Six to eight percent of back pain cases are caused by piriformis syndrome.
Six to eight percent of back pain cases are caused by piriformis syndrome. The piriformis muscle originates off the ventral surface of the sacrum and runs diagonally within the gluteal region and attaches to the upper side of the greater trochanter. The primary action of the piriformis muscle is external rotation and abduction of the hip.
Historically, piriformis syndrome has been defined as the compression of the sciatic nerve through the piriformis muscle that will elicit pain and the gluteus and proximal thigh. The sciatic nerve will travel inferior to the piriformis muscle in 90% of patients. More recently, the term deep gluteal syndrome has replaced the term piriformis syndrome to encompass compression of the sciatic nerve by a structure within the subgluteal region.
Illustration of Piriformis Anatomy of piriformis muscle The clinical signs of piriformis syndrome involve pain in the gluteal region that may radiate into the posterior thigh. Patients may also complain of recent trauma in the gluteal area that provoked symptoms. Pain with sitting for prolonged periods of time and standing from a seated position may also be suggestive of piriformis syndrome.
Diagnosis is mainly clinical, as imaging studies do not have any direct correlation with piriformis syndrome. Providers must rule out other sources of gluteal pain including lumbar pathology, hip pathology, and sacroiliac disorders. On physical exam, providers should palpate the piriformis muscle and provoking pain is consistent with piriformis syndrome.
The active piriformis test, which can be seen below, can also be attempted. Providers instruct the patient to line in the lateral recumbent position and then have the patient push their heel into the table and also try to abduct the leg. The provider will apply resistance and assess for pain while palpating the piriformis.
If you are experiencing symptoms that may be related to piriformis syndrome, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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