer British Journal of Sports Medicine The "piriformis syndrome"- myth or reality? Link M T F Read 7 Waterden Road, Guildford, Surrey GU24 0LX, UK Keywords: piriformis syndrome; sciatic nerve; buttock; hamstring NOTE: I am not a Doctor, Please speak to your doctor regarding any nerve condition. In the above editorial,1 I noted the desire to package these rather indeterminate pains in the buttock, around the trochanter, and which can radiate to the groin or knee, as a deep gluteal syndrome. The piriformis syndrome and the hamstring syndrome, I believe exist, but in my admittedly very small experience, as they are rare, they do have a major clinical finding that differs from pain induced by the hip stabilizers. Because the sciatic nerve is involved, the straight leg raises, Laseque and Bowstring signs, which produce neural stress peripheral to the lesion, are positive, but the slump test, which moves the dura and is proximal to the lesion, is negative. Most patients diagnosed as having "piriformis syndrome" do not have these clinical findings, and their problem better fits the classification of deep gluteal syndrome. Perhaps, in fact, the deep gluteal syndrome diagnosis should be used as well as, and not inclusive of, the piriformis and hamstring syndromes. I feel the gluteals are often not involved and perhaps an even broader term such as hip stabilizer syndrome should be considered. February 3, 2005 - New News: In, "The Journal of Neurosurgery Spine", from studies of UCLA and Cedars Sinai Medical Center in Los Angeles, CA. - Dr. Aaron Filler, M.D. Study of Piriformis Syndrome - Proper Diagnosis now Available: Institute for Nerve Medicine Internet: sjackson@ Company Information: Institute for Nerve Medicine 2716 Ocean Park Blvd. Suite 3082 Santa Monica, CA 90405 USA Ph. 310-314-6410 Fx. 310-314-2414 Media Contacts: Shirlee B. Jackson Executive Director 310.314.6410 VIDEO AND PHOTOS AVAILABLE: Cedars Sinai Medical Center, UCLA and the Institute for Nerve Medicine: Breakthrough Medical Findings Provide Answers To Back Pain Sufferers Revolutionary Medical Report published in the February issue of The Journal of Neurosurgery: Spine - Findings In A Revolutionary Medical Report From Doctors At UCLA, Cedars-Sinai Medical Center And The Institute For Nerve Medicine Reveal That New Technology Better Diagnoses And Treats Back Pain Sufferers With Sciatica For Immediate Release LOS ANGELES, Calif./EWORLDWIRE/Feb. 3, 2005 - In a report that may revolutionize the treatment of more than a million cases of sciatica (radiating leg pain) each year, investigators from Cedars Sinai Medical Center, UCLA and the Institute for Nerve Medicine in Los Angeles, California report today in the Journal of Neurosurgery - Spine that new technology can accomplish the reliable effective diagnosis and treatment of piriformis syndrome and other causes of sciatica that do not involve a herniated lumbar disc. The paper, entitled: "Sciatica of Non-Disc Origin & Piriformis Syndrome: Diagnosis by MR Neurography and Interventional MRI with Outcome Study of Resulting Treatment" addresses the current problem of a nearly 80% failure rate for diagnosis using standard methods. The study involved 240 patients followed for up to seven years. The most common cause for sciatica in the study proved to be a diagnosis called "piriformis syndrome" - one of several disorders the investigators report on that arise due to entrapment of the sciatic nerve in the area of the hip. Currently, the report says, when a patient experiences painful persistent sciatica - pain radiating down the leg - physicians often look only for a herniated lumbar disk relying upon lumbar MRI scanning. Surgery for the disk herniation is often carried out to treat the sciatica. Most spine specialist consider piriformis syndrome to be extremely rare. However, the authors conclude that although it is rarely diagnosed, it is actually a common cause of sciatica - possibly as common as the well known herniated disk syndromes. Although 1.5 million lumbar MRI scans are carried out each year for sciatica (at a cost of about $1.5 billion), only about 300,000 (20%) reveal a herniated disk amenable to surgery. About 1/3rd of the surgeries fail to relieve the sciatica. As a consequence, about 1.2 million (80%) receive no clear diagnosis and 100,000 have spine surgery that fails. The new report includes a diagnostic efficacy study showing that MR Neurography (a new method for imaging the