[jphillips]

#35607

After reading your comments about piriformis syndrome I was intrigued. My daughter is a now 19 year old athlete who was injured playing basketball 15 months ago. She landed hard multiple times on her back and rear end.She has back pain but the more troubling issue is what some call a tremor and others describe as a clonus that makes her entire leg spasm especial the back of the leg. It has been this way for over 15 months. She has seen two chiropractors, three physical therapists, 3 orthopedic surgeons, one neurologist and two neurosurgeons. She has had lumbar, cervical, thoracic MRI’s as well as MRI of the brain with and without contrast. What we though was a back injury was then feared to be MS. She has what they describe as a broad based disk bulge at L-4 – L-5 which they describe as minor, a persistent central canal or slit between 1.0 and 1.5 mm between T-6 -T10 that is thought to not be symptomatic. Some where along the way various orthopedics went from thinking it was a back issue to a neurological issue (Most Likely MS) because of the clonus. After the brain MRI’s were clean that group was ruled out by the our neurologist and neurosurgeon in Colorado. Their thought was to wait and do an addition MRI of the spinal cord slit in the future. The second opinion from a different Neurosurgeon is that the issue is with the piriformis muscle causing a tremor and not a clonus. Injections of the muscle and SI joint are now recommended as treatment. So far baclofen has had no effect, nor have Klonopin or oral steroids. It’s been a long an frustrating journey and the Doctor refereed to to perform the injections can’t even see for 5 months.

Any thoughts or wisdom would be greatly appreciated.

[Donald Corenman, MD, DC]

#35608

Piriformis syndrome is an entrapment neuropathy and exceedingly rare. Piriformis syndrome is not related to clonus or tremors. Most misdiagnosed Piriformis syndromes are nerve root stretch injuries or contusions of the L5 or S1 roots with an occasional L4 thrown in there. A nerve block around the Piriformis muscle that yields great temporary relief is a reasonable test but is not diagnostic as it can be positive (+relief) with no Piriformis syndrome present.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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