What is included in the preprocedural evaluation for piriformis injection?

Updated: Feb 28, 2019
  • Author: Mary Louise Caire, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

Before the diagnosis of piriformis syndrome is made, other causes of gluteal, hip, and leg pain must be ruled out. Various physical testing maneuvers are helpful in making a diagnosis. One such maneuver consists of flexion, passive adduction, and internal rotation of the involved hip with the patient standing (see the first image below) or reclining (see the second and third images below).

Testing for piriformis pain. Involved hip is flexe Testing for piriformis pain. Involved hip is flexed, passively adducted, and internally rotated with patient standing.
Testing for piriformis pain. Involved hip is flexe Testing for piriformis pain. Involved hip is flexed, passively adducted, and internally rotated with patient reclining.
Testing for piriformis pain. Involved hip is flexe Testing for piriformis pain. Involved hip is flexed, passively adducted, and internally rotated with patient reclining.

The Freiberg test (see the first image below) and the Beatty maneuver (see the second image below) are also commonly performed to test for piriformis pain. [8]

Freiberg test. Forceful internal rotation of thigh Freiberg test. Forceful internal rotation of thigh on affected side elicits pain.
Beatty maneuver. Patient lies on uninvolved side a Beatty maneuver. Patient lies on uninvolved side and abducts involved thigh upward, which elicits pain.

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