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Piriformis syndrome

Piriformis syndrome (PS) is a neuromuscular condition where the piriformis muscle – one of the deep gluteal muscles – presses on and compresses the sciatic nerve causing pain, tingling and numbness in the buttock area, and down the path of sciatic nerve to the thigh and leg. Sciatic nerve runs under the piriformis muscle (Fig. 1) and may be irritated when the muscle is too tight or shortened due to spasms. Piriformis syndrome is to be differentiated from sciatica which shows similar symptoms but has different causes.

Fig. 1 : Piriformis syndrome. Posterior view of the pelvis showing location of piriformis muscle and sciatic nerve. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Diagnosis is difficult as it produces similar symptoms as sciatica and is commonly done by exclusion of sciatica caused by compression of sciatic nerve roots by a herniated disc.

Fig. 2 : Sciatica caused by compression of spinal nerve roots by a herniated disc. Lateral view of the lumbar spine. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Causes and Risk factors

– Anatomical abnormality of the nerve/muscle relation. Some people are more likely to get PS than others.

– Tightness or spasm of piriformis muscle due to overuse injury. This commonly happens in sport activities that put pressure on the piriformis muscle such as bicycling, running without proper stretching, or any activity that involves repeated movements of the leg performed in sitting position.

Treatment

– Conservative treatment includes stretching exercises, massage, avoidance of causative activities.

– Physical therapy that strengthens the gluteus maximus, gluteus medius, and biceps femoris is usually recommended to reduce strain on the piriformis muscle.

– Relief of symptoms may be achieved with anti-inflammatory drugs or muscle relaxants.

Glaucoma

Below is a narrated animation about glaucoma development and types of glaucoma. Click here to license this video and/or other eye and vision related videos on Alila Medical Media website.

Glaucoma is a group of eye diseases in which the optic nerve is damaged leading to irreversible loss of vision. In most cases, this damage is due to an increased pressure within the eye – elevated intraocular pressure.

How glaucoma develops

The eye produces a fluid called aqueous humor which is secreted by the ciliary body into the posterior chamber, a space between the iris and the lens. It then flows through the pupil into the anterior chamber between the iris and the cornea. From here, it is drained through a sponge-like structure located at the base of the iris called the trabecular meshwork and leaves the eye. In a healthy eye, the rate of secretion balances the rate of drainage.

In people with glaucoma, this drainage canal is partially or completely blocked. Fluid builds up in the chambers and this increases pressure within the eye. The pressure drives the lens back and presses on the vitreous body which in turn compresses and damages the blood vessels and nerve fibers running at the back of the eye. These damaged fibers result in patches of vision loss and if left untreated may lead to total blindness.

For eye anatomy basics click here.

Click here to see an animation of glaucoma progression on Alila Medical Media website where the video is also available for licensing.

Fig. 1 : Development of glaucoma. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Open-Angle Glaucoma vs. Angle-Closure Glaucoma

These are the two main types of glaucoma. The “angle” here refers to the corner between the cornea and the iris where the trabecular meshwork is located.

Primary Open-Angle or Chronic Open-Angle Glaucoma is the most common form of glaucoma accounting for about 90% of cases. This is caused by partial blockage of the drainage canal. The angle is “open”, meaning the entrance to the drain is clear, but the flow of aqueous humor is somewhat slow. The pressure builds up gradually in the eye over a long period of time. There is no pain and visual loss appears gradually, starting from peripheral vision, and may go on unnoticed until the central vision is affected. Progression of glaucoma can be stopped with medical treatments, but part of vision that is already lost can not be restored. This is why it’s very important to detect signs of glaucoma early with regular eye exams.

Closed-angle or Acute angle-closure glaucoma (AACG) is less common. This type of glaucoma is caused by a sudden and complete blockage of aqueous humor drainage. The pressure within the eye rises rapidly and may lead to total vision loss quickly. This is a medical emergency and requires immediate attention. Symptoms to watch out for: sudden severe pain inside and around the eye, redness, blurry vision, seeing halos around a light, some people may also feel headache, nausea.

Certain anatomical features of the eye make it easier for AACG to happen. These include: narrow drainage angle, shallow anterior chamber, thin and droopy iris, lens sitting too much forward. These features are often inherited and so AACG incidents are likely to run in the family.

