Piriformis syndrome: Difference between revisions
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*Provocative testing with Freiburgs test: placing hip in extension and internal rotation, and then resisting external rotation | *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 | **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== | ||
Revision as of 14:52, 14 December 2020
Background
- Irritation of the sciatic nerve from the piriformis muscle
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