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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Piriformis syndrome is an often overlooked cause of sciatica that typically responds to intramuscular local anesthetic and steroid injection. In this report, our patient presented with sciatica that responded poorly to epidural steroid injection and only transiently to piriformis injection. Surgical exploration of the sciatic nerve revealed a fascial constricting band around the nerve as well as a piriformis muscle lying anterior to the nerve. This unusual anatomical relationship between the piriformis and the sciatic nerve has not been previously described in the literature. Subsequent sectioning of the anomalous muscle and the constricting band yielded complete resolution of our patient's symptoms.
Pain 1994 Oct
PMID:Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. 785 96

Piriformis syndrome is an often misdiagnosed cause of sciatica, leg, or buttock pain, and disability. The sciatic nerve may be compressed within the buttock by the piriformis muscle, with pain increased by muscular contraction, palpation, or prolonged sitting. A thorough medical history and physical examination are essential to proper diagnosis. Diagnostic testing may be used to differentiate piriformis syndrome from other causes of sciatica, lower extremity weakness, and pain. This article reviews the pathophysiology and management of piriformis syndrome.
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PMID:The piriformis syndrome. 918 Nov 89

Between 70% and 80% of the population of the world experience low back pain at some time during their lives. A subgroup of patients who experience back pain also experience sciatic pain as well, with a majority of these patients seeking evaluation from their primary care clinician. One relatively new differential diagnosis to be considered when evaluating the patient with sciatica is piriformis syndrome. Piriformis syndrome has been documented for more than 50 years. Yet its diagnosis still remains confusing at times. Using a case study for the purpose of illustration, this article outlines signs and symptoms of sciatica, as well as differential diagnoses to be considered when examining a patient with sciatica. Piriformis syndrome, diagnostic tests to be performed, treatment, education, and follow-up of the patient with piriformis syndrome are all discussed in detail. Finally, implications for primary care clinicians are presented.
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PMID:Sciatic pain and piriformis syndrome. 917 41

Piriformis syndrome (PS) is an unusual cause of sciatica that, because of the lack of strict diagnostic criteria, remains a controversial clinical entity. The diagnosis of PS is still primarily clinical because no diagnostic tests have proven to be definitive. We report the case of a 30-year-old woman, affected by a severe scoliosis, who developed a persistent buttock pain resembling that of PS. The clinical suspicion was confirmed by magnetic resonance imaging (MRI) of the pelvis, which showed an enlargement of the left piriformis muscle with an anterior isplacement of the sciatic nerve. The role of MRI in the diagnosis, clinical definition, and therapeutic approach to PS is discussed.
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PMID:Magnetic resonance imaging findings in piriformis syndrome: a case report. 1129 14

Piriformis syndrome remains a controversial diagnosis, despite its having first been described over 60 years ago. The controversy stems from several factors: variable and sometimes unclear cause, similarity to other more easily recognizable causes of sciatica, lack of consistent objective diagnostic findings, and relative rarity. Nevertheless, it is reasonable to infer that sciatic pain may be caused by compression anywhere along its length, from the spinal root level to the popliteal fossa, as is peripheral nerve entrapment elsewhere in the body. Pathologic changes at the greater sciatic notch may well be the source of sciatic pain and should be considered by the clinician. The diagnosis of piriformis syndrome remains one of exclusion, however, and in patients who present with sciatica, more common causes such as lumbar disease should be investigated and ruled out first. After excluding the most common causes of sciatica, physicians can use the criteria described here to investigate the possibility of piriformis syndrome. If properly diagnosed, it can often be treated effectively with either surgical or nonsurgical means.
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PMID:Diagnosis and treatment of piriformis syndrome. 1152 9

Piriformis syndrome is a common cause of low back pain. It is often not included in the differential diagnosis of back, buttock, and leg pain. Additionally it has received minimal recognition because it is often seen as a diagnosis of exclusion. Familiarity with the common elements of the syndrome should increase its recognition and facilitate the appropriate treatment. These include buttock pain and tenderness with or without electrodiagnostic or neurologic signs. Pain is exacerbated in prolonged sitting. Specific physical findings are tenderness in the sciatic notch and buttock pain in flexion, adduction, and internal rotation (FADIR) of the hip. Imaging modalities are rarely helpful, but electrophysiologic studies should confirm the diagnosis, if not immediately, then certainly in a patient re-evaluation and as such should be sought persistently. Physical therapy aims at stretching the muscle and reducing the vicious cycle of pain and spasm. It is a mainstay of conservative treatment, usually enhanced by local injections. Surgery should be reserved as a last resort in case of failure of all conservative modalities. Piriformis syndrome may constitute up to 5% of cases of low back, buttock, and leg pain. Recognition and widespread appreciation of the clinical presentation improves its early detection and accurate treatment.
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PMID:Piriformis syndrome and low back pain: a new classification and review of the literature. 1506 19

