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Piriformis Syndrome.
Piriformis syndrome presents with sciatic nerve symptoms due to irritation or compression by the piriformis muscle. This deep buttock muscle can anatomically vary, with the sciatic nerve coursing through or beneath it in some individuals, increasing susceptibility to compression.
Etiology.
Etiology is multifactorial, including prolonged sitting, repetitive hip motions, and direct buttock trauma. Patients may experience buttock pain radiating down the posterior thigh, often exacerbated by hip rotation or prolonged sitting.
Symptoms.
Piriformis syndrome refers to sciatica-like symptoms that do not originate from spinal root compression, but involve the overlying piriformis muscle.
Symptoms may include pain, numbness, and tingling in the buttock and posterior thigh, which may worsen with activities that involve hip rotation or prolonged sitting.
Diagnosis.
Diagnosis relies on a thorough history and physical examination focusing on reproducing symptoms with maneuvers that stress the piriformis muscle.
Imaging studies like MRI or CT scans may be necessary to rule out differential diagnoses such as lumbar radiculopathy or sacroiliac joint dysfunction.
Lasegue sign or straight leg raising test is a neurodynamic exam to assess nerve root irritation in the lumbosacral area. A positive straight leg raising test may indicate the presence of sciatic nerve compression due to intervertebral disc herniation or piriformis syndrome.
The piriformis stretching test is performed by adducting and internally rotating the hip, this maneuver will stretch the piriformis and compress the nerve, reproducing the patient’s symptoms, causing buttock pain. When the examiner adds pressure to the posterior part of the buttock, the patient will complain of severe tenderness and pain.
Treatment.
Treatment is typically conservative, involving physical therapy with stretching exercises to improve piriformis flexibility and core strengthening to enhance lumbo-pelvic stability. Anti-inflammatory medications can manage pain. In refractory cases, corticosteroid or botulinum toxin injections into the piriformis may be considered. Surgery remains a last resort for patients unresponsive to conservative measures.
Pitfall.
Piriformis syndrome can be misdiagnosed as sciatica from lumbar radiculopathy due to similar symptoms.
Misdiagnosis of piriformis syndrome can lead to suboptimal management and prolonged patient suffering.
It is important to conduct a thorough physical examination, use imaging studies like MRI, and monitor the patient's response to treatment to ensure an accurate diagnosis and effective treatment.