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Piriformis muscle syndrome: A cross-sectional imaging study in 116 patients and evaluation of therapeutic outcome

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 19 June 2018

Abstract

Objectives

To increase the clinical awareness of piriformis muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome.

Methods

Within a 10-year-period, 116 patients referred for radiological evaluation of clinically suspected PMs, with excluded lumbar pathology related to symptomatology, were prospectively studied with MRI and/or computed tomography (CT). Piriformis muscle (PM), sciatic nerve (SN), piriformis region and sacroiliac joints were evaluated. PMs was categorised into primary/secondary, according to a reported classification system. Treatment decisions were recorded. Outcome was categorised using a 3-point-scale.

Results

Seventy-four patients (63.8%) exhibited pathologies related to PMs. Primary causes were detected in 12 and secondary in 62 patients. PM enlargement was found in 45.9% of patients, abnormal PM signal intensity/density in 40.5% and sciatic neuritis in 25.7%. Space-occupying lesions represented the most common related pathology. Treatment proved effective in 5/8 patients with primary and 34/51 patients with secondary PMs. In 34 patients, imaging revealed an unknown underlying medical condition and altered treatment planning.

Conclusions

Secondary PMs aetiologies appear to prevail. In suspected PMs, PM enlargement represented the most common imaging finding and space-occupying lesions the leading cause. Imaging had the potential to alter treatment decisions.

Key Points

• In clinically suspected PMs cross-sectional imaging may reveal variable pathology.

• Secondary PMs aetiologies appeared to be more common than primary.

• PM enlargement represented the most common imaging finding in clinically suspected PMs.

• Space-occupying lesions in the piriformis region represented the leading cause of PMs.

• In clinically suspected PMs cross-sectional imaging may alter treatment planning.

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Abbreviations

CT:

Computed tomography

DGS:

Deep gluteal syndrome

MRI:

Magnetic resonance imaging

MRN:

Magnetic resonance neurography

PM:

Piriformis muscle

PMs:

Piriformis muscle syndrome

SN:

Sciatic nerve

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Author information

Authors and Affiliations

  1. Department of Medical Imaging, Heraklion University Hospital, Voutes, 71110, Crete, Greece

    Evangelia E. Vassalou & Apostolos H. Karantanas

  2. Department of Orthopaedics, University Hospital of Heraklion, Voutes, 71110, Crete, Greece

    Pavlos Katonis

  3. Department of Radiology, University of Crete, Voutes, 71110, Crete, Greece

    Apostolos H. Karantanas

Authors
  1. Evangelia E. Vassalou
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  2. Pavlos Katonis
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  3. Apostolos H. Karantanas
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Corresponding author

Correspondence to Apostolos H. Karantanas.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Apostolos H. Karantanas.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study has received funding from the ‘Young Researchers Grant’ awarded by the European Society of Musculoskeletal Radiology (ESSR).

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Study subjects or cohorts overlap

Some study subjects have been previously reported in ECR 2011 (Scientific Paper; Poster No.: C-0772; Title: ‘Primary and secondary piriformis syndrome: a cross sectional imaging study’).

Methodology

• prospective

• observational study

• performed at one institution

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Cite this article

Vassalou, E.E., Katonis, P. & Karantanas, A.H. Piriformis muscle syndrome: A cross-sectional imaging study in 116 patients and evaluation of therapeutic outcome. Eur Radiol 28, 447–458 (2018). https://doi.org/10.1007/s00330-017-4982-x

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  • DOI: https://doi.org/10.1007/s00330-017-4982-x

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