Fig. 2 : Open angle vs closed angle glaucoma. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Typically, this is what happens in AACG : the pupil is dilated (e.g. when looking in the dark) and the lens is stick to the back of the iris. This prevents the aqueous humor from flowing through the pupil into the anterior chamber (primary block). As the fluid accumulates in the posterior chamber it presses on the iris causing it to bulge outward and block the drainage angle (secondary block).

Other types of Glaucoma

Normal pressure glaucoma – Some people can get glaucoma (vision loss due to damaged optic nerve) without elevated intraocular pressure. This may be due to poor blood supply (e.g. damaged blood vessels in diseases such as diabetes) to the nerve fibers.

Secondary glaucoma – glaucoma develops as a result of trauma after eye injuries.

Congenital glaucoma – glaucoma that is present at birth.

Treatments

Progression of glaucoma can be halted or slowed down with medical treatments, but part of vision that is already lost can not be recovered. This is why it’s very important to detect signs of glaucoma early with regular eye exams.

– Eye drops that lower intraocular pressure and/or reduce fluid production.

– Laser treatments : Laser is used to burn part of the trabecular meshwork to improve fluid flow – laser trabeculoplasty. It can also be used to remove part of the ciliary body to reduce fluid secretion. For acute glaucoma, small holes can be made in the iris to relieve the primary block – laser iridotomy.

– Eye surgeries: a procedure called trabeculectomy is used to create a channel – an alternative route – for aqueous fluid drainage. For acute glaucoma a procedure called iridectomy may be performed to drill a hole in the iris. Canaloplasty is a newer, less invasive surgical procedure performed for treatment of open angle glaucoma. This procedure involves enlargement of the eye’s natural drainage canal.

In people with AACG, laser and surgical treatments may be performed for the other, still healthy eye as well to prevent future development of glaucoma.

GERD and Heartburn (with video)

Gastroesophageal reflux disease

This video and other animations of the digestive system are available for licensing on Alila Medical Media website. Click here!

Gastroesophageal reflux disease (GERD) or gastric reflux disease is a chronic condition where acid from the stomach flows up and damages the mucosa of the esophagus.
At the junction between the esophagus and the stomach is the lower esophageal sphincter (LES). The LES is a ring of muscle that is generally closed tight to prevent stomach acid from coming up. In normal digestion, the LES opens shortly to allow food bolus passing down to the stomach and closes back tight instantly. GERD occurs when the LES is abnormally relaxed and can not close properly (Fig. 1). Heartburn is a burning sensation in the chest associated with each regurgitation of gastric acid and is the most prominent symptom of GERD.

Fig. 1: Abnormal relaxation of the lower esophageal sphincter as cause of GERD. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Hiatus hernia is believed to be another cause of GERD. Hiatus hernia or hiatal hernia is a condition where the top portion of the stomach is pulled up forming a herniation above the diaphragm. This situation somehow compromises the esophagus – stomach barrier and facilitates acid reflux.

Fig. 2: Types of hiatal hernia. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Treatment

Treatment includes dieting and medication. Proton-pump inhibitors, which act to reduce gastric acid production, are drugs of choice. If these fail, a surgery may be recommended. In a procedure called Nissen fundoplication, the top portion of the stomach is wrapped around the lower part of esophagus and sewn into place. This way, the muscles in the wall of the stomach reinforce the closure of the esophagus. This surgical procedure is particularly recommended when hiatus hernia is present as this can be fixed at the same time. The procedure can be done with minimal invasive laparoscopic technique through small incisions with the aid of a camera.

Fig. 3: Nissen fundoplication procedure. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

> See all Digestive topics

Common knee injuries and surgical repair, part 1

Knee anatomy

The knee has three bones : the femur (the thigh bone), the tibia (the shinbone) and the patella (the kneecap). The femur and the tibia form a hinge joint. The joint is enclosed by the joint capsule at the back and on the sides, and is covered by the patella and patellar ligament in front. The knee joint is stabilized mainly by the tendons of quadriceps femoris muscle in front and semimembranosus muscle (one of the hamstrings) on the back. Strengthening these two muscles therefore helps to reduce the risk of knee injuries.

