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Piriformis Syndrome

“A very common source of leg pain that can be simply treated without need for surgery”

Piriformis syndrome is sciatica-like pain due to impingement of the sciatic nerve as it courses through the piriformis muscle. It can be located only within the piriformis muscle or radiate different degrees all the way to the foot.  The incidence is thought to be 6% to 8% of all low back pain cases and is most often noted in the 30 to 40 year old age group. The female-to-male ratio is thought to be 3 to 6:1. The piriformis muscle is the largest of the short external rotators of the hip. Other external rotators of the hip include the superior and inferior gemellus, quadratus femoris and obturator internus muscles which all may be involved as well. The piriformis muscle originates from the second to fourth sacral vertebrae, exiting the pelvis through the sciatic notch and inserting on the upper portion of the greater trochanter with variations in the course of the sciatic nerve through the piriformis muscle. The exact mechanism of this type of sciatica remains unknown, although theories include nerve entrapment due to adhesions from an initial injury such as a fall; compression due to myofascial pain; or compression of the nerve by the muscle or tendon with hip internal rotation.

Why your buttock and leg hurts.

If your piriformis muscle is compromised, even simple normal activities can cause the piriformis muscle to spasm and become painful. Activities that can worsen the pain include arising from a chair, walking up stairs or standing for a long period of time. Any activity that increases hip external rotation can increase the pain. Also blunt trauma to the gluteal region, pregnancy and prolonged sitting on hard surfaces can also be factors in piriformis syndrome.

Symptoms

Piriformis syndrome is considered a diagnosis of exclusion with no consensus on clinical findings. Most importantly it is critical to rule out a pinched nerve in the lower back, because it has “sciatica-like” features such as buttock and lower leg pain. Also a progressive limp may overload adjacent structures worsening the pain.
If you are experiencing pain in the buttock you could be suffering from piriformis syndrome. Our expert doctors at Spine & Sports Medicine of New York use expertise in innovative assessments to accurately diagnose the
cause of your buttock pain.

Other diseases that can mimic piriformis syndrome include:

• Endometriosis
• Herniated nucleus pulposus
• Hip joint pathology
• Pelvic tumors
• Sacroiliac joint pathology
• Spinal stenosis
• Spondylosis

Our Board-Certified Physicians Can Accurately Diagnose the Source of Your Pain

We conduct a thorough clinical evaluation to determine if the pain is generated from piriformis syndrome as well as other conditions that share similar symptoms. We begin our evaluation of your problem with a complete medical history using detailed information gathering tools followed by a focused physical examination. We then confirm our diagnosis with specialized tests which may include x-rays, CT, electrodiagnostic (EMG) studies, ultrasonography, or MRI.

“No surgery is needed to relieve your pain from piriformis syndrome”

The symptoms of piriformis syndrome can respond quite well to non-surgical treatments. In some cases, pain can be temporarily or permanently relieved with the following:
• Relief of pain to get you back to living.
• Several treatment options available to target the root of the problem
• Simple measures such as oral anti-inflammatory medications, muscle relaxants, physical therapy, and a strengthening exercise programs
• Ultrasound or fluoroscopic (x-ray) guided trigger point injections can be very precise in accurately diagnosing and treating the underlying problem
• Many patients gain considerable to complete relief with the first or second injection
• No general anesthesia or prolonged recovery periods to worry about
• Thousands of patients have been helped by our innovative approach to pain management

References

Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C.
Piriformis syndrome: diagnosis, treatment, and outcome, a 10-year study. Arch Phys
Med Rehabil. 2002 Mar;83(3):295-301.
Panagos A. Rehabilitation Medicine Quick Reference-Spine (ed. Buschbacher R.M.)
New York: Demos Publishing; 2010. p. 194-195.
Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new
classification and review of the literature. Orthop Clin North Am. 2004
Jan;35(1):65-7.

This is a figure demonstrating the referral pattern (speckled pattern) of a piriformis muscle spasm (red X).

This is a figure demonstrating the referral pattern (speckled pattern) of a piriformis muscle spasm (red X).

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