The piriformis muscle is a small, pyramidal-shaped muscle deep in the buttock near the center. It arises from the front side of the sacral bone at the base of the spine and extends across the buttock to attach at the top of the femur near the hip. It lies beneath the biggest gluteal muscle called the gluteus maximus. This muscle is a rotator of the hip. It rotates the hip internally or externally depending on the position of the hip. It also helps with stability at the hip.

The sciatic nerve is a bundle of nerve fibers that originate from the base of the spine and innervates many of the leg and foot muscles. Generally this nerve runs just beneath the piriformis muscle exiting the pelvis below the belly of the muscle but anatomical variations exist wherein the nerve travels over or through the muscle belly of the piriformis and sometimes even splits around it. When piriformis syndrome is thought to be caused by these anatomical anomalies of nerve orientation it is called primary piriformis syndrome but it is unclear how often these variations in nerve position actually cause symptoms.

The most common type of piriformis syndrome occurs due to compression of the sciatic nerve by the piriformis muscle. This can occur due to several causes of which the most common include:

• Spasm or inflammation of the soft tissue around the buttocks due to trauma
• Muscle spasms of the piriformis following back surgery
• Piriformis muscle spasms due to lumbar or sacral joint pathology
• Piriformis muscle spasms due to overuse
• Shortening of the piriformis muscle due to biomechanical factors which compresses or irritates the sciatic nerve

• Pain felt deep in the buttocks
• Numbness in the buttock or down the leg
• Persistent low back pain that may be radiating
• Paresthesias/tingling or abnormal sensations in the buttock or leg
• Pain with prolonged sitting
• Tenderness to palpation over the area
• Increased pain after activities like stair climbing, bending, squatting or walking

If you decide to work with a physical therapist to help correct your dislocated elbow issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your rotator cuff PT sessions yet in the comfort of your own home.

TREATMENT FOR ELBOW DISLOCATION

Treatment of an elbow dislocation is usually multi-disciplinary

STEP 1: Reduce the dislocation
Reduction of the dislocation is the first and most important step in treating a dislocated elbow. Reduction involves slowly manipulating the bones back into place. This often happens in the emergency room but it is possible that an athletic trainer or certified sports-medicine physician or PT will perform a reduction on the field of a sporting event. Often an x-ray is ordered to visualize the structures of the elbow and look for a fracture.

A complex elbow dislocation, especially one that involves bony fractures, may require surgery to realign and possibly stabilize the bones. The healing time following a complex elbow dislocation is longer than for a simple dislocation that can be manually reduced.

STEP 2: Protect the healing tissue
Dislocation can cause bony fractures and injure ligaments and soft tissues. Your doctor or physical therapist may recommend a sling to support and protect the elbow for 1-3 weeks. Gentle, pain-free range of motion may be performed early by your PT to reduce pain and stiffness and maintain flexibility. Light soft tissue mobilization and modalities to manage pain and inflammation are often prescribed. Exercises to prevent atrophy and disuse in unaffected areas may also be prescribed.

STEP 3: Restore normal elbow function
In an uncomplicated elbow dislocation without serious fracture, physical therapy exercises to restore normal elbow function typically begin within a few weeks of the injury. Beginning with light exercise and progressing to more intensive ones, your physical therapist will prescribe exercises and activities to restore range of motion, flexibility and stability to the elbow, improve muscle strength and prepare the elbow for return to normal activities. Careful monitoring of symptoms is important to ensure exercise progressions aren’t happening too quickly which can reinjure the elbow.

As you can see, the process of recovering from an elbow dislocation is best monitored and guided by a knowledgeable healthcare professional. Our team of physical therapists at Evolve Physical Therapy are ready to support you through this process. If you have dislocated your elbow, call today to schedule your initial evaluation and get your rehabilitation journey started.