Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options

Cassidy, Lindsey; Walters, Andrew; Bubb, Kathleen; Shoja, Mohammadali Mohajel; Tubbs, R. Shane; Loukas, Marios

doi:10.1007/s00276-012-0940-0

Cited by 76 publications

(61 citation statements)

References 26 publications

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“…22,33 This is probably the most common cause of PS. 13,22,33 Certain anatomic variants, such as double piriformis and course variants of the sciatic nerve, posterior cutaneous femoral nerve, inferior gluteal nerve, and superior gluteal nerve 4,5,7,14,15,26,27,40,41,60,61 can predispose to PS. 7,26,34,44 The presence of PS is frequently overlooked; the differential diagnosis is presented in Table 2.…”

Section: Pathophysiology and Etiologymentioning

confidence: 99%

“…88 When the newly introduced neuroradiological technique of magnetic resonance neurography has been used alongside established imaging methods, such as MRI, for evaluating unexplained chronic sciatica, it has led to the identification of various changes relating to the PM and sciatic nerve which have been further shown with surgical exploration. 26 Diagnostic injection with local anesthetics and steroids Although PM injection has not been compared with other diagnostic tests, it is a widely used method of establishing the diagnosis after initial evaluation. 13,38,39 …”

Section: Electrophysiological Testsmentioning

confidence: 99%

“…36 Even so, if PS is suspected, a CT examination of the pelvis should certainly be conducted in order to detect side-to-side differences in the PM or other causes of the narrowing of the infrapiriform foramen. 26,86,87 If uncertainties remain, an MRI examination of the sciatic nerve and its vicinity -particularly with regard to structural changes in the PM -is indicated. 88 When the newly introduced neuroradiological technique of magnetic resonance neurography has been used alongside established imaging methods, such as MRI, for evaluating unexplained chronic sciatica, it has led to the identification of various changes relating to the PM and sciatic nerve which have been further shown with surgical exploration.…”

Section: Electrophysiological Testsmentioning

confidence: 99%

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

Jankovic¹,

Peng

Zundert

2013

Can J Anesth/J Can Anesth

132

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In this narrative review, we aim to provide the pathophysiology and diagnostic criteria of the piriformis syndrome (PS), an underdiagnosed cause of buttock and leg pain that can be difficult to treat. Based on existing evidence, frequencies of clinical features are estimated in patients reported to have PS. In view of the increasing popularity of ultrasound for intervention, the ultrasound-guided technique in the treatment of PS is described in detail. A literature search of the MEDLINEA (R) database was performed from January 1980 to December 2012 using the search terms e.g., " piriformis injection", " ultrasound guided piriformis injection", " botulinum toxin", "pain management", and different structures relevant in this review. There was no restriction on language. A review of the medical literature pertaining to PS revealed that the existence of this entity remains controversial. There is no definitive proof of its existence despite reported series with large numbers of patients. Piriformis syndrome continues to be a controversial diagnosis for sciatic pain. Electrophysiological testing and nerve blocks play important roles when the diagnosis is uncertain. Injection of local anesthetics, steroids, and botulinum toxin into the piriformis muscle can serve both diagnostic and therapeutic purposes. An ultrasound-guided injection technique offers improved accuracy in locating the piriformis muscle. Optimizing the therapeutic approach requires an interdisciplinary evaluation of treatment

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Section: Pathophysiology and Etiologymentioning

confidence: 99%

Section: Electrophysiological Testsmentioning

confidence: 99%

Section: Electrophysiological Testsmentioning

confidence: 99%

See 1 more Smart Citation

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

Jankovic¹,

Peng

Zundert

2013

Can J Anesth/J Can Anesth

132

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“…Sakral 1 ve 2, nadiren lomber 5 spinal kökleri tarafından innerve olur [1] . Siyatik sinir ile piriformis kasının anatomik ilişkisi ile ilgili çeşitli varyasyonlar görülebilir [3,4] :…”

