The American journal of orthopedics
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Piriformis syndrome is an often misdiagnosed cause of sciatica, leg, or buttock pain, and disability. The sciatic nerve may be compressed within the buttock by the piriformis muscle, with pain increased by muscular contraction, palpation, or prolonged sitting. ⋯ Diagnostic testing may be used to differentiate piriformis syndrome from other causes of sciatica, lower extremity weakness, and pain. This article reviews the pathophysiology and management of piriformis syndrome.
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Case Reports
Painful adult thoracic Scheuermann's disease. Diagnosis by discography and treatment by combined arthrodesis.
This is the case report of a 42-year-old woman with chronic thoracic pain, nonradicular and refractory to all nonoperative treatment. Radiographs showed the classic findings of Scheuermann's disease, but without abnormal kyphosis. Magnetic resonance imaging scans showed multilevel thoracic disc degeneration typical of long-term Scheuermann's disease. ⋯ Treatment consisted of an anterior fusion, T5-11, and posterior fusion of T3 through L1, with Cotrel-Dubousset instrumentation. At follow-up, she was pain free and able to work full time and had been able to return to golf, her favorite recreation. Discography of the thoracic spine, as of the lumbar spine, can reveal the true source of pain and thus lead to precise and effective treatment.
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An alternative method of operating on the anterior structures of the shoulder is presented. With the patient in the decubitus lateral position, the joint is readily accessible without cutting the conjoined tendon or performing an osteotomy of the coracoid process. ⋯ This approach eliminates repositioning the patient to the supine position. It can be performed without a surgical assistant if the scrub technician is able to rotate the arm at certain times during the operation.