Dr. Ebraheim’s educational animated video illustrates the condition of Piriformis Syndrome and Sciatic nerve pain. Is the
condition Piriformis Syndrome or True Sciatica from lumbar disc radiculopathy.
Dr. Ebraheim’s educational animated video describing disc herniation of the lumbo sacral spine, the etiology, signs and symptoms, diagnosis, and treatment options.
it explains the anatomy of the spine the structure of the disc and types ,site ,level of disc prolapse bulge herniation
L4_L5 AND L5-S1 are the most common levels causing sciatica and positive SLR OR STRETCH TEST.
Sciatica means: pain radiating along the course of the sciatic nerve, which runs from the lower back to the buttock, to the back of the thigh and into the lower leg and the foot.
Sciatica usually affects one side of the body and it is usually called lumbar radiculopathy.
The largest number of cases involving sciatica occur from disc herniations.
Sciatica is not a diagnosis; it is a symptom of an underlying condition, For example: in periformis syndrome, it is a condition that may cause sciatica.
The condition of sciatica due to compression from herniated disc s called lumbar radiculopathy.
Let’s explain the condition in some details:
Periformis syndrome is a condition that has sciatic nerve symptoms due to compression of the sciatic nerve around the buttock and the hip.
This condition is usually connected to the periformis muscle and its relationship to the sciatic nerve.
The sciatic nerve exits below and anterior to the periformis muscle.
Causes of the periformis syndrome:
- Anatomic anomalies, such as:
• Split periformis muscle.
• Vascular structure.
• Variation to the sciatic nerve path.
- The periformis syndrome may also be caused by tightness or spasm of the preiformis muscle that will squeeze the sciatic nerve.
The pressure is being placed on the nerve will cause swelling and inflammation.
Clinical diagnosis of periformis syndrome:
- Pain in the posterior gluteal region and the buttock that is shooting down the leg in the area of the sciatic nerve that cause symptom-like sciatica.
- There will be symptoms of burning, tingling and shooting pain.
- Provocative tests:
• Fair test: flexion, adduction, and internal rotation of the hip will produce the symptoms due to the tension of the periformis muscle.
• Lasegue’s test: the straight leg raising pain is aggravated by forced ankle dorsiflexion.
Periformis syndrome needs to be differentiated from sciatica.
Both could have the same symptoms, however both have different causes.
The diagnosis should be done by exclusion of possible spine problems that could be compressing the spinal nerve root and causing sciatica.
The main cause of a true sciatica is disc herniation.
When a patient complains of sciatica related pain, the doctor needs to ask themselves a question:
Is this sciatica is due to compression on the sciatic nerve itself? Or is it due to compression on the nerve roots of the sciatic nerve?
Get an MRI to rule out the spine as a cause of compression on the nerve roots of the sciatic nerve.
If the patient does not have a herniated disc, then the patient will probably have periformis syndrome.
Treatment of periformis syndrome:
• Conservative treatment:
- Anti- inflammatory medication.
- Physical therapy and stretching of the periformis muscle.
- Injection (ultrasound guided or under fluoroscopy).
- Make sure that the patient has someone present to drive them home, because the sciatic nerve may become numb and the patient may not be able to drive.
• Surgery (last resort):
- Release of the periformis muscle.
- Sciatic nerve neurolysis.
Surgery is done as a last resort and after you exclude any possible spine conditions and after you have a positive test from injection of the periformis muscle (the patient must acknowledge that they feel better from the injection.
Periformis syndrome is a diagnosis of exclusion.
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