| Piriformis syndrome | |
|---|---|
| Other names | Deep gluteal syndrome[1] |
 | |
| Location of piriformis syndrome within the body | |
| Specialty | Orthopedics, sports medicine |
| Symptoms | Buttock pain that is worse with sitting[2] |
| Duration | Long-term[3] |
| Causes | Trauma, spasms, overuse injury[2] |
| Diagnostic method | Based on symptoms[4] |
| Differential diagnosis | Herniated disc, kidney stones, SI joint dysfunction[3][2] |
| Treatment | Avoiding activities that cause symptoms, stretching, medications[3][5] |
| Medication | NSAIDs, steroids, botulinum toxin injections[2] |
| Frequency | Unknown (2017)[4] |
Piriformis syndrome is a condition which is believed to result from nerve compression at the sciatic nerve by the piriformis muscle.[2][5] It is a specific case of deep gluteal syndrome.[6]
The largest and most bulky nerve in the human body is the sciatic nerve. Starting at its origin it is 2 cm wide and 0.5 cm thick. The sciatic nerve forms the roots of L4-S3 segments of the lumbosacral plexus. The nerve will pass inferiorly to the piriformis muscle, in the direction of the lower limb where it divides into common tibial and fibular nerves.[7] Symptoms may include pain and numbness in the buttocks and down the leg.[2][3] Often symptoms are worsened with sitting or running.[3]
Causes may include trauma to the gluteal muscle, spasms of the piriformis muscle, anatomical variation, or an overuse injury.[2] Few cases in athletics, however, have been described.[2] Diagnosis is difficult as there is no definitive test.[5][4] A number of physical exam maneuvers can be supportive.[3] Medical imaging is typically normal.[2] Other conditions that may present similarly include a herniated disc.[3]
Treatment may include avoiding activities that cause symptoms, stretching, physiotherapy, and medication such as NSAIDs.[3][5] Steroid or botulinum toxin injections may be used in those who do not improve.[2] Surgery is not typically recommended.[3] The frequency of the condition is unknown, with different groups arguing it is more or less common.[4][2]
- ^ Martin HD, Reddy M, Gómez-Hoyos J (July 2015). "Deep gluteal syndrome". Journal of Hip Preservation Surgery. 2 (2): 99–107. doi:10.1093/jhps/hnv029. PMC 4718497. PMID 27011826.
- ^ a b c d e f g h i j k Cass SP (January 2015). "Piriformis syndrome: a cause of nondiscogenic sciatica". Current Sports Medicine Reports. 14 (1): 41–4. doi:10.1249/JSR.0000000000000110. PMID 25574881. S2CID 10621104.
- ^ a b c d e f g h i "Piriformis Syndrome". Merck Manuals Professional Edition. October 2014. Retrieved 30 December 2017.
- ^ a b c d Hopayian K, Danielyan A (23 August 2017). "Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features". European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie. 28 (2): 155–164. doi:10.1007/s00590-017-2031-8. PMID 28836092. S2CID 19275213.
- ^ a b c d Miller TA, White KP, Ross DC (September 2012). "The diagnosis and management of Piriformis Syndrome: myths and facts". The Canadian Journal of Neurological Sciences. 39 (5): 577–83. doi:10.1017/s0317167100015298. PMID 22931697.
that is presumed to be a compression neuropathy of the sciatic nerve at the level of the piriformis muscle
- ^ Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH (May 2020). "Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain". Bone Joint J. 102-B (5): 556–567. doi:10.1302/0301-620X.102B5.BJJ-2019-1212.R1. PMID 32349600. S2CID 217593533.
- ^ Barbosa AB, Santos PV, Targino VA, Silva Nd, Silva YC, Gomes FB, Assis Td (September 2019). "Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?". Arquivos de Neuro-Psiquiatria. 77 (9): 646–653. doi:10.1590/0004-282x20190093. ISSN 1678-4227. PMID 31553395. S2CID 202761655.