Updated: 11/4/2016

Piriformis Muscles Syndrome

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Introduction
  • A condition characterized by sciatic symptoms (leg pain) due to extrapelvic sciatic nerve compression at the hip
    • sometimes called deep gluteal syndrome 
  • Pathophysiology
    • pathoanatomy
      • sciatic nerve entrapment occurs
        • anterior to piriformis muscle or posterior to obturator internus/gemelli complex 
        • at level of ischial tuberosity
      • anatomic anomalies may contribute to compression including
        • bipartite piriformis
        • variations of sciatic nerve path
        • tumors
        • aneurysm of inferior gluteal artery
  • Associated conditions
    • femoroacetabular impingement 
      • decreased internal rotation may contribute to contractures of short external rotators and compression on sciatic nerve
Anatomy
  • Sciatic nerve 
    • exits 
      • inferior to piriformis  
      • superior to superior gemellus
  • Muscles
    • external rotators of the thigh include (superior to inferior)
      • piriformis 
      • superior gemellus 
      • obturator internus 
      • inferior gemellus  
      • obturator externus 
      • quadratus femoris 
Presentation
  • Symptoms
    • pain in the posterior gluteal region and migrating down the back of the leg
    • pain may be burning or aching in nature similar to sciatica symptoms
  • Physical exam 
    • FAIR test
      • Flexion, Adduction, and Internal Rotation of hip can reproduce symptoms 
      • maneuver places piriformis muscle on tension
Imaging
  • Radiographs
    • unremarkable
  • MRI
    • usually unremarkable
    • lumbar MRI helpful to rule out spine as cause of compression of sciatic nerve
  • Electrodiagnostic studies
    • can document functional impairment of sciatic nerve
Treatment
  • Nonoperative
    • rest, NSAIDS, muscle relaxants, PT, steroid injections
      • indications
        • first line of treatment
      • technique
        • focused on stretching the piriformis muscle and short external rotators
        • corticosteroid injection directed near the piriformis muscles
  • Operative
    • piriformis muscle release and external sciatic neurolysis
      • indications
        • only indicated in refractory cases after failed conservative measures
 

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Questions (1)
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(OBQ09.37) Which of the following is the most common anatomical pattern of the sciatic nerve as it exits the pelvis? Review Topic | Tested Concept

QID: 2850
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1

As a single nerve, anterior to the piriformis muscle

69%

(2156/3145)

2

As a single nerve, posterior to the piriformis muscle

24%

(751/3145)

3

As two branches, both anterior to piriformis muscle

4%

(116/3145)

4

As two branches, one anterior to piriformis and one through the piriformis muscle

1%

(43/3145)

5

As two branches, both posterior to the piriformis muscle

2%

(66/3145)

L 3 C

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