Skip to main content
SpringerLink
Log in

Piriformis muscle syndrome with assessment of sciatic nerve using diffusion tensor imaging and tractography: a case report

  • Case Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Piriformis muscle syndrome (PMS) is difficult to diagnose by objective evaluation of sciatic nerve injury. Here we report a case of PMS diagnosed by diffusion tensor imaging (DTI) and tractography of the sciatic nerve, which can assess and visualize the extent of nerve injury. The patient was a 53-year-old man with a 2-year history of continuous pain and numbness in the left leg. His symptoms worsened when sitting. Physical examination, including sensorimotor neurologic tests, the deep tendon reflex test, and the straight leg raise test, revealed no specific findings. The hip flexion adduction and internal rotation test and resisted contraction maneuvers for the piriformis muscle were positive. There were no abnormal findings on magnetic resonance imaging (MRI) of the lumbar spine. The transverse diameter of piriformis muscle was slightly thicker in affected side on MRI of the pelvis. A single DTI sequence was performed during MRI of the pelvis. Fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) of the sciatic nerve were quantified at three levels using the fiber-tracking method. FA values were significantly lower and ADC values were significantly higher distal to the piriformis muscle. We performed endoscopic-assisted resection of the piriformis tendon. Intraoperatively, the motor-evoked potentials in the left gastrocnemius were improved by resection of the piriformis tendon. The patient’s symptoms improved immediately after surgery. There was no significant difference in FA or ADC at any level between the affected side and the unaffected side 3 months postoperatively. MRI-DTI may aid the diagnosis of PMS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. 1987;217:266–80.

    Google Scholar 

  2. Pace JB, Nagle D. The piriformis syndrome. West J Med. 1976;124:435–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Fishman LM, Dombi GW, Michaelsen C, et al. Piriformis syndrome: diagnosis, treatment, and outcome: a 10-year study. Arch Phys Med Rehabil. 2002;83:295–301. doi:10.1053/apmr.2002.30622.

    Article  PubMed  Google Scholar 

  4. Beatty RA. The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurgery. 1994;34:512–4.

    Article  CAS  PubMed  Google Scholar 

  5. Michel F, Decavel P, Toussirot E, et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56:371–83. doi:10.1016/j.rehab.2013.04.003.

    Article  CAS  PubMed  Google Scholar 

  6. Pecina HI, Boric I, Smoljanovic T, et al. Surgical evaluation of magnetic resonance imaging findings in piriformis muscle syndrome. Skelet Radiol. 2008;37:1019–23. doi:10.1007/s00256-008-0538-0.

    Article  Google Scholar 

  7. Filler AG, Haynes J, Jordan SE, et al. Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine. 2005;2:99–115. doi:10.3171/spi.2005.2.2.0099.

    Article  PubMed  Google Scholar 

  8. Basser PJ, Mattiello J, LeBihan D. MR diffusion tensor spectroscopy and imaging. Biophys J. 1994;66:259–67. doi:10.1016/S0006-3495(94)80775-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kabakci N, Gürses B, Firat Z, et al. Diffusion tensor imaging and tractography of median nerve: normative diffusion values. Am J Roentgenol. 2007;189:923–7. doi:10.2214/AJR.07.2423.

    Article  Google Scholar 

  10. Balbi V, Budzik JF, Duhamel A, Bera-Louville A, Le Thuc V, Cotton A. Tractography of lumbar nerve roots: initial results. Eur Radiol. 2011;21:1153–9. doi:10.1007/s00330-010-2049-3.

    Article  PubMed  Google Scholar 

  11. Wada K, Hashimoto T, Miyagi R, Sakai T, Sairyo K. Diffusion tensor imaging and tractography of the sciatic nerve: assessment of fractional anisotropy and apparent diffusion coefficient values relative to the piriformis muscle, a preliminary study. Skelet Radiol. 2017;46:309–14. doi:10.1007/s00256-016-2557-6.

    Article  Google Scholar 

  12. Miyagi R, Sakai T, Yamabe E, Yoshioka H. Consecutive assessment of FA and ADC values of normal lumbar nerve roots from the junction of the dura mater. BMC Musculoskelet Disord. 2015;16:156. doi:10.1186/s12891-015-0576-4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Smith J, Hurdle MF, Locketz AJ, Wisniewski SJ. Ultrasound-guided piriformis injection: technique description and verification. Arch Phys Med Rehabil. 2006;87:1664–7. doi:10.1016/j.apmr.2006.08.337.

    Article  PubMed  Google Scholar 

  14. Eguchi Y, Oikawa Y, Suzuki M, et al. Diffusion tensor imaging of radiculopathy in patients with lumbar disc herniation: preliminary results. Bone Joint J. 2016;98-B:387–94. doi:10.1302/0301-620X.98B3.36036.

    Article  CAS  PubMed  Google Scholar 

  15. Wang H, Ma J, Zhao L, Wang Y, Jia X. Utility of MRI diffusion tensor imaging in carpal tunnel syndrome: a meta-analysis. Med Sci Monit. 2016;22:736–42. doi:10.12659/MSM.895758.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bernabeu Á, López-Celada S, Alfaro A, Mas JJ, Sánchez-González J. Is diffusion tensor imaging useful in the assessment of the sciatic nerve and its pathologies? Our clinical experience. Br J Radiol. 2016;89:20150728. doi:10.1259/bjr.20150728.

    Article  PubMed  Google Scholar 

  17. Yamasaki T, Fujiwara H, Oda R, et al. In vivo evaluation of rabbit sciatic nerve regeneration with diffusion tensor imaging (DTI): correlations with histology and behavior. Magn Reson Imaging. 2015;33:95–101. doi:10.1016/j.mri.2014.09.005.

    Article  PubMed  Google Scholar 

  18. Hernando MF, Cerezal L, Pérez-Carro L, Abascal F, Canga A. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skelet Radiol. 2015;44:919–34. doi:10.1007/s00256-015-2124-6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan

    Keizo Wada, Tomohiro Goto, Tomoya Takasago, Daisuke Hamada & Koichi Sairyo

Authors
  1. Keizo Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomohiro Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomoya Takasago
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daisuke Hamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koichi Sairyo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keizo Wada.

Ethics declarations

Funding

This case study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this case involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wada, K., Goto, T., Takasago, T. et al. Piriformis muscle syndrome with assessment of sciatic nerve using diffusion tensor imaging and tractography: a case report. Skeletal Radiol 46, 1399–1404 (2017). https://doi.org/10.1007/s00256-017-2690-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2690-x

Keywords

Search

Navigation