Sitting down on a thick Wallet in the back pocket produces uneven pressure in the hip region that impinges on the Piriformis muscle and / or sciatic nerve. Wallet induced chronic sciatic nerve constriction produces gluteal and ipsilateral lower extremity pain, tingling, and burning sensation.Diagnostic modalities such as ultrasound Imaging, MRI, CT scan, and EMG are mostly useful in excluding other conditions. Increased thickness [iTh] and increased cross‐sectional area [iCSA] for piriformis muscle may be demonstrated on ultrasound imaging and MRI.Magnetic resonance neurography is a medical imaging technique that can show the presence of irritation of the sciatic nerve at the level of the sciatic notch where the nerve passes under the piriformis muscle. However, Magnetic resonance neurography is considered "investigational/not medically necessary" by some insurance companies. Neurography can determine whether or not a patient has a split sciatic nerve or a split piriformis muscle – this may be important in getting a good result from injections or surgery. Image guided injections carried out in an open MRI scanner, or other 3D image guidance can accurately relax the piriformis muscle to test the diagnosis. Other injection methods such as blind injection, fluoroscopic guided injection, ultrasound, or EMG guidance can work but are not as reliable and have other drawbacks. Prevention
The most common etiology of piriformis syndrome is that resulting from a specific previous injury due to trauma. Large injuries include trauma to the buttocks while "micro traumas" result from small repeated bouts of stress on the piriformis muscle itself.
Necrobiotic xanthogranuloma (also known as "necrobiotic xanthogranuloma with paraproteinemia") is a multisystem disease that affects older adults, and is characterized by prominent skin findings. : 707

See also
List of cutaneous conditions

References


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