What is Piriformis Syndrome?
Piriformis syndrome, also known as wallet-neuritis and deep gluteal syndrome, is a condition described as chronic pain in the back of the hip and down the leg due to entrapment of the sciatica nerve along a small gluteal muscle called the piriformis. Roughly
2.4 million people are believed to experience piriformis syndrome every year. This condition is mostly observed in middle age populations and tends to be seen in women more than men.
Cause of Piriformis Syndrome:
Piriformis syndrome can be caused by a variety of factors that could lead to compression of the sciatica nerve to lead to pain. Piriformis syndrome is oftentimes a muscular driven condition, where muscle tightness is the main culprit. Piriformis syndrome may also be associated with other painful conditions:
- Disc degenerative disease in the lumbar spine
- Ischiofemoral impingement
- Gluteus medius tear
- Hamstring tear
Symptoms of Piriformis Syndrome
Symptoms of Piriformis syndrome vary, and can include:
- Unilateral pain on the back of the hip and lower leg
- A burning and sharp pain radiating from the hip down the leg
- Increase pain with prolonged sitting
- Tightness and decrease range of motion in the hip
- Pain getting out of bed
Diagnosis of Piriformis Syndrome
As lateral hip, thigh, and knee pain can have several causes, diagnosing Piriformis syndrome requires a variety of tests to be diagnosed confidently. Your doctor will carefully review your symptoms and medical history and perform a physical examination. Diagnostic tests for Piriformis syndrome include:
Physical Examination: A variety of tests can be used to stretch the nerves and muscles associated with piriformis syndrome. A series of provocative tests can be used to rule out other back and hip issues.
MRI Scan: This study uses a large magnetic field and radio waves to produce images of soft tissue and bone that help exclude other possible diagnoses.
X-rays: This study uses electromagnetic beams to exclude other possible diagnoses, such as the presence of stress fractures or bony deformities.
Ultrasound: This study uses high-frequency sound waves to produce images of the tissues.
Treatment for Piriformis Syndrome
Treatment for Piriformis syndrome varies based on age, health, type of damage, and severity. Your doctor may initially recommend conservative treatment to help relieve the symptoms. This plan is usually enough to treat most cases of Piriformis syndrome.
Anti-inflammatory medication: Your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation in the sciatic nerve.
Rest and Activity Modification: Reducing or modifying physical activity can provide time for sciatic nerve to heal.
Ice or Heat: Applying ice or heat can allow the sciatic nerve and tight gluteal muscle to relax..
Injections: Your doctor may recommend steroid injections or platelet-rich plasma (PRP) injections to reduce pain and promote healing.
Physical therapy: After a rest period, exercises are recommended to address muscle imbalances and allow the sciatic to return to normal function.
If conservative treatment methods are ineffective, and if the patient and physician feel necessary, surgical methods can be recommended. Below are possible surgical interventions for Piriformis syndrome:
- Decompression of the sciatic nerve
- Piriformis muscle release
- Neurolysis of the sciatic nerve
Depending on operative findings and procedures performed, rehabilitation from surgery can take several weeks to several months.