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synonyms: deep gluteal syndrome
Piriformis Syndrome ICD-10
- G57.00 - Lesion of sciatic nerve, unspecified lower limb
- G57.01 - Lesion of sciatic nerve, right lower limb
- G57.02 - Lesion of sciatic nerve, left lower limb
- M62.838 Other muscle spasm
Piriformis Syndrome ICD-9
- 355.0 (lesion of sciatic nerve)
Piriformis Syndrome Etiology / Epidemiology / Natural History
- Extrapelvic sciatic sciatic nerve compression in the area of the greater sciatic notch of the pelvis.
- Post-traumtic piriformis syndrome is associated with blunt trauma to the buttock
Piriformis Syndrome Anatomy
- Thought to result from compression of the sciatic nerve, gluteal nerves, posterior femoral cutaneous nerve or pudendal nerve by the piriformis muscle or by obturator internus/gemelli
Piriformis Syndrome Clinical Evaluation
- Symptoms are non-specific
- Pain/dysethesias in gluteal region +/- radiation into hip/posterior thigh/down leg
- +/- history of trauma
- May have buttock or thigh pain as only symptom
- tenderness in sciatic notch
- Flexion, adduction, and internal rotation exacerbates symptoms
- palpable tender mass over piriformis if present is pathognomonic (Robinson DR, Am J Surg 1947;73:355)
- Lasegue's sign: pain in the vacinity of the greater sciatic notch with extension of the knee with the hip flexed to 90 degrees and tenderness to palpation of the greater sciatic notch
- Frieberg's sign: pain with passive internal rotation of the hip
- Pace's sign: pain and weakness in association with resisted abduction and external rotation of the affected thigh. (Pace JB, Western J Med 1976;124:435)
- may have intolerance to sitting
Piriformis Syndrome Xray / Diagnositc Tests
- A/P pelvis, A/P and lateral of affected hip will be normal
- MRI is useful to r/o other diagnoses and should be normal
- CT may show asymmetrical enlargement of the piriformis muscle. (Jankiewicz, JJ Clin Orthop 1991;262:205)
- EMG/NCV can document nerve impingement. Often normal at rest, but become abnormal with hip flexion/IR (Fishman L Arch Phys Med Rehabil 1992;73:359)
- Diagnosis can be confirm by fluoroscopic or electomyographic assisted anesthetic injections immediately alleviating symptoms
Piriformis Syndrome Classification / Treatment
- Rest, NSAIDs, muscle relaxants, physical therapy aimed at stretching the piriformis and short external rotators
- Consider piriformis anesthetic/corticosteroid injection
- Surgery = sectionoing piriformis at its origin, release of any fibrous bands and external sciatic neurolysis (Benson ER, JBJS 1999;81A:941)
Piriformis Syndrome Associated Injuries / Differential Diagnosis
Piriformis Syndrome Complications
- Sciatic nerve palsy
- Vascular injury
- Infection
- Hematoma
Piriformis Syndrome Follow-up Care
Piriformis Syndrome Review References
- Fishman L, Dombi G, Michealsen C, et al: Piriformis syndrome: Diagnosis, treatment, and outcome. A 10 year study; Arch Phys Med Rehabil 2002;83:295-301
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