sciatic nerve) has a 93% specificity for identifying piriformis syndrome. Treatments involved new technology employing Open MRI real time image guidance for injection therapy as well as a new minimal access outpatient surgery technique. Good and excellent outcomes were over 80% in a group of patients that typically have extremely poor outcomes. For a copy of this breakthrough report, media can e-mail afiller@. Media interested in interviewing Dr. Aaron Filler, M.D. can call Charles Barrett, The Barrett Company Communications, in Los Angeles at 310-471-5764 or by cell at 323-595-5941. HTML: PDF: ONLINE NEWSROOM: LOGO: CONTACT: Charles Barrett The Barrett Company 12021 Wilshire Blvd. #600 Los Angeles, CA 90025 PHONE. 310-471-5764 FAX. 310-471-5215 EMAIL: barcorpr@ Kelli Hanley Cedars-Sinai Medical Center 8700 Beverly Blvd. Room 2429A Los Angeles, CA 90048-1865 PHONE. 310-423-4767 FAX. 310-423-0435 EMAIL: kelli.hanley@ KEYWORDS: Medicine, Technology, Patents, Neurosurgery, Imaging, Sciatica, Back Pain, UCLA, Medical Advance SOURCE: Publicist, Cedars Sinai Medical Center AVAILABLE MEDIA: Photo: Sciatica Neurography (size: 271.9 k) Sciatica Neurography Click for full-size Photo: Piriformis Injection (size: 295.6 k) Open MR Guided Injection Click for full-size Video Clip: Press Release Highlights (size: 3.0 k) Report Findings Published This is the personal web page of Paul Dean, Piriformis Syndrome Sufferer: disclaimer: I am not a doctor and do not claim anything except that there are many problems people have in getting the proper treatment for Piriformis Syndrome. The below information to bring about more awareness of Piriformis Syndrome with description and links as well as Paul Dean's diagnosis and treatment in trying to recover from this rare condition which many doctors have overlooked in Paul Dean's recovery process. You will find many conflicting Doctors recovery plans because every Doctor has their own research and their own ideas on what Piriformis Syndrome is and how to treat it. Terms: The Disk: Dense tissue between the vertebrae that acts as a shock absorber and prevents damage to nerves and blood vessels along the spine. Electromyography: A medical test in which a nerve's ability to conduct an impulse is measured. Lumbosacral: Referring to the lower part of the backbone or spine. Myelography: A medical test in which a special dye is injected into a nerve to make it visible on an x ray. Piriformis: A muscle in the pelvic girdle that is closely associated with the sciatic nerve. Radiculopathy: A condition in which the spinal nerve root of a nerve has been injured or damaged. Spasm: Involuntary contraction of a muscle. Vertebrae: The component bones of the spine. Where is the Piriformis Muscle? In non medical terms, it would be the middle of the buttocks cheek, and very deep. Piriformis Syndrome: Sciatica, and Back Pain. Located deep in the hip underneath the Glutes are the 'Deep Six' lateral rotators of the leg; Gemellus Superior and Inferior, Obturator Internus and Externus, Quadratus Femoris, and last but not least, the (Piriformis). The Deep Six not only rotate and stabilize the legs, they also play an important role in pelvic balance. If one hip is tight then the pelvis will be pulled to the side and rotated causing an imbalance in the lower back. If both hips are tight then pelvic movement becomes restricted and the lower back has to contend with the torsion created. Trigger points in the Deep Six can refer pain into the legs and pelvis and can contribute to other dysfunction such as 'Restless Leg Syndrome'. One leg or both will usually be rotated outwards and the joint compressed contributing significantly to arthritic hip joints as well as problems with the knees and ankles. There are many medical ideas on what Piriformis Syndrome is and how to fix it, and it is an ongoing problem in diagnosis and agreement of treatment as you will see below. Every body is different and there can be many different variations of the problem in piriformis syndrome so treatment will have to vary per the individual case by case study. Where is the pain? If it lies deep in the buttock and follows down the leg then you may have sciatica, from a Piriformis Syndrome Condition. Link Sciatica The largest nerve in your body has a very devious twist-and when you have a pain in that nerve, it can really get around. Sciatica, pain in the sciatic nerve, can radiate from the buttocks down the back of the leg to