What is piriformis syndrome?

Updated: Nov 03, 2020
  • Author: Mary Louise Caire, MD; Chief Editor: Erik D Schraga, MD  more...
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Piriformis syndrome is a common cause of buttock and posterior leg pain. Pain in these areas can begin spontaneously or after an injury. The symptoms are commonly seen in patients with other inflammatory conditions and in patients who sit for most of their work day.

The pain usually begins when the piriformis muscle becomes taut, tender, and contracted. This process causes a deep aching sensation in the midgluteal region that is sometimes associated with pain radiating down the posterior leg or up to the lower back. The tight piriformis may cause a nerve and vessel entrapment syndrome as a consequence of its close proximity to the sciatic nerve and surrounding vessels.

Piriformis syndrome may constitute as many as 6-8% of low back pain conditions associated with sciatica. [1] Some patients experience symptoms in all five toes (multiple dermatomes) rather than in either lateral toes (S1 radiculopathy) or medial toes (L5 radiculopathy), as is generally the case in patients with herniated lumbar discs. The straight-leg raise (SLR) test is generally negative. Pain in the gluteal area is the predominant symptom. Numbness or weakness is rare. [2]

Piriformis syndrome is frequently a diagnosis of exclusion. Before the diagnosis is made, other causes of gluteal, hip, and leg pain must be ruled out (see Periprocedural Care). Michel et al created a 12-point clinical scoring system for standardization of the diagnosis and development of a treatment plan for piriformis syndrome. [3]

Many forms of therapy, medication, and injections have been used effectively to alleviate the pain associated with piriformis syndrome. This topic describes the most commonly piriform injection techniques (see Technique). [4]

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