Piriformis syndrome: Difference between revisions
(Text replacement - "==References== " to "==References== <references/> ") |
|||
| (10 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
* | [[File:Piriformis syndrome.jpg|thumb|Piriformis muscle in relation to sciatic nerve.]] | ||
*The piriformis muscle acts as an external rotator, weak abductor, and weak flexor of the hip | |||
*It originates from the anterior sacrum and inserts on the greater trochanter of the femur | |||
*The sciatic nerve typically exits the greater sciatic foramen deep along the inferior surface of the piriformis muscle, but in approximately 20% of people, the sciatic nerve pierces the piriformis muscle <ref>Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach. J Am Osteopath Assoc 2008;108(11):657–664.</ref> | |||
*Local inflammation of the piriformis can cause muscular compression or irritation of the sciatic nerve causing local or radicular pain | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 11: | Line 15: | ||
==Evaluation== | ==Evaluation== | ||
*May have palpable, tender mass over piriformis muscle | *May have palpable, tender mass over piriformis muscle | ||
* | *Consider when patient has classic signs of lumbar radiculopathy with negative provocative testing, normal neurologic exam | ||
*Provocative testing with Freiburgs test: placing hip in extension and internal rotation, and then resisting external rotation | |||
**Pain or sciatic symptoms yield a positive test | |||
*Consider XR or outpatient MRI to rule out other causes of gluteal and sacroiliac pain | |||
==Management== | ==Management== | ||
*Conservative | *Conservative | ||
**Avoidance of contributory activity (e.g. running, cycling, heavy lifting) | |||
**Physical therapy | |||
**[[NSAIDs]] +/- [[gabapentin]] if patient has neuropathic pain | |||
*May benefit from referral for steroid or botulinum toxin injection <ref>Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep. 2015 Jan;14(1):41-4. doi: 10.1249/JSR.0000000000000110. PMID: 25574881.</ref> | |||
==Disposition== | |||
*Outpatient | |||
==See Also== | |||
==External Links== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Neurology]] | |||
Latest revision as of 16:46, 12 January 2021
Background
- The piriformis muscle acts as an external rotator, weak abductor, and weak flexor of the hip
- It originates from the anterior sacrum and inserts on the greater trochanter of the femur
- The sciatic nerve typically exits the greater sciatic foramen deep along the inferior surface of the piriformis muscle, but in approximately 20% of people, the sciatic nerve pierces the piriformis muscle [1]
- Local inflammation of the piriformis can cause muscular compression or irritation of the sciatic nerve causing local or radicular pain
Clinical Features
- Pain in area of buttocks and hamstring muscles
- Worsened by sitting, climbing stairs, or squatting
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
- May have palpable, tender mass over piriformis muscle
- Consider when patient has classic signs of lumbar radiculopathy with negative provocative testing, normal neurologic exam
- Provocative testing with Freiburgs test: placing hip in extension and internal rotation, and then resisting external rotation
- Pain or sciatic symptoms yield a positive test
- Consider XR or outpatient MRI to rule out other causes of gluteal and sacroiliac pain
Management
- Conservative
- Avoidance of contributory activity (e.g. running, cycling, heavy lifting)
- Physical therapy
- NSAIDs +/- gabapentin if patient has neuropathic pain
- May benefit from referral for steroid or botulinum toxin injection [2]
Disposition
- Outpatient
See Also
External Links
References
- ↑ Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach. J Am Osteopath Assoc 2008;108(11):657–664.
- ↑ Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep. 2015 Jan;14(1):41-4. doi: 10.1249/JSR.0000000000000110. PMID: 25574881.