First, piriformis syndrome
Piriform muscle originates from the anterior part of the 2nd, 3rd and 4th sacral vertebrae, distributes on the internal surface of pelvis, enters the buttocks through the ischial foramen, and ends at the greater trochanter of femur. This kind of muscle is prone to traumatic inflammatory changes due to acute and chronic injury or anatomical variation, which stimulates or compresses nerves and produces low back and leg pain, which is called piriformis syndrome, also known as femoral nerve pelvic outlet syndrome.
Piriform muscle injuries are mostly caused by severe movements such as abduction, external rotation or internal rotation of lower limbs. Its symptoms are very similar to those of disc herniation, but the patient has no low back pain and spinal signs, and the piriformis muscle has obvious tenderness and radiation pain. After the straight leg is raised 60 degrees, the pain is relieved and the local pain disappears. The pain disappeared after piriformis block.
The patient complained of hip and lower limb pain, mostly chronic and sometimes acute, aggravated after walking or activity, intermittent claudication and bed rest. Straight leg start-up test can be positive, accompanied by numbness of calf and lateral foot, and no radiation pain when coughing or sneezing. The pain of patients with severe symptoms can be knife-like, tearing-like pain and difficulty in walking. Physical examination shows gluteal muscular atrophy, tenderness at the edge of sciatic incision, and digital rectal examination can touch the swollen ancestral piriformis muscle, which may lead to the above symptoms.
① Patients with piriformis syndrome have no obvious tenderness and deformity in the waist, and their activities are not restricted;
② Piriform muscle tension test was positive; Piriform muscle tension test is a method to check piriformis muscle injury. The specific steps are as follows: the patient lies on his back on the examination table, straightens the affected limb and does adduction and pronation. If there is radiation pain in the sciatic nerve, the affected limb will abduct and rotate rapidly, and the pain will be relieved immediately, that is, the piriformis muscle tension test is positive. It is a common examination method for piriformis syndrome;
③ The pain was relieved immediately after partially blocking the tender point with a long needle.
Second, sciatica.
Primary sciatica: namely, there is inflammatory lesion of sciatic nerve, or direct injury of sciatic nerve (hip injection, operation). The onset is more acute, and the pain spreads from the hip to the far end along the sciatic nerve pathway, passing through the back of the thigh and the fossa to the outside of the calf. The pain is persistent dull pain, which can be aggravated or burned, and the pain is relieved when standing. Someone suddenly felt a sharp pain in one hip, even the legs and feet on the same side were numb, and then the pain slowly disappeared.
Third, radicular sciatica.
It is mostly caused by disc herniation, spinal osteoarthritis, spinal bone tumor and thickening of ligamentum flavum. Slow onset, history of chronic low back pain. The pain is more obvious when sitting than when walking. The pain in supine position is relieved or disappeared, and the symptoms can recur. The skin sensation on the outside of the calf and the dorsum of the foot is weakened or disappeared, the flexion strength of the foot and toe is weakened, and the ankle reflex is weakened or disappeared. X-rays can be performed to help diagnose the disease.
Fourth, hip abscess
Abscess can be divided into deep and deep. Generally, the abscess formed by subcutaneous soft tissue is called shallow abscess, and the abscess formed under the deep fascia, muscle layer and deep tissue space is called deep abscess. Gluteal muscles are well developed, and the largest is gluteus maximus. If there is purulent infection between muscles or muscles, a deep abscess will form.
Five, sciatic nerve neurilemmoma
Schwannomas occur in sensory, motor or mixed peripheral nerve sheath cells, mostly in the nerves of the neck and limbs. Generally, the size is about 3cm, with a few exceeding 10cm. Sciatic neurilemmoma has a raised buttock and a huge lump. Surgery is the only way to treat this disease.
6. Hip epithelial neuritis, also known as "pain in the posterior branch of lumbar nerve", has many causes, such as intervertebral facet joint disease, hyperosteogeny, compression of the posterior branch of spinal nerve, and chronic aseptic inflammation of the posterior branch. Because the gluteal epithelial nerve comes from the lateral cutaneous branch of the posterior branch of the lumbar 1 ~ lumbar spinal nerve and is distributed in the upper and lateral skin of the hip, the pain often appears in the waist, hip and thigh, and rarely exceeds the knee joint. Comprehensive judgment based on medical history, symptoms and signs. There are tenderness and soft tissue cord-like hard objects 3 ~ 5 cm below the highest point of iliac crest.
Seven. Dense sacroiliitis
Nonspecific inflammation characterized by osteoporosis has a high density of osteoporosis, especially in the lower 2/3 of ilium, but the joint space has not changed. There is recurrent low back pain, sometimes radiating down to the buttocks and thighs.
Eight, pseudo-dissociation
Gluteus minimus's buttocks swelled after frostbite, which caused pain by pressing the sciatic nerve. The hip pain caused by false dissociation is that the waist is not painful, but the hip is the most painful and tender.