Dr. Ebraheim’s educational animated video describes the anatomy of the piriformis muscle.
This educational animated video describes the condition know as piriformis syndrome, the signs and symptoms, etiology, diagnostic tests, and the treatment options.
The sciatic nerve is compressed by the piriformis muscles in the buttock. piriformis syndrome may be associated with lower lumbar-radiculopathy similar to spine pathology. Some patients may have spine surgery without improvement.
Symptoms
•Occasionally develops from blunt trauma to the buttock.
•Localized buttock pain increased by sitting or driving.
•Pain increased by bicycling or running in young individuals.
•Radicular symptoms with pain and paresthesia, however it is not common.
•Pain may present when palpating directly into the area of the greater sciatic notch.
Provocative test
Lasegue’s maneuver
•Reproduction of the pain by the hip is flexed to 90 degrees and the knee extended.
The sciatic nerve is compressed by the piriformis muscle, fibrous bands or by vascular anomalies.
Be aware of possible anatomical variation of the sciatic nerve ( Four types of variations).
The sciatic nerve is composed of the tibial and peroneal divisions which are usually bound together but sometimes may divide as they pass the piriformis muscle.
Relation of the sciatic nerve to the piriformis muscle
1-A normal relationship with the sciatic nerve passing beneath piriformis muscle.
2-Piriformis divided into two parts with the peroneal division of the sciatic nerve passing between the two parts of the piriformis muscle.
3-Peroneal division of the sciatic nerve passes over the muscle and the tibial division passes beneath the undivided piriformis muscle.
4-The entire nerve passes through the divided piriformis muscle.
Diagnosis
•High index of suspicion
•Patient history and exam
•EMG and bone scan are not very helpful
•MRI:
a)enlarged piriformis
b)anomalies of the vessels
c)compression of the nerve.
Diagnostic injection is helpful.
Treatment
•Aquatic therapy
•Physiotherapy
•NSAID medication
•Injections.
•Surgical release of the piriformis muscle and decompression of the sciatic nerve is the last resort.
Consider possibility of piriformis syndrome when treating trochanteric bursitis or patient with sciatica especially after a failed spine surgery.
Patient with sciatica will have pathology in the lumbar spine as shown on MRI such as disc herniation, lumbar stenosis, or degenerative changes.
Patient with piriformis syndrome may not have symptoms or MRI findings related to the lower back.
High index of suspicion in a patient with buttock or leg pain in the absence of lumbar pathology.
This pain is increased while sitting with minimal or no back pain.
Piriformis syndrome is a hidden cause of sciatica.