the knee, even as far as the big toe. "People with sciatica often say their back pain is bad but their leg pain is worse," says Loren M. Fishman, M.D., a physiatrist and rehabilitation medicine specialist at Flushing Hospital Medical Center in New York City. Often the hip pain is far more severe on one side than the other. When you've got pain like that, you'll need a hands-on diagnosis before anything else, Dr. Fishman says. Once the doctor has ruled out a disk problem or fracture, he may be able to find out whether tight buttocks muscles are causing your pain by compressing the sciatic nerve. If you do have sciatica, the doctor will probably recommend a program of supervised exercises. Rashad Net University Post traumatic piriformis syndrome Link It is postulated by several investigators that sciatica may be secondary to an aberrant relationship between the piriformis muscle and the sciatic nerve. Pace and Nagle describe a diagnostic maneuver that is now referred to as Pace's sign-pain and weakness in association with resisted abduction and external rotation of the affected thigh. gluteal atrophy, depending on the duration of the condition. The piriformis syndrome is thought to occur after blunt trauma to the buttocks. A hematoma forms and scarring occurs between the sciatic nerve and the short external rotators. Patients who have a history of this type of trauma and typical findings on physical examination, and intractable pain after conservative treatment will benefit from release of the piriformis tendon and sciatic neurolysis. The authors report the operative treatment and outcome in fifteen cases of piriformis syndrome (in 14 patients) all patients had blunt trauma to the buttocks. They all underwent operative release of the piriformis tendon and sciatic neurolysis. The patients had an average delay of 32 months from the time of injury to the surgery. Intraoperative findings revealed adhesions between the piriformis muscle, the sciatic nerve, and the roof of the greater sciatic notch. At twenty-four months all patients had excellent and four good results from the surgery. All had returned to work. If conservative treatment has failed a nerve conduction test and referral to an experience hip surgeon who is familiar with the syndrome is necessary. Note: In the case of myself, and my occurrence of piriformis syndrome I sought the help of a Neurosurgeon. ============================================================================ Piriformis Muscle and Blunt Injury Adhesions Link ============================================================================ As mentioned earlier, the sciatic is not the only nerve that may get compressed in this region. Pressure may be placed on the superior gluteal nerve between the piriformis muscle and the greater sciatic notch. The piriformis muscle may also compress the inferior gluteal nerve, either with fibrous bands in the muscle or with pressure against the sacrospinous ligament. The pressure on nerves in piriformis syndrome is usually from a hypertonic piriformis muscle, but it may also occur from external pressure, such as sitting on a wallet. There are also reports of piriformis syndrome occurring from a direct blow to the buttock area, (fall injury trauma). As a result of the blunt trauma, adhesions may develop between the piriformis muscle, the sciatic nerve and the roof of the greater sciatic notch. Myofascial trigger points in the piriformis or other gluteal muscles may play an important role in piriformis syndrome. Piriformis trigger points will often perpetuate muscle tightness, leading directly to nerve compression. Trigger points in the gluteus minimus are known to reproduce "sciatica-like pain. Furthermore, sacroiliac joint dysfunction may perpetuate trigger pointymptoms and may easily be confused with nerve entrapment by the piriformis muss in the piriformis muscle and increase the likelihood of nerve compression. A sudden load placed on the sacroiliac region or the piriformis muscle - from a fall on the stairs, for example - is often the initial cause of perpetual trigger-point problems. The constant hypertonicity may then lead to nerve compression. "trigger points perpetuate muscle tightness, forcing nerve compression" ============================================================================ The Journal of Bone & Joint Surgery Excellence Through Peer Review Sciatica Sciatica is a condition involving impaired movement and/or sensation in the leg, caused by damage to the sciatic nerve. Piriformis syndrome is estimated to cause 6-8% of sciatica, but is more common in the general population because it has been under diagnosed and under treated. Information about Sciatica Sciatica is a form of peripheral neuropathy. It occurs when there is damage to the sciatic nerve, located in the back of the leg. