Piriformis syndrome

Piriformis syndrome is a condition which is believed to result from compression of the sciatic nerve by the piriformis muscle.[2][5] Symptoms may include pain and numbness in the buttocks and down the leg.[2][3] Often symptoms are worsened with sitting or running.[3]

Medical condition
Piriformis syndrome
Other names Deep gluteal syndrome[1]
Location of piriformis syndrome within the body
Specialty Orthopedics, sports medicine
Symptoms Buttock pain that is worse with sitting[2]
Duration Long-term[3]
Causes Trauma, spasms, overuse injury[2]
Diagnostic method Based on symptoms[4]
Differential diagnosis Herniated disc, kidney stones, SI joint dysfunction[3][2]
Treatment Avoiding activities that cause symptoms, stretching, medications[3][5]
Medication NSAIDs, steroids, botulinum toxin injections[2]
Frequency Unknown (2017)[4]

Causes may include trauma to the gluteal muscle, spasms of the piriformis muscle, anatomical variation, or an overuse injury.[2] Few cases in athletics, however, have been described.[2] Diagnosis is difficult as there is no definitive test.[5][4] A number of physical exam maneuvers can be supportive.[3]Medical imaging is typically normal.[2] Other conditions that may present similarly include a herniated disc.[3]

Treatment may include avoiding activities that cause symptoms, stretching, physiotherapy, and medication such as NSAIDs.[3][5]Steroid or botulinum toxin injections may be used in those who do not improve.[2] Surgery is not typically recommended.[3] The frequency of the condition is unknown, with different groups arguing it is more or less common.[4][2]

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The signs and symptoms include gluteal pain that may radiate down buttock and the leg, and that is made worse in some sitting positions.[2][3]

Causes of piriformis syndrome include the following

  • Anatomic anomalies, present since birth:

Bipartite piriformis muscle

Sciatic nerve course/branching variations with respect to the piriformis muscle: In over 80% of the population, the sciatic nerve courses deep to and exits inferiorly to the piriformis muscle belly/tendon.[6][7] Early (proximal) divisions of the sciatic nerve into its tibial and common peroneal components can predispose patients to piriformis syndrome, with these branches passing through and below the piriformis muscle or above and below the muscle.[7][8]

  • Acquired[9]

Sitting for prolonged periods (office workers, taxi drivers, bicycle riders)

Overuse syndromes: Piriformis muscle hypertrophy (viz., in athletes)

Trauma to the hip or buttock area

When the piriformis muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle. Generally, conditions of this type are referred to as nerve entrapment or as entrapment neuropathies; the particular condition known as piriformis syndrome refers to sciatica symptoms not originating from spinal roots and/or spinal disc compression, but involving the overlying piriformis muscle.[3]

In 17% of an assumed normal population the sciatic nerve passes through the piriformis muscle, rather than underneath it; however, in patients undergoing surgery for suspected piriformis syndrome such an anomaly was found only 16.2% of the time leading to doubt about the importance of the anomaly as a factor in piriformis syndrome.[10] Some researchers discount the importance of this relationship in the etiology of the syndrome.[10][11]

MRI findings have shown that both hypertrophy (unusual largeness) and atrophy (unusual smallness) of the piriformis muscle correlate with the supposed condition.[12]

Piriformis syndrome may also be associated with direct trauma to the piriformis muscle, such as in a fall or from a knife wound.[13]

. . . Piriformis syndrome . . .

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