The Diagnosis and Management of Piriformis Syndrome: Myths and Facts

Abstract

This article explores and reviews the controversies surrounding piriformis syndrome (PS) with respect to diagnosis, investigation and treatment. While some authors have argued that PS is analogous to other well accepted compression neuropathies such as carpal tunnel syndrome, there is a wide spectrum of opinions concerning the diagnosis. These range from the belief that cases of true piriformis-induced entrapment exist but are rare, 1-5 to strongly held skepticism regarding the piriformis muscle's causative role. 6,7 Silver and Leadbetter 7 reported on a survey of 75 U.S. physiatrists and found only 72% were confident that PS exists. Moreover, 55% felt that the disorder was over-diagnosed, while 38% felt it was underdiagnosed. Still other authors have argued that the syndrome is a symptom complex and represents a myofascial pain disorder rather than an entrapment neuropathy. 2,[8][9][10]

Nerve stiffness - a challenge for ultrasound elastography

“…Therefore the position of ROI was marked up to priformis muscle structure. The resection was done from trochanter's attachment, by separation of joint tendon of m.piriformis and m.obturator internus, and by release of n.peroneus and n.tibialis from fibrous bands and surrounding muscles (Hopayian,Hernando and Perez Carro,(14)(15)(16)(17). The study was limited by the technology used and depended on external probe force, ultrasound equipment, the position of ROI and by colour maps.…”

“…Miller and Cass believed that deep gluteal syndrome is a result of sciatic nerve compression caused by piriformis muscle (14,2). Symptoms vary and can include pain and numbness down the leg (Cass and Liebert) and worsened with sitting or running (2,11).…”

Effect of Reciprocal inhibition and Post Isometric relaxation; types of muscle energy technique in Piriformis syndrome ? A Comparative study

“…Participants from age group 25-45 years, both genders, Onset of pain not > 2 weeks, Single incidence, Decreased hip medial rotation ROM (knee in 00 flexion), Unilateral involvement of piriformis muscle, VAS : 3-6, & Any three positive test among piriformis test, beatty test, Freiberg test, FAIR test, Sign of Pace & Nagel, tonic external rotation of hip [1,8,[11][12][13].…”

“…There will be Asymmetrical weakness in affected limb. Positive Finding of Piriformis test, sign of Pace and Nagel, Freiberg sign, Beatty test, Exacerbation of pain in the "FAIR" position Limited medial rotation of ipsilateral lower extremity, Tonic external rotation of the hip and in chronic cases there may be ipsilateral short leg & Gluteal atrophy [1,8,[11][12][13][14][15]. The differential diagnosis of PS includes the causes of low back pain and sciatica [16].…”

Therapeutic Effectiveness of Hijama in Sciatica Pain

“…Piriformis syndrome is also known as "wallet sciatica" i.e., if a wallet carried in a rear hip pocket pressurizes the hip muscles and sciatic nerve when the person sits down on it. In this syndrome sciatic pain occurs but the nerve root is normal [8].…”