The Piriformis Syndrome Treatment, Causes and Diagnosis

The piriformis muscle- why it is important

Piriformis Syndrome

The sciatic nerve may become
compressed or irritated by the piriformis muscle, which can give piriformis
syndrome. piriformis syndrome is a leading cause of sciatica.

Always consider the possibility of piriformis
syndrome when treating patients with sciatica, SI joint pain, or trochanteric
bursitis that's not improving, or in patients with sciatica, especially after
field spine surgery.

The piriformis muscle will irritate
the sciatic nerve and the pain will go down into the back of the buttock, into
the posterior thigh, and into the back of the leg.

In piriformis syndrome, the patient
may have symptoms of sciatica that may be similar to this herniation symptoms.

How do you diagnose piriformis
syndrome?

• A High index of Suspicion
• Patient history and exam

Important Points!

They found that there are three
common symptoms that the patient experiences in piriformis syndrome which
includes.

• Buttock pain
• Aggravation of pain with sitting
• point tenderness over the greater
  sciatic notch

The diagnosis of piriformis syndrome
is made clinically with the pain being in the posterior gluteal region.

Patients will have localized body
pain increased by sitting or driving

The patients may have tenderness in
the sciatic Notch and the pain is increased by bicycling or running in young
individuals.

patients will have ridiculous
symptoms with pain and paresthesia.

The pain may be present when
palpating directly deep into the area of the greater sciatic notch.

The cost of piriformis syndrome is
not fully understood there might be anatomical anomalies that lead to compression
of the sciatic nerve.

The sciatic nerve is compressed by
the piriformis muscle, fibrous bands, or by vascular anomalies. MRI may show
enlarged piriformis Muscle anomalies of the vessels or compression of the
sciatic nerve.

Tightness or space of the piriformis
muscle may cause irritation of the sciatic nerve itself. The pressure being
placed on the nerve may cause swelling and inflammation.

The symptoms of a reformer syndrome occasionally
develop from blunt trauma to the buttock.

In piriformis syndrome, the sciatic
nerve can become irritated where it runs under the piriformis muscle in the
buttock region and when the performance muscle irritates the sciatic nerve it
can cause sciatica.

The patient will complain of “pins
and needles” down the leg and confusion may occur as the patient may be
misdiagnosed as having a lumbar disc herniation.

performance syndrome is not a true lumbar
radiculopathy. true sciatica is caused by irritation of the nerve root Itself
by a disc herniation.

• lumbar radiculopathy enthusiastic is
  a spine problem!
• piriformis syndrome is a muscle and
  static nerve problem!

The diagnosis of piriformis syndrome
should be done by exclusion of any other possible spine problem which could compress
the spinal nerve root and cause true sciatica

 

A high index of Suspicion is needed
in patients with buttock or leg pain in the absence of lumbar disc herniation
on an MRI.

we must look at the spine first and exclude
spine problems because spine problems are the most common cause of sciatica
and piriformis syndrome is not that common.

If the patient complains of sciatica
and the MRI of the spine does not show there is a disc problem, then the
patient probably has piriformis syndrome.

It is really hard to differentiate between
piriformis syndrome and lumbar disc herniation because both conditions can
cause sciatica and because there are a lot of positive findings in the MRI, which
does not mean that disc herniation or bulge that's present in the MRI is causing
the patient's symptoms.

There are a lot of patients that have a disc herniation and disc Bulger MRI that are asymptomatic, which does not cause
them any symptoms, therefore you must correlate the MRI findings with the clinical
examination of the patient.

How do you know the primary source
of pain?

In fact, the patient may have both conditions
of herniated disc and piriformis syndrome.

Provocative Test For Testing the
Piriformis Muscle

There are clinical examinations that
are commonly used to diagnose piriformis syndrome and these are called provocative
tests.

• Lasegue’s maneuver Stretches the
  sciatic nerve
• The Faddir test stretches the
  piriformis

Lasegue’s Maneuver

Reproduces the Pain by flexing the
Hep to 90 degrees you are keeping the knee extended. Dr prefers to do that test
with the patient on the side so I can localize the site of the pain, which is
directly over the piriformis muscle.

 

Faddir test

The test is done by stretching the
piriformis muscle to see if it is causing irritation and pressure on the
sciatic nerve and reproducing the patient's symptoms. that this is done by
flexing abducting and internally rotating the hip.

If you are not sure about the
diagnosis, then a diagnostic injection of the piriformis muscle may be helpful.

Piriformis syndrome Treatment 

• Water therapy
• Physical therapy
• Nonsteroidal anti-inflammatory
  medication
• Injections(diagnostic injection is
  helpful)
• surgery is the last resort

surgery is done as the last resort after we exclude all other causes of spine conditions and after the patient
has an immediate positive response from injection around the piriformis muscle.
surgery will entail the release of the piriformis muscle and decompression of the
sciatic Nerve.

 

Disclaimer:

This Post is for Education Purposes
Only. Please consult your Docter before making decisions about your care.