Piriformis Syndrome

By Adam Shuster, DO Pain Management Consultants of SWFL –

Piriformis SyndromePiriformis syndrome is a painful condition affecting 5-6% of patients referred for low back and leg pain.  There are many causes of piriformis syndrome. Piriformis syndrome can occur in patients after surgery, trauma to the buttock or pelvis, or in patients with a leg length discrepancy. Trauma to the buttock can lead to inflammation and spasm of the piriformis muscle. Occasionally, an enlarged piriformis muscle can compress or irritate the sciatic nerve.

Patients with piriformis syndrome may have pain in the region of the sacroiliac joint. The pain may radiate from the buttocks to the leg and may cause difficulty in walking. Bending or lifting can also exacerbate the pain. Patients may also have a tender sausage-shaped mass over the piriformis syndrome.

The diagnosis of piriformis syndrome may be aided by obtaining a CT scan, MRI, or electromyography (EMG). Other painful conditions, which may mimic piriformis syndrome, include radiculopathy and other causes of low back pain. However, patients typically do not suffer from weakness or numbness in piriformis syndrome, unless the sciatic nerve is affected or irritated.

Treatment of piriformis syndrome includes physical therapy, muscle relaxants, anti-inflammatory agents, and other analgesics. Physical therapy may focus on correcting any biomechanical abnormalities, such as fixing posture, pelvic tilt, and leg length discrepancies. Patients who fail conservative treatment may benefit from injection with steroid and local anesthetic. The injection may help decrease irritation of the sciatic nerve and break the pain/spasm cycle of the piriformis muscle.

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