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot. Incomplete damage to the sciatic nerve may appear identical to damage to one of the branches of the sciatic nerve (tibial nerve dysfunction or common peroneal nerve dysfunction). A problem in a single nerve group, such as the sciatic nerve, is classified as a mononeuropathy. The usual causes are direct trauma (often due to an injection into the buttocks), prolonged external pressure on the nerve, and pressure on the nerve from nearby body structures. It can also be caused by entrapment - pressure on the nerve where it passes through a narrow structure. The damage slows or prevents conduction of impulses through the nerve. The sciatic nerve is commonly injured by fractures of the pelvis, gunshot wounds, or other trauma to the buttocks or thigh. Prolonged sitting or lying with pressure on the buttocks may also injure it. Systemic diseases, such as diabetes, can typically damage many different nerves, including the sciatic nerve. The sciatic nerve may also be harmed by pressure from masses such as a tumor or abscess, or by bleeding in the pelvis. In many cases, no cause can be identified. Note: A ruptured lumbar disk in the spine may cause symptoms that simulate the symptoms of sciatic nerve dysfunction. Symptoms Chronic pain may arise from more than just compression on the nerve. According to some pain researchers, physical damage to a nerve is only half of the equation. A developing theory proposes that some nerve injuries result in a release of neurotransmitters and immune system chemicals that enhance and sustain a pain message. Even after the injury has healed, or the damage has been repaired, the pain continues. Control of this abnormal type of pain is difficult. Link Diagnosis of Sciatica Before treating sciatic pain, as much information as possible is collected. The individual is asked to recount the location and nature of the pain, how long it has continued, and any accidents or unusual activities prior to its onset. This information provides clues that may point to back strain or injury to a specific location. Back pain from disk disease, piriformis syndrome, and back strain must be differentiated from more serious conditions such as cancer or infection. Lumbar stenosis, an overgrowth of the covering layers of the vertebrae that narrows the spinal canal, must also be considered. The possibility that a difference in leg lengths is causing the pain should be evaluated; the problem can be easily be treated with a foot orthotic or built-up shoe. Often, a straight-leg-raising test is done, in which the person lies face upward and the health- care provider raises the affected leg to various heights. This test pinpoints the location of the pain and may reveal whether it is caused by a disk problem. Other tests, such as having the individual rotate the hip joint, assess the hip muscles. Any pain caused by these movements may provide information about involvement of the piriformis muscle, and piriformis weakness is tested with additional leg-strength maneuvers. Further tests may be done depending on the results of the physical examination and initial pain treatment. Such tests might include magnetic resonance imaging (MRI) and computed tomography scans (CT scans). Other tests examine the conduction of electricity through nerve tissues, and include studies of the electrical activity generated as muscles contract (electromyography), nerve conduction velocity, and evoked potential testing. A more invasive test involves injecting a contrast substance into the space between the vertebrae and making x-ray images of the spinal cord (myelography), but this procedure is usually done only if surgery is being considered. All of these tests can reveal problems with the vertebrae, the disk, or the nerve itself. If the pain is chronic and conservative treatment fails, surgery to repair a herniated disk or cut out part or all of the piriformis muscle may be suggested, particularly if there is neurological evidence of nerve or nerve-root damage. Sciatica Following a Fall 1 continued Link It is