Piriformis Syndrome Information
The sciatic nerve is compressed by the piriformis muscle in the buttock. The piriformis syndrome may be associated with lower lumbar radiculopathy similar to spine pathology. Some patients may have spine surgery without improvement.
With regards to symptoms, we have very limited information about this topic. It may develop from blunt trauma to the buttocks. The patient usually complains of localized buttock pain increased by sitting or driving, and tenderness in the sciatic notch. The pain may increase by bicycling or running in younger patients. Radicular symptom with pain and paresthesia, but it is not very common. Pain may be present when palpating directly deep into the area of the greater sciatic notch.
Provocative test with Lasègue’s maneuver, you bend the hip to 90° and extend the knee will reproduce the pain in the greater sciatic notch. The sciatic nerve is usually compressed by the piriformis muscle, by some fibrous bands or by vascular anomalies. Be aware of the possible anatomical variation of the sciatic nerve in relationship to the piriformis.
There are four types of anatomical variations of the sciatic nerve. The sciatic nerve has a tibial part and peroneal part that are usually bound together, but sometimes they divide as they pass to the piriformis muscle or underneath it.
The relationship of the sciatic nerve to the piriformis varies. 1) The sciatic nerve passes underneath the piriformis muscle. 2) The piriformis is flat and the nerve is flat as you can see from the picture. 3) One piriformis and the nerve split above and below the piriformis. 4) The entire nerve passed through the split piriformis muscle.
Diagnosis & Treatment of Piriformis Syndrome
Diagnosis is a high index of suspicion. The patient’s history and exam is important. Imaging and bone scan are not very helpful. The MRI may show enlarged piriformis, anomalies of the vessels or compression of the sciatic nerve. A diagnostic injection is helpful.
Treatment includes aquatic therapy and physiotherapy, some medications, injections, and the last resort is surgical release of the piriformis muscle and decompression of the sciatic nerve. This operation is usually successful in relieving the pain of the patient.
Consider the possibility of piriformis syndrome when treating the patient for trochanteric bursitis or patient with sciatica especially after he failed a spine surgery. Patient with sciatica would have pathology in the lumbar spine as seen on the MRI such as disc herniation, stenosis or degenerative changes. Patient with piriformis syndrome may not have symptoms or MRI findings related to the lower back. How do you really diagnose a piriformis syndrome? Diagnose it by high index of suspicion in the patient with buttock or leg pain in the absence of lumbar pathology. This pain is increased by sitting and the patient will then have very little back pain. Piriformis syndrome is a hidden cause of sciatica.
Dr. Steven Becker is a Chiropractor in West Los Angeles (West LA) and specializes in treating sciatica and slipped disc injuries. He also treats patients with spinal stenosis, radiculopathy and tailbone pain. Dr. Steven Becker is committed to relieving your pain using the principles of traditional chiropractic Care, by finding and fixing the cause of your condition. Dr. Steven Becker strives to create an awareness of the importance of a healthy spine, and in doing so, provide the highest level of chiropractic service that is beneficial to all of his patients. He strongly believes in patient education as an integral part in providing this optimum level of health care. Dr. Steven Becker’s focus is not only rehabilitation and maintenance of spinal problems, but as an on-going commitment to his patients’ overall health and well-being. Dr. Steven Becker frequently sees patients from the surrounding neighborhoods in West Los Angeles (West LA) including Culver City, Century City and Beverly Hills. Please feel free to call with any questions or comments (310)277–8822.