i need help pls!!

[spy007]

i have a 47 y/o female im treating now, pt is being treated for pilriformis syndrome by a previous PT in same clinic and there has been much progress as per pt in the past 2 weeks, however MRI of L hip jt shows no fx or dislocation or djd in the hip area bt w mild tendonitis of proximal hamstring.
my concern now is that pt came to d clinic today w sharp pain in the anterio medial / lateral thigh w/ numbness n radiculopathy lateral part of the knee. there was no localized pain on the hip jt, SLR test(+) @ 45 - 60 degree L w/ sharp pain at above mentioned area , (any hip flexion or trunk flexion mvt) bt pt denied any back pain. faber test on left was negative, . could this be an herniation or just a dysfunction in the biomechanics of the pelvis?

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[yelufem]

Hi Spy007,looking into your assessment and giving room for the possibility of an oversite,the problem i guess remains pirifomis syndrome.
The piriformis can go into spasm if the pt overdo his exercise or carried out her program wrongly. Piriformis would go back into spam at slightest opportunity,compressing on the siatic nerve eliciting radicular pain.

Yes,SLR the affected limb would further worsen the torniquet effect of already hyperactive piriformis muscle and more pain ensue.
I think what has happened is nothing but a relapse and the pt must be causioned against over exercising or not complying with precribed home program.
Just what u already know that PS mgt must be tallored along evidence based protocol to succeed.

I wish u all the best.yelufem.

[physiobob]

My question would be what is the client doing (or what had they been doing) that lead to the issue in the first place. Remember that you are focusing at the moment on symptoms but these should only be used to understand the cause. To many symptoms are just going to confuse you. Let's work backwards a few weeks or even months to see what she might have some tendinosis/itis of the proximal hamstring. And which hamstring at that? This type of thing doesn't come on by sitting on a chair. The lateral issues on the knee could indeed be related to hamstring dysfunction (and therefore the lateral joint line) and or proximal tib/fib issues. But yet again we must consider the lower limb biomechanics to see what it is that she is doing that is resulting in her problem. Does she have a rotational instability (ALC or PCL issues) in the knee. Please do share this information.

[spy007]

thanks guys for all ur suggestion, i will be seeing the pateint again this week... and i def will get more infor and cont w my assessment, sharemore details asap