piriformis_syndrome

Piriformis syndrome (PS) is a sciatic neuropathy condition caused by compression of the sciatic nerve by the piriformis muscle.

The prevalence of PS in patients with low back pain was reported by Bernard et al. as 0.33%, Pace and Nagle as 6% and Parziale as 5% 1) 2) 3).

PS is more prevalent in women than men and this situation was evaluated to be due to the wide angle of the quadratus femoris in the pelvis 4).

Usually depends on individual predisposition or congenital anomalies. However, trauma such as falling in the sitting position or heavy lifting can also trigger the condition. The mechanism here is internal rotation of the hip or sciatic nerve impingement under the tendinous portion of the piriformis muscle due to spasm of the muscle 5) 6).

It has been classified as primary and secondary. While the primary condition is caused by intrinsic pathology originating from the piriformis muscle such as myofascial pain or myositis ossificans as a result of trauma, the secondary condition is caused by other causes of hip pain due to pathology of adjacent structures of the sciatic notch 7) 8).

Is not fully understood. The major etiology was known to be the spasm, edema and inflammation of the piriformis muscle and sciatic nerve compression of the muscle later on.

Patients can be diagnosed immediately with a comprehensive clinical examination and early diagnosis makes the treatment much easier. Diagnosis of the piriformis syndrome, a very rare cause of low back pain, first requires that this syndrome is remembered, and then a differential diagnosis should be performed 9).


1)
Bernard Jr TN, Kirkaldy-Willis WH: Recognizing specific characteristics of nonspecific low back pain. Clin Orthop 217: 266-280, 1987
2)
Pace JB, Nagle D: Piriform syndrome. West J Med 124: 435-439, 1976
3)
Parziale JR, Hudgins TH, Fishman LM: The piriformis syndrome. Am J Orthop 25: 819-823, 1996
4)
Boyajian OL, McClain R: Diagnosis and management of Piriformis Syndrome: An osteopathic Approach. JAOA 108: 657-664, 2008
5)
Barton PM: Piriformis syndrome: A rational approach to management. Pain 47: 345-352, 1991
6)
Hughes SS, Goldstein MN, Hicks DG, Pellegrini VD: Extrapelvic compression of the sciatic nerve. J Bone Joint Surg (Am) 74: 1553-1559, 1992
7)
Robinson DR: Piriformis syndrome in relation to sciatic pain. Am J Surg 73: 335-358, 1947
8)
Yeoman W: The relation of arthritis of the sacroiliac joint to sciatica, with an analysis of 100 cases. Lancet 2: 1119-1122, 1928
9)
Parlak A, Aytekin A, Develi S, Ekinci S. Piriformis syndrome: a case with non-discogenic sciatalgia. Turk Neurosurg. 2014;24(1):117-9. doi: 10.5137/1019-5149.JTN.7904-13.0. PubMed PMID: 24535806.
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