Piriformis Syndrome

Introduction

  • Piriformis syndrome is pain in the buttock or posterior thigh and calf caused by inflammation or spasm of the piriformis muscle that causes compression or irritation to the sciatic nerve as it courses caudally out from under the edge of the piriformis.
  • Nerve irritation can begin with blunt trauma to the buttock or overuse activities that place the sciatic nerve under tension such as running.
  • 14% of all individuals exhibit a perforation of the piriformi muscle by the peroneal branch of the sciatic nerve, leading to nerve compression each time the piriformis is used (Synek 1987)

Clinical Presentation

  • Patients complain of pain with walking, ascending stairs, or trunk rotation, whereas sitting may decrease the pain
  • Pain may refer into the posterior thigh to the knee when more severe
  • If the inferior gluteal nerve becomes compressed, there may be gluteus maximus atrophy
  • Pain is produced when the hip is positioned in less that 90 degrees of flexion, abduction, and IR (Fishman 2002)
  • Possible positive straight leg raise or slump
  • Special Tests

Treatment

  • Educate the patient to avoid stretching and sitting on hard surfaces.
  • Correct leg length discrepency
  • Neural mobilizations
  • Injection of corticosteroids and analgesics
  • Botulinum toxin A injection
  • Surgical release
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