PIRIFORMIS SYNDROME & MERALGIA PARESTHETICA( NUMBNESS IN OUTER THIGH)
Piriformis syndrome is a painful condition of the hip in which the piriformis muscle, located in the buttock, goes in to spasm and causes buttock pain. The piriformis muscle can also cause irritation to the Sciatic nerve and result in pain, numbness and tingling along the back of the leg and foot (similar to sciatica). The piriformis muscles are engaged in daily activities and enable the internal rotation movement of thighs. Symptoms associated with the condition include pain, numbness and tingling in the buttocks, tenderness of the muscles with pain and difficulty in sitting comfortably.
The common causes of piriformis syndrome are: the overuse of piriformis muscle, Sacroilitis and prolonged sitting which may apply excess pressure over the muscles and nerves causing numbness and pain in the buttocks and thighs.
Conventional treatment method involves taking rest, NSAIDS/ anti-inflammatory drugs, avoiding activities that trigger the symptoms, alternate ice and heat packs on the buttocks or legs and physical therapy that improve the strength and flexibility of the muscles.
Alternative treatment methods at Beth Yehuwdah Arthritis Centre, Pullad and Daystar clinic, Alappuzha for Pyriformis Syndrome:
1) Platelet Rich Plasma (PRP) in Pyriformis Syndrome :
PRP is given when the Pyriformis Syndrome is due to underlying inflammation in the Sacroiliac region. Plasma rich platelet prolotherapy is the recent trend in treating various joint conditions and is designed to stimulate repair of chronically inflamed tissues in the affected Sacroiliac joint and to reduce swelling and pain caused by the condition, indirectly improving symptoms of Pyriformis Syndrome. PRP prolotherapy is a combination treatment where PRP is injected into the joint and dextrose prolotherapy is given to the ligaments and muscle attachments surrounding the joint. This treatment may help a patient who does not want surgery and helps to overcome the disease condition with minimally invasive injection techniques. The treatment method stimulates the natural immune repair mechanisms of the body and delivers the building block essential to build and repair damaged tissues.
How does PRP work?
Blood components are of four major types - plasma, platelets, white blood cells and red blood cells. Platelets assist in clotting and are also the “first-responders” of the body post injury; helping repair an injured region and in building up of new tissue and thereby promoting the healing process. Once platelets contact collagen in damaged tissues, the platelets release various biological growth factors (Table 1 as given below) to promote healing in soft tissues locally. Activated platelets commonly release the following growth factors:
Platelet-Derived Growth Factor (PDGF)
Attracts cells of the immune system to the site and stimulates their proliferation. Also shown to assist in healing of ligaments and tendons.
Transforming Growth Factor-ÃŸ (TGF-ÃŸ)
Similar affects as PDGF. It is Secreted by all major cell types involved in healing.
Vascular Endothelial Growth Factor (VEGF)
Helps in formation of new blood vessel, thereby increasing vascularity in injured areas.
Fibroblast Growth Factor (FGF)
Promotes the growth of the cells involved in collagen and cartilage formation.
Table 1: Various biological growth factors released by PRP when activated
PRP injection delivers a high concentration of autologous (patient’s own) platelets to the Sacroiliac region (related to Pyriformis) . Platelets present in the blood are the first responders to an injured area and helps build up new soft tissues. Introducing high concentration of platelets directly into the site using PRP injection stimulates the healing process and faster recovery from the condition.
Patient Benefits of PRP Prolotherapy
Neural & Soft Tissue Infilteration Therapy (NESTIT)
Low Dose Steroid Infilteration/ Neural & Soft Tissue Infilteration Therapy (NESTIT): Steroid tablets and injections of the group Corticosteroids, (which are very different from Anabolic steroids misused by some athletes) have been repeatedly proven medically for the last 70 years in the successful treatment of inflammatory conditions due to its potent anti-inflammatory effect. Though corticosteroids are very effective in reducing inflammation, they carry numerous potential side effects, which are undesirable. To circumvent this problem, and in order to utilize the potent anti-inflammatory effects of steroid injections, at the same time taking appropriate measures to considerably lower its side-effects, Dr Tejaz Koshy John in 2010 while working as an Orthopaedician in his private clinic in Guyana, South America developed NESTIT. NESTIT stands for (Juxta) Neural and Soft Tissue Infilteration Therapy. It consists of injecting small amounts of diluted anti inflammatory steroid solution indirectly near (juxta) nerve CCPs- (chronic constricting points) in the lower back/ hip/ neck/ shoulder regions, in order to reduce juxtaneural and perineural inflammation, as well as in certain soft tissue sites including but not limited to trigger points (painful muscle “knots”)/ myofascial syndrome and/or enthesitis (inflammation of soft tissue-bone junctions) and/or sites of nerve inflammation (neuritis/ radiculitis) and/or bursitis (inflammation of fluid filled cushions called bursa) and/or additional sites causing pain referrals (referred pain) to distant sites; in order to obtain a reduction in inflammation and pain in the concerned joint/ region/ limb. It is preferably given for those patients who have Rheumatoid Arthritis, Inflammatory Arthritis, Synovitis, Inflammatory Low Back Pain, Spondyloarthropathy & Nerve and Nerve root irritation. It is not a substitute for DMARDS (Disease modifying anti rheumatoid drugs), however when given with low dose DMARDS, in Dr Tejaz John’s clinical experience it may result in significant reduction of local inflammation, pain and improvement of joint function in most cases, also indirectly reducing side effects of high dose DMARDS.
In Dr Tejaz John’s clinical experience, the patient benefits of Low Dose Steroid Infilteration/ Neural & Soft Tissue Infilteration Therapy (NESTIT) treatment are:
MERALGIA PARESTHETICA is a condition caused due to irritation or compression of nerves of the outer thigh under the pelvis bone protuberance called ASIS (Anterior Superior Iliac Spine) causing tingling, numbness and burning pain in the outer thigh region. Numerous factors can account to the cause of the condition including tight clothing, obesity, local trauma as the nerves may become compressed, or pinched.
Clinical examinations are conducted to evaluate the symptoms along with strength and sensory perseption of the affected thigh. Conventional treatment focuses on relieving nerve compression through pain relievers, medications and surgery to decompress the nerve with severe and long-lasting symptoms.
Alternative treatment method at Beth Yehuwdah Arthritis Centre, Pullad and Daystar clinic, Alappuzha for Meralgia Paresthetica:
NESTIT (Neural and Soft Tissue Infilteration Therapy): NESTIT could be a great option to treat Meralgia Paresthetica. It is a unique and innovative Injection based treatment originally developed by Dr Tejaz John in 2010 in Guyana, South America . He has used it extensively for the past 8.5 years. It generally consists of injecting small amounts of diluted anti inflammatory steroid solution indirectly near nerve CCPs (chronic constricting points) as well as in certain soft tissue sites in the pelvis and hip region which are in close proximity to sites of nerve inflammation (neuritis/ radiculitis) in order to obtain a reduction/ cessation in symptoms of Meralgia Paresthetica.
In Dr Tejaz John’s clinical experience, the patient benefits of NESTIT treatment are:
MBBS, MS Ortho (Christian Medical College, Ludhiana), Joint Replacement Fellowship (HOSMAT Hospital, Bangalore), Orthopaedic Trauma Fellowship (Hebrew University Hospital, Jerusalem, Israel)Read More