Section: Anatomiunclassified

Piriformis Syndrome

Mesci¹

2017

Haydarpasa Numune Med J

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Piriformis sendromu (PS), siyatik sinirin piriformis kası tarafından tuzaklanması ile oluşan bir klinik tablodur. Siyatik sinir ile piriformis kasının anatomik ilişkisi ile ilgili çeşitli varyasyonlar görülebilir. Piriformis kası kalça eklemine uyluk ekstansiyondayken dış rotasyon, kalça fleksiyondayken abduksiyon yaptırır. Piriformis kasında miyofasial tetik nokta, hipertrofi, inflamasyon, travmatik yaralanmalar, piriformis kası ve/veya siyatik sinirin anatomik varyasyonları ve myositis ossifikans gibi nedenler PS'na yol açabilmektedir. Siyatik ağrısı vakalarının %5-6'sının PS olduğu gösterilmiştir. Ancak radiküler ağrı ile karıştığı için bu oranın daha fazla olduğu düşünülmektedir. Bu derlemede nondiskojenik siyatalji ayırıcı tanısında düşünülmesi gereken PS ve ultrasonografinin PS tanı ve tedavisindeki öneminden bahsedilmiştir. Anahtar sözcükler: Piriformis sendromu; siyatik sinir; ultrasonografi. Piriformis Syndrome AbstractPiriformis syndrome (PS) is a clinical picture that develops when the sciatic nerve is trapped by the piriformis muscle. Several variations in the anatomical relationship of the sciatic nerve and the piriformis muscle may be seen. The piriformis muscle externally rotates the hip joint when the thigh is in extension and abducts when the hip is in flexion. Myofascial trigger points in the piriformis muscle, hypertrophy, inflammation, traumatic injury, anatomical variations of the piriformis muscle and/or the sciatic nerve, and myositis ossificans can cause PS. It has been reported that 5% to 6% of sciatic pain cases are PS. However, it is thought that this percentage may actually be higher because it can be confused with radicular pain. PS should be considered in the diagnosis of nondiscogenic sciatica, and the importance of ultrasonography in the diagnosis and treatment of PS are described in this review.

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“…

In their otherwise comprehensive review of the piriformis syndrome, Cassidy and colleagues [1] overlooked two systematic reviews on the subject. Hopayian et al [3] have reviewed the diagnostic features and Cramp et al [2] have reviewed conservative management.

Evidence on the symptoms and signs of the syndrome are to be found in case reports and case series.

…”

mentioning

confidence: 99%

The clinical features of the piriformis syndrome

Hopayian

2012

Surg Radiol Anat

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In their otherwise comprehensive review of the piriformis syndrome, Cassidy and colleagues [1] overlooked two systematic reviews on the subject. Hopayian et al. [3] have reviewed the diagnostic features and Cramp et al. [2] have reviewed conservative management.Evidence on the symptoms and signs of the syndrome are to be found in case reports and case series. Because such data are frequently taken from routine records where significant negative findings may not be recorded, calculating the frequency of clinical features requires a specific type of analysis. A range of frequencies, from all cases reported to only those that specifically reported both positive and negative findings, must be provided. The review by Hopayian et al. [3] synthesised the information dispersed across over 50 case studies. The reviewers identified the three commonest symptoms as buttock pain (range 50-95 %), pain aggravated by sitting (39-97 %) and external tenderness near the greater sciatic notch (59-92 %). There were insufficient numbers to calculate a frequency for the FAIR test, which Cassidy et al. focussed on. However, other signs of sciatic nerve impingement were present in 32-74 %.Cramp et al. [2] found few good quality studies of the effectiveness of non-surgical treatments but there was limited evidence for the effectiveness of botulinum toxin injection. We are unlikely to get high quality research on the treatment of piriformis syndrome until we have defined the syndrome more rigorously. The best way forward is a prospective study of clinical features matched to imaging. I believe that a good starting point is with the clinical features identified through systematic reviews.

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Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options

Cited by 76 publications

References 26 publications

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

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

Piriformis Syndrome

The clinical features of the piriformis syndrome

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