Piriformis syndrome is a questionable clinical entity that has been cited as a cause of buttock pain and sciatica. The intimate relationship between the piriformis and the sciatic nerve has been suspected as being the source of the signs and symptoms that often appear following minor trauma to the pelvic or buttock region. Muscle function is an important consideration in the evaluation and treatment of the athlete with suspected piriformis syndrome. The action of the piriformis muscle on the hip varies as the hip moves from a neutral to a flexed position. While in a flexed position, the piriformis internally rotates and abducts the hip; however, in a neutral position, the piriformis acts as an external rotator of the hip. A comprehensive evaluation provides the information necessary to design a treatment plan specific to the involved structures, while meeting the functional needs of the individual athlete. This paper describes the anatomy, pathomechanics, physical examination, and treatment options relevant to the piriformis syndrome. Treatment protocols stressing exercises that promote strength, flexibility, and functional activities are believed to be essential in restoring the athlete's ability to return to pain-free competition.
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PMID:Conservative management of piriformis syndrome. 1655 44

Chronic pelvic pain can present in various pain syndromes. In particular, interventional procedure plays an important diagnostic and therapeutic role in 3 types of pelvic pain syndromes: pudendal neuralgia, piriformis syndrome, and "border nerve" syndrome (ilioinguinal, iliohypogastric, and genitofemoral nerve neuropathy). The objective of this review is to discuss the ultrasound-guided approach of the interventional procedures commonly used for these 3 specific chronic pelvic pain syndromes. Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of the piriformis muscle with local anesthetic and steroids or the injection of botulinum toxin. Various techniques for piriformis muscle injection have been described. CT scan and EMG-guidance are not widely available to interventional physicians, while fluoroscopy exposes the performers to radiation risk. Ultrasound allows direct visualization and real-time injection of the piriformis muscle. Chronic neuropathic pain arising from the lesion or dysfunction of the ilioinguinal nerve, iliohypograstric nerve, and genitofemoral nerve can be diagnosed and treated by injection to the invloved nerves. However, the existing techniques are confusing and contradictory. Ultrasonography allows visualization of the nerves or the structures important in the identification of the nerves and provides the opportunities for real-time injections. Pudendal neuralgia commonly presents as chronic debilitating pain in the penis, scrotum, labia, perineum, or anorectal region. A pudendal nerve block is crucial for the diagnosis and treatment of pudendal neuralgia. The pudendal nerve is located between the sacrospinous and sacrotuberous ligaments at the level of ischial spine. Ultrasonography, but not the conventional fluoroscopy, allows visualization of the nerve and the surrounding landmark structures. Ultrasound-guided techniques offer many advantages over the conventional techniques. The ultrasound machine is portable and is more readily available to the pain specialist. It prevents patients and healthcare professionals from the exposure to radiation during the procedure. Because it allows the visualization of a wide variety of tissues, it potentially improves the accuracy of the needle placement, as exemplified by various interventional procedures in the pelvic regions aforementioned.
Pain Physician
PMID:Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of techniques and review of literature. 1852 15

Of patients presenting to pain clinics, complaints are of low back or buttock pain with or without radicular leg symptoms is one of the most common. Piriformis syndrome may be a contributor in up to 8% of these patients. The mainstay of treatment is conservative management with physical therapy, anti-inflammatory medications, muscle relaxants, and correction of biomechanical abnormalities. However, in recalcitrant cases, a piriformis injection of anesthetic and/or corticosteroids may be considered. Because of its small size, proximity to neurovascular structures, and deep location, the piriformis muscle is often injected with the use of commuted tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), fluoroscopy, electrical stimulators, or electromyography (EMG). Numerous techniques have been proposed using one or a combination of the above modalities. However, application of these techniques is limited by unavailability of CT, MRI, and EMG equipment as well as a paucity of trained physicians in US-guided procedures in many pain treatment centers throughout the United States. Fluoroscopy, however, is more widely available in this setting. This study utilized a cadaveric specimen to confirm proper needle placement for piriformis or peri-sciatic injection utilizing the previously documented landmarks for fluoroscopic guidance as described by Betts. An anteroposterior of the pelvis with inclusion of the acetabular region of the hip and the inferior aspect of the sacroiliac joint was obtained. The most superior-lateral aspect of the acetabulum and the inferior aspect of the sacroiliac joint were identified. A marker was placed one-third of the distance from the acetabular location to the inferior sacroiliac joint, indicating the target location. A 22-gauge, 3.5-inch spinal needle was directed through the gluteal muscles to the target location using intermittent fluoroscopic guidance. The posterior ileum was contacted and the needle was withdrawn 1 -2 mm. This approach found the needle within the piriformis muscle belly 2 -3 cm lateral to sciatic nerve. The present study was the first study, to our knowledge, that has confirmed the intramuscular position of the needle within the piriformis muscle of a cadaveric specimen using these anatomic landmarks and fluoroscopic guidance.
Pain Physician
PMID:Confirmation of needle placement within the piriformis muscle of a cadaveric specimen using anatomic landmarks and fluoroscopic guidance. 1852 3

Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.
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PMID:Diagnosis and management of piriformis syndrome: an osteopathic approach. 1901 Dec 29


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