Piriformis

Insert the electrode deep to bone at the midpoint of a line between the posterior inferior iliac spine (SIS) and the posterior-superior margin of the greater trochanter (GT), then withdraw slightly. The electrode will travel through the gluteus maximus muscle. 

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Rhizopus-soft rot is a threat in all postharvest situations including storage, marketing, and transport of crops. It causes soft rot of avocados, cassava, crucifers, pulses, yams, and sweet potatoes. This spoilage type is mainly caused by Rhizopus stolonifer and to a lesser extent by R. oryzae, Mucor piriformis, and Gilbertella persicaria (Dijksterhuis and Samson 2006). 

Barley seeds Scenedesmus quadricauda Daphnia magna Tetrachymena piriformis... 

Scherbaum, O., and Zeuthen, E. (1954). Induction of synchronous cell division in mass cultures of Tetrahymena piriformis. Exp. Cell Res. 6, 221-227. 

Both pectate-based culture filtrates and ripe strawberries, artificially inoculated with Rhizopus stolonifer, R. sexualis, Mucor piriformis, ox Aureobasidium pullulans, contained erado-poly-D-galacturonase and pectin esterase. Uninfected... 

The stability of pectin-depolymerizing enzymes (poly-D-galacturonases) produced by Mucor piriformis, Rhizopus sexualis, R. stolonifer, Botrytis cinerea, Aureobasidium pullulans, Trichosporon puUulans, and Cryptococcus albidus var. albidus in sulphite liquor was studied in relation to the breakdown of sulphited strawberries. Marked breakdown of fruit occurred only when pectolytic activity could be detected in the liquor for more than two weeks using a viscometric assay. Of the fungi tested, Rhizopus species produced enzymes which were most stable in sulphite liquor. For each of the Mucor and Rhizopus species tested, the stability of poly-D-galacturonases in sulphite liquor was very similar for extracts of infected fruit and culture filtrates. It was suggested that sulphite labile (= acid labile) and sulphite stable (= acid stable) forms of the poly-D-galacturonases are present. 

Fig. 9.2. a Femoral shaft fracture with large butterfly fragment. Since the proximal capital physis is closed, a locked intramedullary nail can be inserted. This nail has been introduced via the piriformis fossa. This is a very unstable fracture, b Image intensifler view of distal femoral locking bolt, c Only an accurate lateral view of the femur confirms that the locking screw has passed through the nail and not in front or behind. The screw obscures the distal hole. The more proximal distal locking hole has not been utilized. 

The patient was treated using facilitated positional release techniques for relief of the muscle hypertonicity as well as the restrictions and somatic dysfunctions found. Special attention was given to the treatment of the piriformis and tensor fascia lata muscles. A prescription was given for nonsteroidal antiinflammatory (NSAID) medication. 

The movement of flexion and external rotation may be modified to achieve maximal softening of the piriformis. 

This tender point is palpated by pushing the monitoring finger medially on the lateral edge of the sacrum at the midpoint between the posterior superior iliac spine (PSIS) and the sacral apex. This is at the site of the piriformis attachment to the sacrum and probably represents a second piriformis tender point, it is often found in association with the tender point in the belly of the muscle. 

FIG. 63-1 Facilitated positionai reiease treatment for hypertonicity of the right piriformis muscie. 

FIG. 65-1 PINS sacrum and pelvis point patterns. Posterior I, piriformis muscle 2, Iliotibial band 3, sciatic nerve/ posterior femoral cutaneous nerve/hamstrtng muscles 4, gluteal muscles 5, sacroiliac. 

The lateral rotator muscles of the hip include the piriformis and the obturator internus. The piriformis muscle has its medial attachment to the lateral border of the sacrum and is often involved in sacral dysfunctions. 

The piriformis muscle lies deep to the gluteal muscles. It originates on the anteriolateral surface of the sacrum, joint capsule, and anterior sacrotuberous ligament and attaches to the superomedial surface of the greater trochanter of the femur. It is an external rotator and abductor of the thigh. This muscle has an intimate relationship to the sciatic nerve, which passes just beneath it, or, sometimes, through the muscle belly or between two tendinous origins of the piriformis. 

Hypertonicity or spasm of the piriformis muscle may cause irritation of the sciatic nerve, sometimes to the point of causing neuritis. Although the sciatic nerve most typically passes inferior to the piriformis, normal variants exist with its passage through or posterior to the piriformis muscle. The sciatic involvement often causes confusion between piriformis syndrome and a disc herniation. 

Piriformis syndrome is manifested as pain in the buttocks or hip with radiation into the calf or foot. It can be severe enough to result in the patient becoming bedridden. More rarely, there is low back pain as well, especially around the sacroiliac joint. Examination demonstrates decreased internal rotation and adduction of the hip with pain accompanying these motions. 

Muscle strengih in external rotation and abduction is generally normal but may exhibit some decrease. The muscle and Its attachments are tender to palpation. There are three counterstrain lender points associated wiih piriformis syndrome mid-pole sacrum, piriformis muscle, and the posteromedial trochanteric point. 

Clinically, a hypertonic piriformis is correlated with a posterior inferior lateral angle [11-A] on the same side. The muscle could be significant in causing or maintaining sacral somatic dysfunctions. 

Counterstrain and facilitated positional release techniques are most useful. Each of the three tender points must be treated, if they are present, to be effective. Any dysfunction of sacral motion should also be corrected. A piriformis stretching exercise should be prescribed for use at home. 

On examination, the left buttocks was lender to palpation and there were tender points at the mid-pole of the sacrum on the lateral border and one deep to the gluteus maximus, where a lense piriformis could be palpated. There was a unilateral sacral flexion (sacral shear) present on the left. No lumbar somatic dysfunctions were present. There was mild tenderness at the sciatic notch of the ischium. Deep tendon reflexes were normal and muscle strength of the ihigh was normal. There was some pain on internal rotation and adduction of the left hip. 

Left piriformis syndrome was diagnosed and was treated with osteopathic manipulation. The sacral shear was treated with a muscle energy technique and the tender points were treated with counterstrain. She was given a piriformis stretch to perform at home three time daily. She experienced immediate improvement after the treatment. 

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