Fig.1 : Midsagittal section of the knee joint. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Apart from the regular articular cartilage that cover the end surfaces of the three bones there are two additional pads of cartilage that are unique to the knee joint : medial meniscus and lateral meniscus (Fig. 2 and Fig. 3). The menisci act as shock absorbers to cushion the joint.

Two pairs of ligaments help to stabilize the knee : collateral ligaments run along two sides of the knee (Fig. 2), and cruciate ligaments which connect the femur and tibia in the center of the joint and cross each other in the from of an X (hence the names) : anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) (Fig. 2 and Fig. 3).

Fig. 2 : Front view of the right knee (the kneecap is removed in this picture to show structures behind). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Fig. 3 : The right knee viewed from top (femur removed to show structures underneath). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Meniscus tear and repair

Commonly referred to as torn cartilage, torn meniscus is a common sport injury. Mild injuries maybe treated with rest, ice, compression and elevation (the RICE approach). Larger tears may require surgery. The goal of surgery is to remove the damaged tissue which is the source of irritation, pain and possibly inflammation, and attempt to induce healing. Treatments vary depending on the location of the tear. If the tear is located on the outer border of the meniscus (the red zone, see Fig. 3) where there is a good blood supply, the damaged loose tissue will be removed and sutures will be used to tight the cartilage together to facilitate self healing. If the tear is located on the inner part (the white zone, see Fig. 3) where the blood supply is poor and hence healing is unlikely, the damaged part is simply removed (partial meniscectomy) (Fig. 4).

Minimal invasive arthroscopic surgery is commonly used for meniscus repair. In case of large tears, open surgery may be required.

Click here to see an animation of arthroscopic meniscus repair on Alila Medical Media website where the video is also available for licensing.

Fig. 4 : Treatment of meniscus tear depends on its location. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

> See all Orthopedic topics

Common shoulder injuries and surgical repair (part 2)

Rotator cuff injuries

Fig. 1 shows a group of four muscles that cover the shoulder joint. These muscles originate on the scapula and insert on the humerus: the supraspinatus, infraspinatus, subscapularis and teres minor. The tendons of theses muscles form the rotator cuff (tendons connect muscles to bones). The most common injury to the rotator cuff is the impingement of one or more of these tendons. This may happen as a result of a trauma or sport related injury but more commonly as a result of aging. The tendons may rub against the acromion (a bony extension of the scapula that hangs over the cuff) every time the person raises an arm and become irritated, inflamed and ultimately torn.

Fig. 1: Rotator cuff muscles of the right shoulder. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Below is a narrated animation of arthroscopic rotator cuff repair. Click here to license this video and/or other orthopedic videos on Alila Medical Media website.

Impingement usually develops over a period of time. Treatment includes rest, shoulder exercise, physical therapy and surgery. In most cases surgical treatment is done through an arthroscope but open surgery may be needed for larger tears. During surgery the damaged tissue is removed, source of irritation (commonly bone spurs on the acromion) is identified and removed. If there is no tear, the treatment may stop here and the surgical procedure is called shoulder debridement. In case of tear sutures will be used to tight the tendon back down to the bone (Fig.2).

Fig 2. Rotator cuff injury (1) and repair: small holes are drilled (2) into the bone of the humerus to hold small suture anchors with threads (3). The threads are attached to the tendon (4) and pulled tightly to hold the tendon to the bone (5). Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Separated shoulder

Separated shoulder is a condition affecting the “second” joint of the shoulder : the AC joint (acromioclavicular joint) between the acromion (an extension of the scapula) and the clavicle. This condition is commonly due to a direct blow to the shoulder as in a fall or sport injury. Fig. 3 shows the ligaments involved in stabilization of AC joint, injury to any of these ligament results in separated shoulder. Injuries are graded according to the extend of tears and number of ligaments involved. Grade I injury (partial tear in one of the ligament) may be treated with simple rest and ice, small tears heal themselves over time. Grade III injury where the clavicle is completely detached from the scapula requires surgery where a screw will be inserted to fix the clavicle to the coracoid process of the scapula.

Fig.3 : Shoulder separation grading. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Frozen shoulder (adhesive capsulitis)

The shoulder, like all synovial joint, has a capsule around it. The capsule encloses the two end surfaces of the bones involved in the joint and a joint cavity containing a lubricant called synovial fluid. In people with frozen shoulder condition this capsule is thicken and inflamed (Fig. 4) causing pain when they try to move an arm. The pain increases with time and the range of motion decreases, the shoulder becomes stiff or “frozen”.

