medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-294medsovet-8474Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYСиндром грушевидной мышцы: мифы и реальностьPiriformis muscle pain syndrome: the myths and realityhttps://orcid.org/0000-0002-7384-6715АхмеджановаЛ. Т.AkhmedzhanovaL. T.

Ахмеджанова Луиза Талгатовна, к.м.н., доцент кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119021, Москва, ул. Россолимо, д. 11, стр. 1

Louiza T. Akhmedzhanova, Cand. Sci. (Med.), Associate Professor of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

11, Bldg. 1, Rossolimo St., Moscow, 119991

khmedzhanova_l_t@staff.sechenov.ruhttps://orcid.org/0000-0003-4950-144XИсайкинА. И.IsaikinA. I.

Исайкин Алексей Иванович, к.м.н., врач-невролог, доцент кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119021, Москва, ул. Россолимо, д. 11, стр. 1

Aleksei I. Isaikin, Cand. Sci. (Med.), Neurologist, Associate Professor of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

11, Bldg. 1, Rossolimo St., Moscow, 119991

alexisa68@mail.ruhttps://orcid.org/0000-0002-0834-4030ВахнинаН. В.VakhninaN. V.

Вахнина Наталья Васильевна, к.м.н., доцент кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119021, Москва, ул. Россолимо, д. 11, стр. 1

Natalia V. Vakhnina, Cand. Sci. (Med.), Neurologist, Associate Professor of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

11, Bldg. 1, Rossolimo St., Moscow, 119991

vakhnina_n_v@staff.sechenov.ruБусольВ. Н.BusolV. N.

Бусоль Вера Николаевна, студент

119021, Москва, ул. Россолимо, д. 11, стр. 1

Vera N. Busol, Student

11, Bldg. 1, Rossolimo St., Moscow, 119991

verafbmusik@yandex.ruБашкатоваМ. М.BashkatovaM. M.

Башкатова Маргарита Максимовна, студент

119021, Москва, ул. Россолимо, д. 11, стр. 1

Margarita M. Bashkatova, Student

11, Bldg. 1, Rossolimo St., Moscow, 119991

m.m.bashkatova@gmail.comhttps://orcid.org/0009-0008-5330-7619ЕфимоваЕ. Т.EfimovaE. T.

Ефимова Екатерина Тимуровна, студент

119021, Москва, ул. Россолимо, д. 11, стр. 1

Ekaterina T. Efimova, Student

11, Bldg. 1, Rossolimo St., Moscow, 119991

katys535353@gmail.comhttps://orcid.org/0009-0005-3198-1440УпатоваА. Г.UpatovaA. G.

Упатова Антонина Геннадьевна, студент

119021, Москва, ул. Россолимо, д. 11, стр. 1

Antonina G. Upatova, Student

11, Bldg. 1, Rossolimo St., Moscow, 119991

upatovaantalika@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation20241408202401278–85Copyright © Ахмеджанова Л.Т., Исайкин А.И., Вахнина Н.В., Бусоль В.Н., Башкатова М.М., Ефимова Е.Т., Упатова А.Г., 20242024Ахмеджанова Л.Т., Исайкин А.И., Вахнина Н.В., Бусоль В.Н., Башкатова М.М., Ефимова Е.Т., Упатова А.Г.Akhmedzhanova L.T., Isaikin A.I., Vakhnina N.V., Busol V.N., Bashkatova M.M., Efimova E.T., Upatova A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8474

Вопросы диагностики, эффективного лечения и предотвращения хронизации болевых синдромов представляют актуальную проблему современной медицины. Около 80% населения хотя бы один раз в жизни столкнулось с болью в нижней части спины (БНЧС), у 20% пациентов острая БНЧС переходит в хроническую. Боль в ягодичной области с иррадиацией в ногу может быть обусловлена поражением различных структур (суставы, связки, глубокие мышцы ягодичной области, спинномозговые корешки), которые имеют тесное расположение и сходную иннервацию. В статье приведен клинический случай, который иллюстрирует сложности диагностики синдрома глубинных болей в ягодичной области у молодой спортсменки. Состояние, которое изначально рассматривалось как миофасциальный болевой синдром грушевидной мышцы, при детальном обследовании и наблюдении оказалось ревматологической патологией (болезнь Бехтерева). В статье обсуждаются вопросы этиологии, диагностических критериев, дифференциальной диагностики и лечения синдрома грушевидной мышцы. В настоящее время отсутствуют надежные диагностические тесты и утвержденные диагностические критерии для подтверждения диагноза, в связи с чем синдром грушевидной мышцы должен рассматриваться как диагноз исключения. В клинической практике имеет место как гипердиагностика синдрома грушевидной мышцы с широким применением различных инвазивных процедур, так и игнорирование данного синдрома. В большинстве случаев наблюдается вторичный синдром грушевидной мышцы, и определение причинного фактора является определяющим для успешного лечения пациентов. Лечение синдрома грушевидной мышцы должно включать в себя устранение провоцирующих факторов, кинезиотерапию, нестероидные противовоспалительные препараты (НПВП), миорелаксанты, по показаниям – лечебные блокады, а при хроническом болевом синдроме – когнитивно-поведенческую терапию и антидепрессанты. Нимесулид является НПВП с доказанной эффективностью и хорошим профилем безопасности, поэтому может быть рекомендован для лечения как скелетно-мышечной патологии, так и симптоматической терапии ревматологических заболеваний.

Issues of diagnosis, effective treatment and prevention of chronic pain syndromes represent an urgent problem of modern medicine. About 80% of the population has experienced low back pain (LBP) at least once in their life; in 20% of patients acute LBP becomes chronic. Pain in the gluteal region with radiation to the leg can be caused by damage to various structures (joints, ligaments, deep muscles of the gluteal region, spinal roots), which are closely located and have similar innervation. The article presents a clinical case that illustrates the difficulties of diagnosing deep pain syndrome in the gluteal region in a young athlete. The condition, which was initially considered as myofascial pain syndrome of the piriformis muscle, upon detailed examination and observation turned out to be a rheumatological pathology (Bechterew’s disease). The article discusses the etiology, diagnostic criteria, differential diagnosis and treatment of piriformis muscle syndrome. There are currently no reliable diagnostic tests or validated diagnostic criteria to confirm the diagnosis, and therefore piriformis syndrome should be considered a diagnosis of exclusion. In clinical practice, there is both overdiagnosis of piriformis muscle syndrome with the widespread use of various invasive procedures, and ignorance of this syndrome. In most cases, secondary piriformis syndrome is observed and identification of the causative factor is decisive for the successful treatment of patients. Treatment of piriformis muscle syndrome should include the elimination of provoking factors, kinesiotherapy, NSAIDs, muscle relaxants, and, if indicated, therapeutic blockades, and for chronic pain syndrome, cognitive behavioral therapy and antidepressants. Nimesulide is a NSAID with proven effectiveness and a good safety profile, and therefore can be recommended for the treatment of both musculoskeletal pathologies and symptomatic treatment of rheumatological diseases.

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The authors declare that there are no conflicts of interest present.