Which physical findings are characteristic of piriformis syndrome?

Updated: Dec 21, 2018
  • Author: Shishir Shah, DO; Chief Editor: Sherwin SW Ho, MD  more...
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Piriformis syndrome is a diagnosis of exclusion.

  • At physical examination, the most important factor that differentiates sciatic pain from piriformis syndrome is the absence of neurologic deficit in piriformis syndrome.

  • Herniation or disc compression results in intraneural derangement of the nerve root structure, whereas piriformis syndrome causes a qualitative epineural irritation.

  • In piriformis syndrome, the only true-positive sign is tenderness over the gluteal region. [27]

    • The pain can be reproduced with maximum elongation of the piriformis muscle in flexion, adduction, and internal rotation of the hip.

    • Weakness can be observed with resisted external rotation and abduction of the hip.

  • Several authors describe the use of the following signs in diagnosing piriformis syndrome:

    • Lasegue sign: Pain is present in the vicinity of the greater sciatic notch during extension of the knee with the hip flexed to 90 º, tenderness to palpation of the greater sciatic notch is noted.

    • Pace sign: Pain and weakness are present on resisted abduction-external rotation of the thigh.

    • Freiberg sign: Pain occurs with passive internal rotation of the extended thigh when the patient is supine.

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