Fig. 4: Frozen shoulder. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

The causes of frozen shoulder are not fully established. People with diabetes and some other diseases show increased risk for frozen shoulder. It can also be resulted from a long-term immobilization of the shoulder (for example after a shoulder surgery). Treatments include pain management and physical therapy although in some cases surgery may be necessary. A procedure called arthroscopic capsular release is usually performed to cut through the tight area of the capsule.

> See all Orthopedic topics

Male Reproductive System Gallery

Download diagrams of male organs anatomy and diseases, formation and structure of sperms.

Please note: Free downloads are intended to facilitate healthcare education for people in need in low income countries and can be used for educational purposes only. If you can afford it or if you plan to use the images for commercial purposes, please consider buying instead. You can find a larger image collection at higher resolution for sale at affordable prices on Alila Medical Media website.

To download: right click on full size image – choose “Save image as” and save it into your computer. By downloading from this website you acknowledge that you agree to our Conditions of Use.
To purchase larger sizes of the image: (left) click on full size image.

Spermatogenesis process, labeled diagram.

Process of sperm production and meiosis in seminiferous tubule, labeled diagram.

Ovum and spermatozoon structure, labeled diagram.

Egg and sperm cells anatomy, labeled drawing.

Male reproductive organs sagittal, unlabeled diagram.

Illustration of male reproductive system in median section

Male reproductive organs sagittal, labeled diagram.

Illustration of male reproductive system in median section

Prostate cancer staging, unlabeled diagram.

Illustration of staging of prostate gland cancer, from small tumor size to metastasis.

Prostate cancer staging, labeled diagram.

Illustration of staging of prostate gland cancer, from small tumor size to metastasis.

Lymphatic System Gallery

Download illustrations of major groups of lymph nodes, lymphatic organs and vessels, their anatomy, function, disorders and involvement in cancer metastasis.

Axillary lymph nodes, medical drawing.

Axillary lymph nodes diagram, simple version. 1-3 = different groups of axillary nodes, 4= supraclavicular lymph nodes. Unlabeled diagram.

Lymph node structure, unlabeled diagram.

Diagram illustrating structure of a lymph node with lymph flow, unlabeled.

Lymph node structure, labeled diagram.

Diagram illustrating structure of a lymph node with lymph flow, labeled.

Lymph nodes of head and neck, medical drawing.

Lymph nodes of the head and neck, unlabeled. 1= preauricular, 2= posterior auricular, 3= parotid, 4= occipital, 5= submandibular, 6= submental, 7-10 = cervical, 11= supraclavicular.

Lymphatic fluid drainage, labeled diagram.

Uptake of tissue fluid by lymphatic capillary, labeled drawing.

Metastatic cancer, medical drawing.

Cancer cell squeezes through the endothelium of blood and lymph vessel, illustration unlabeled.

Breast cancer staging, diagram.

Stages of Breast Cancer, from small tumor to metastasis, medical illustration, unlabeled.

Lymphatic system, unlabeled diagram.

Human lymphatic system with all organs, major trunks, ducts and groups of lymph nodes illustrated, unlabeled illustration.

Lymphatic system, labeled diagram.

Human lymphatic system with all organs, major trunks, ducts and groups of lymph nodes illustrated, labeled illustration.

Female Reproductive System Gallery

Download cliparts illustrating anatomy of reproduction organs, oogenesis and sexual cycle, hormonal control, women’s diseases and conditions.

Cervical cancer, labeled diagram.

Diagram showing cancer of the cervix, labeled.

Uterine cancer, labeled diagram.

Illustration of tumor of the endometrium of female uterus, labeled.

Women's system simple version, unlabeled.

Diagram showing female body with anatomy of reproductive system, anterior view, simple unlabeled version.

Women's system simple version, labeled.

Diagram showing female body with anatomy of reproductive system, anterior view, simple labeled version.

From fertilization to implantation, labeled diagram.

Diagram showing early human embryo development events, from fertilization to implantation of blastocyst, labeled.

Polycystic and normal ovary, labeled diagram.

