Which physical findings are characteristic of piriformis syndrome?

Updated: Sep 16, 2020
  • Author: Milton J Klein, DO, MBA; Chief Editor: Ryan O Stephenson, DO  more...
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Examination findings may include the following:

  • Piriformis muscle spasm often is detected by careful, deep palpation.

  • The reproduction of sciatica-type pain with weakness results from resisted abduction/external rotation (Pace test). [2]

  • The Freiberg test is another diagnostic sign that elicits pain, upon forced internal rotation of the extended thigh. [3]

  • The Beatty maneuver reproduces buttock pain by selectively contracting the piriformis muscle. [4] The patient lies on the uninvolved side and abducts the involved thigh upward; this activates the ipsilateral piriformis muscle, which is a hip external rotator and, when the hip is flexed, an abductor.

  • Some specialists may include a digital rectal examination, which may reveal a tenderness on the lateral pelvic wall that reproduces piriformis symptoms; this procedure is less commonly performed, as it is uncomfortable and leads to a nonspecific finding.

  • A painful point may be present at the lateral margin of the sacrum.

  • Shortening of the involved lower extremity may be seen.

  • The patient may have difficulty sitting due to an intolerance of weight bearing on the buttock.

  • The patient may have the tendency to demonstrate a splayed foot on the involved side when in the supine position.

  • Piriformis syndrome alone is rarely the cause of a focal neuromuscular impairment; either a sciatic mononeuropathy or an L5-S1 radiculopathy can mimic both of these conditions, obscuring diagnosis of piriformis syndrome.

  • A Morton foot may predispose the patient to developing piriformis syndrome. The prominent second metatarsal head destabilizes the foot during the push-off phase of the gait cycle, causing foot pronation and internal rotation of the lower limb. As a compensatory mechanism, the piriformis muscle (external hip rotator) reactively contracts repetitively during each push-off phase of the gait cycle , leading to piriformis syndrome.

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