Abstract
Piriformis syndrome (PS) is an example of extra-spinal sciatica that is often confused with spinal sciatica (prolapsed lumbar intervertebral disc), which makes diagnosis and treatment delay. The condition is not as rare as we believe; its prevalence is reported to vary between 0.3% and 36% among patients complaining of radiating low back pain. The female has a higher disease predilection; however, men also get the disease significantly. The most common complaint is a deep-seated gluteal pain that gets worse when sitting for a long time; walking usually intensifies the pain, but in chronic PS cases, ambulation may lessen pain. Moreover, Pace sign, FAIR (Flexion- Adduction-Internal Rotation of hip) test, Freiberg test, and Beatty tests are positive. Pain responds partially with analgesics and therapeutic exercise (stretching of piriformis muscle, PM), some may require ultrasound or fluoroscopy-guided steroid and botulinum toxin injections in PM. PS refractory to the above interventions may require surgery. PS is considered a chronic benign condition; however, deep-seated gluteal pain with raised ESR (Erythrocyte Sedimentation Rate), and CRP (C-Reactive Protein) because of piriformis pyomyositis as seen following vaginal delivery is an emergency and should be treated with judicial antibiotics and surgical drainage, where appropriate.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Beauchesne RP, Schutzer SF. Myositis ossificans of the piriformis muscle: an unusual cause of piriformis syndrome. A case report. J Bone Joint Surg. 1997;79:906–910.
Boyajian-O’Neil LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008;108:657–64.
Chang C, Jeno SH, Varacallo M. Anatomy, Bony Pelvis and lower limb: piriformis muscle. Updated 2022 Oct 3. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519497/
Chen CK, Nizar AJ. Prevalence of piriformis syndrome in chronic low back pain patients. A clinical diagnosis with modified FAIR test. Pain Pract. 2013;13:276–281 J 19:2095–2101.
Foster MR. Piriformis syndrome. Orthopedics. 2002;25:821–5.
Fritz J, Chhabra A, Wang KC, Carrino JA. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome. Neuroimaging Clin N Am. 2014;24(1):211–34. https://doi.org/10.1016/j.nic.2013.03.028.
Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001;5:412–20.
Hicks BL, Lam JC, Varacallo M. Piriformis syndrome. Updated 2022 Sep 4. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/
Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systemic review. Eur Spine J. 2010;19:2095–101.
Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, et al. Surgical management of deep gluteal syndrome causing sciatic nerve entrapment: a systematic review. Arthroscopy. 2017;33(12):2263–2278 e1. https://doi.org/10.1016/j.arthro.2017.06.041.
Lutz EG. Credit-card-wallet sciatica. JAMA. 1978;240(8):738 PMID: 671698.
Misirlioglu TO, Palamar D, Akgun K. Letter to the editor involving the article ‘piriformis muscle syndrome: a cross-sectional imaging study in 116 patients and evaluation of therapeutic outcome.’ Eur Radiol. 2018;28(12):5354–5.
Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:210–5.
Payne JM. Ultrasound-Guided hip procedures. Phys Med Rehabil Clin N Am. 2016;27(3):607–29. https://doi.org/10.1016/j.pmr.2016.04.004.
Siahaan YMT, Tiffani P, Tanasia A. Ultrasound-Guided measurement of piriformis muscle thickness to diagnose piriformis syndrome. Front Neurol. 2021;7(12):721966. https://doi.org/10.3389/fneur.2021.721966.
Siddiq MAB. Piriformis syndrome and wallet neuritis: are they the same? Cureus. 2018;10(5):e2606. https://doi.org/10.7759/cureus.2606.
Siddiq AB, Rasker JJ. Piriformis syndrome: still unsolved issues. Int J Clin Rheumatol. 2018;13(6):338–40.
Siddiq MAB, Rasker JJ. Piriformis pyomyositis, a cause of piriformis syndrome-a systematic search and review. Clin Rheumatol. 2019;38(7):1811–21. https://doi.org/10.1007/s10067-019-04552-y.(12).
Siddiq MA, Khasru MR, Rasker JJ. Piriformis syndrome in fibromyalgia: clinical diagnosis and successful treatment. Case Rep Rheumatol. 2014;2014:893836. https://doi.org/10.1155/2014/893836.
Siddiq MA, Hossain MS, Uddin MM, Jahan I, Khasru MR, Haider NM, Rasker JJ. Piriformis syndrome: a case series of 31 Bangladeshi people with literature review. Eur J Orthop Surg Traumatol. 2017;27(2):193–203. https://doi.org/10.1007/s00590-016-1853-0.
Siddiq MAB, Clegg D, Hasan SA, Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain. 2020;33(4):305–17. https://doi.org/10.3344/kjp.2020.33.4.305.
Siddiq MAB, Hossain MS, Khan AUA, Sayed MA, Rasker JJ. Piriformis syndrome in pre-monsoon, monsoon, and winter: an observational pilot study. Cureus. 2023;15(2):e35296. https://doi.org/10.7759/cureus.35296.
Siddiq AB, Jahan I, Alpha M. Wallet neuritis—an example of peripheral sensitization. Curr Rheum Rev. 2017;13(999). https://doi.org/10.2174/1573397113666170310100851.
Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth. 2007;99:461–73.
Vij N, Kiernan H, Bisht R, Singleton I, Cornett EM, Kaye AD, Imani F, Varrassi G, Pourbahri M, Viswanath O, Urits I. Surgical and non-surgical treatment options for piriformis syndrome: a literature review. Anesth Pain Med. 2021;11(1):e112825. https://doi.org/10.5812/aapm.112825.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Abu Bakar Siddiq, M., Jahan, I., Rasker, J.J. (2023). Piriformis Syndrome: Epidemiology, Clinical features, Diagnosis, and Treatment. In: Iyer, K.M. (eds) Piriformis Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-031-40736-9_15
Download citation
DOI: https://doi.org/10.1007/978-3-031-40736-9_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-40735-2
Online ISBN: 978-3-031-40736-9
eBook Packages: MedicineMedicine (R0)