Piriformis muscle syndrome: An underdiagnosed cause of sciatica

Abstract

This is a retrospective review of 26 patients with sciatica due to the piriformis muscle syndrome. Most patients had pain in the buttock area and sciatica, and most experienced difficulty walking and sitting, even for short periods of time. Reproduction of the sciatica upon deep palpation, either by gluteal or rectal route, was diagnostic. Reproduction of sciatica occurred in 92% of the patients upon deep digital palpation and in 100% of the patients upon rectal or pelvic examination. Other signs were helpful but not consistent. After the appropriate diagnosis, the treatment was relatively easy and rewarding. This study emphasizes that the diagnosis of piriformis muscle syndrome is clinical; without the appropriate clinical examination, it can be easily misdiagnosed.

Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report

“…1,2,3,5,8,13,17,27,32 Yet only 2 of these reports included hip abduction strengthening as part of the treatment program, 1,17 with 1 of the 2 authors noting that hip abduction exercises "seemed to hasten recovery." 17 Therefore, a treatment program addressing hip strength and movement reeducation to control the femur in the frontal and transverse planes during functional activities may play a role in the treatment of patients with piriformis syndrome who demonstrate excessive frontal and transverse plane motions at the hip.…”

“…1,5,11,15,20,27,30 The most commonly reported physical therapy interventions include ultrasound, 1,5,11,16,19 soft tissue mobilization, 1,5,11,15,16,19,30 piriformis stretching, 1,11,15,16,19,26,27,30 hot packs or cold spray, 5,11,15,16,19 and various lumbar spine treatments. 1,5,8,10,13,26,30 As noted above, a common assumption guiding physical therapy intervention for piriformis syndrome is that the piriformis is shortened or in spasm, creating compression of the sciatic nerve. Our alternate theory is that the piriformis muscle may be functioning in an elongated position or subjected to high eccentric loads during functional activities secondary to weak agonist muscles.…”

Brief review: Piriformis syndrome: etiology, diagnosis, and management

“…7 A number of etiological factors that may account for the presence of PS have been described (Table 1). [3][4][5]7,[13][14][15]18,20,22,33, In most patients, there is no identifiable cause.…”

“…With a few exceptions, the literature on PS includes only isolated case reports. [13][14][15][16] Many synonyms for the condition are used in the literature, such as ''deep gluteal syndrome'' and ''pelvic outlet syndrome''. 17 Analogous to other entrapment neuropathies, such as carpal tunnel syndrome, this clinical picture can also be correctly termed ''infrapiriform foramen syndrome''.…”

Treatment of piriformis syndrome with oxygen-ozone therapy

“…Literature data show how responsible it can be of sciatalgia syndrome. 1,2 Symptomatology results from sciatic nerve compression in the stomach of the muscle itself. Indeed, the sciatic nerve emerges from the pelvis through a single trunk, which in most cases passes before the piriformis muscle, whereas in 15% of cases it crosses the piriformis or divides into a tibial and a peroneal branch running from the front, back or through the muscle.…”