Normal ovarian cycle and Polycystic ovary syndrome illustration, labeled.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) diagram, unlabeled

Pelvic inflammatory disease (PID) diagram

Pelvic inflammatory disease (PID) diagram, labeled

Axillary lymph nodes, medical drawing.

Axillary lymph nodes diagram, simple version. 1-3 = different groups of axillary nodes, 4= supraclavicular lymph nodes. Unlabeled diagram.

Breast cancer staging, diagram.

Stages of Breast Cancer, from small tumor to metastasis, medical illustration, unlabeled.

Menstrual cycle and ovulation, labeled diagram.

Normal menstrual cycle and the hormonal control of ovulation, labeled illustration.

Women's reproductive system, unlabeled diargam.

Diagram showing organs of female reproductive tract in median section.

Women's reproductive system, labeled diargam.

Diagram showing organs of female reproductive tract in median section.

Ovum and spermatozoon structure, labeled diagram.

Egg and sperm cells anatomy, labeled drawing.

Oral Cavity Gallery

Download illustrations of permanent and deciduous dentition, tooth anatomy, periodontal diseases, teeth replacement therapy, mouth anatomy and diseases.

Tooth anatomy, unlabeled diagram.

Tooth anatomy from outside and in cross section, unlabeled drawing.

Tooth anatomy, labeled diagram.

Tooth anatomy from outside and in cross section, labeled drawing.

Dental checkup icon

Magnifying glass on a molar tooth, illustration.

Plaque and tooth decay, medical drawing.

Tooth decay stages diagram.

Periodontal Disease, labeled diagram.

Gum disease stages, from gingivitis to periodontitis.

Adult dentition, medical drawing.

Permanent teeth, adult dentition, upper and lower jaws, unlabeled.

Deciduous dentition, medical drawing.

Deciduous dentition (baby or milk teeth), upper and lower jaws, medical illustration unlabeled..

Head anatomy median section, medical drawing.

Median section of human head diagram with details of brain, sinuses, tonsils, oral and nasal cavity, pharynx and larynx, unlabeled.

Mouth and throat anatomy, medical drawing.

Diagram of human oral cavity with denture, tonsils, unlabeled.

Urinary System Gallery

Download anatomical illustrations of kidneys, urine formation process, urinary tract diseases and conditions.

To purchase larger sizes of the image: (left) click on full size image.

Treatment of kidney stones, medical drawing.

Ultrasound shock wave therapy for kidney stones, unlabeled.

Kidney stones, medical drawing.

Diagram of healthy kidney anatomy and kidney with stones blocking urine passage, unlabeled.

Formation of urine, labeled diagram.

Basic steps in urine formation in a nephron of kidney.

Urinary bladder cancer stages, medical drawing.

Staging of urinary bladder cancer diagram, unlabeled

Urinary bladder cancer stages, labeled.

Staging of urinary bladder cancer diagram, labeled

Chronic pyelonephritis, labeled diagram.

Chronic pyelonephritis kidney disease with tissue scarring and blunted calyx, medical illustration.

Polycystic kidney disease, medical drawing.

Diagram of enlarged kidney with multiple cysts compared to normal anatomy, unlabeled.

Urinary organs in female, medical illustration.

Female urinary system diagram showing kidneys, ureters and bladder, simple version unlabeled.

Prostate cancer staging, unlabeled diagram.

Illustration of staging of prostate gland cancer, from small tumor size to metastasis.

Prostate cancer staging, labeled diagram.

Illustration of staging of prostate gland cancer, from small tumor size to metastasis.

Medical Information Illustrated

Medical and health topics fully illustrated with pictures and videos for easy understanding.

Tag Archives: pics

Piriformis syndrome

Causes and Risk factors

Treatment

Glaucoma

How glaucoma develops

Open-Angle Glaucoma vs. Angle-Closure Glaucoma

Other types of Glaucoma

Treatments

GERD and Heartburn (with video)

Gastroesophageal reflux disease

Treatment

Common knee injuries and surgical repair, part 1

Knee anatomy

Meniscus tear and repair

Common shoulder injuries and surgical repair (part 2)

Rotator cuff injuries

Separated shoulder

Frozen shoulder (adhesive capsulitis)

Male Reproductive System Gallery

Lymphatic System Gallery

Female Reproductive System Gallery

Oral Cavity Gallery

Urinary System Gallery