thought that acute or chronic injury causes swelling of the piriformis muscle and irritates the sciatic nerve, resulting in sciatica. Patients with an aberrant course of the nerve through the muscle are particularly predisposed to this condition. Answer: Piriformis syndrome secondary to myositis ossificans of the piriformis muscle. Discussion Piriformis syndrome is usually a diagnosis of exclusion once the more common causes of sciatica have been ruled out2. Yoeman3 is credited as being the first author to have described entrapment of the sciatic nerve by the piriformis muscle. Freiberg and Vinke4,5 further defined the condition and described what is known as the Freiberg sign (pain caused by passive internal rotation of the extended thigh). Beaton and Anson6 described four anatomical variations in the relationship between the piriformis muscle and the sciatic nerve and implicated these variations as a cause of compression and inflammation of the sciatic nerve. The diagnosis often can be made on the basis of a careful clinical evaluation2, 7-10. Physical findings that suggest compression of the sciatic nerve by the piriformis muscle include tenderness over the sciatic notch, isolated atrophy of the gluteus maximus, dysesthesia of the posterior aspect of the thigh, and tenderness of the rectal wall with or without a sausage-shaped mass that is felt laterally during a rectal examination11. Additional findings that are indicative of such compression include the Freiberg sign4,5 ============================================================================ The Piriformis Syndrome Link By September Nelson -------------------- Introduction. Not all low back, hip, and gluteal (buttock) pain are manifestations of back injury. Pain in any of these areas may indicate injury or irritation of any one of a number of muscles and nerves surrounding the low back and hip. Injury to any of these structures can result in pain and loss of function. A specific muscle that is susceptible to injury and inflammation is the piriformis muscle. Due to the location of this muscle, the sciatic nerve is often involved with piriformis problems. Pain and dysfunction resulting from piriformis injury is referred to as piriformis syndrome. The symptoms of this disorder sometimes mimic those of a bulging lumbar disc, or similar low back injury. Therefore, diagnosis of pain in the low back, gluteal, or hip region should include an evaluation of the piriformis muscle (PM), other hip musculature, and surrounding nerves. Anatomy and Function. The piriformis muscle is located deep in the gluteal region. This muscle attaches to the sacrum and the lateral portion of the upper part of the femur. It is one part of a group of muscles whose actions include abduction (moving the thigh away from the midline) and external rotation of the thigh (turning the knee and toes outward). These muscles are important in maintaining stability of the hip in all weight bearing activities. References. (1) Julsrud, M. E. (1989). Piriformis syndrome. Journal of the American Podiatric Medical Association, 79, 128-131. (2) Chen, W. S. (1992). Sciatica due to piriformis pyomyositis. The Journal of Bone and Joint Surgery, 74-A, 1546-1548. (3) Vandertop, W. P., and Bosma, N. J. (1991). The piriformis syndrome. The Journal of Bone and Joint Surgery, 73-A, 1095-1097. (4) Keskula, D. R. and Tamburello, M. (1992). Conservative management of piriformis syndrome. Journal of Athletic Training, 27, 102-108. (5) Barton, P. (1991). Piriformis syndrome: a rational approach to management. Pain, 47, 345-352. ============================================================================ Acupuncture Today May, 2002, Volume 03, Issue 05 Treatment of Piriformis Syndrome Pain: Acupuncture Link ============================================================================= Dr. Katz's Corner Alejandro J. Katz, MD, OMD, LAC, QME Treatment of Piriformis Syndrome Pain Some of the cases termed "lower back pain" are in reality piriformis syndrome. In piriformis syndrome, the piriformis muscle gets tight (due to overstretching, trauma, prolonged bad posture, etc.) and compresses the sciatic nerve, producing numbness and pain going down the thigh and calf (UB channel). If the compression is on the inferior gluteal nerve (a branch of the sciatic nerve), the pain will be in the buttock (local symptoms). Piriformis Trigger Points /Acupuncture
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