Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment

Probst, Daniel; Stout, Alison; Hunt, Devyani

doi:10.1002/pmrj.12189

Cited by 65 publications

(68 citation statements)

References 66 publications

(142 reference statements)

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“…It was observed, that above of this angle, in the hip joint the retroversion of the pelvis occurs caused by ischiofemoral muscles, which may be the source of the pain. It is also known that the flexion in the hip joint is responsible for 44% of changes in the length of the sciactic nerve in the SLR test, whereas, the extension in the knee joint elongates its length by 60mm, contributing to the elongation of the nerve by 49% (21). What is more, the internal rotation and the adduction increase the test sensitivity by additional tension of the nerve structures located at the back of the joints.…”

Section: Biomechanicsmentioning

confidence: 99%

The SLR test – neurodynamics and biomechanics

Cichosz¹,

Jetwuch²,

Kochański³

et al. 2020

PPS

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The SLR test (straight leg raise), often reffered to as Lasègue's test, is one of the most often used provocative manoeuvres among patients with the pain ailments of the lower back (LBP). For the first time it was described in 1880 by a Serbian doctor called Lazerevic and since then numerous versions od this test has developed (1). According to the authors' own experience, despite its large popularity in the clinical practice, the practitioners' interpretation of the test is often incorrect and is entirely confined to indicating the results in the dichotomous scale with the determination of the pain level. Such interpretation of the test cannot indicate the source of the pain ailments reported by the

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Section: Biomechanicsmentioning

confidence: 99%

The SLR test – neurodynamics and biomechanics

Cichosz¹,

Jetwuch²,

Kochański³

et al. 2020

PPS

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“…There is no “gold standard” treatment for PMS; however, first‐line management consists of conservative treatment and lifestyle correction . The main objective of conservative therapies is reducing local pain, muscle tension, and spasm . DN is a therapeutic technique that uses a thin sterile needle to penetrate the skin and affect deep target tissue that is not manually palpable .…”

Section: Introductionmentioning

confidence: 99%

“…The main objective of conservative therapies is reducing local pain, muscle tension, and spasm. 11,12 DN is a therapeutic technique that uses a thin sterile needle to penetrate the skin and affect deep target tissue that is not manually palpable. 13 Although a recent systematic review showed that DN could improve muscle tension, decrease pain, and rapidly increase muscular efficacy, these effects are reported in other muscular conditions, such as myofascial pain syndrome in the neck and lumbar region.…”

Section: Introductionmentioning

confidence: 99%

“…Although a recent systematic review showed that DN could improve muscle tension, decrease pain, and rapidly increase muscular efficacy, these effects are reported in other muscular conditions, such as myofascial pain syndrome in the neck and lumbar region . Indeed, use of the DN technique in the piriformis muscle has only been recommended in review articles by expert opinion . There are currently no randomized, controlled trials (RCTs) investigating the effectiveness of ultrasound‐guided piriformis DN.…”

Section: Introductionmentioning

confidence: 99%

“…14 Indeed, use of the DN technique in the piriformis muscle has only been recommended in review articles by expert opinion. 12,15,16 There are currently no randomized, controlled trials (RCTs) investigating the effectiveness of ultrasound-guided piriformis DN.…”

mentioning

confidence: 99%

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Ultrasound‐guided dry needling decreases pain in patients with piriformis syndrome

et al. 2019

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Introduction Piriformis muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip‐joint mobility, and may have an impact on quality of life. Methods Thirty‐two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound‐guided dry needling (DN) of the piriformis muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment. Results At 1‐week follow‐up, pain intensity was significantly less in the DN group than in the waitlist control group (−2.16 [−1.01 to −3.32], P = .007) by an amount consistent with clinically meaningful improvement. Discussion The findings suggest that DN resulted in clinically meaningful short‐term improvement in pain intensity of patients with PMS.

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Musculoskeletal mimics of lumbosacral radiculopathy

Bateman,

Fortin,

Guo

2024

Muscle and Nerve

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Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non‐radiating pain, tenderness, and give‐way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high‐yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.

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Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment

Cited by 65 publications

References 66 publications

The SLR test – neurodynamics and biomechanics

The SLR test – neurodynamics and biomechanics

Ultrasound‐guided dry needling decreases pain in patients with piriformis syndrome

Musculoskeletal mimics of lumbosacral radiculopathy

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