Skip to main content

Advertisement

SpringerLink
Log in

Surgical evaluation of magnetic resonance imaging findings in piriformis muscle syndrome

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The objective of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of the piriformis muscle syndrome (PMS).

Materials and Methods

In ten patients, seven female and three male, with a long history of clinical symptoms of the PMS, an MRI was performed as the last preoperative diagnostic tool. All patients were imaged using 2T MR system (Elscint, Haifa, Israel). Axial and coronal spin-echo, fast spin-echo (FSE), and fat-suppressed FSE-weighted images were made through the pelvic region with 3-mm section thickness and a 0.5-mm gap to show the whole piriformis muscle and the course of sciatic nerve on its way out of the pelvis. A routine examination also included axial fast spin-echo T2, three-dimensional gradient echo.

Results

In seven cases, an MRI abnormality for the PMS was found. In two women, the MRI demonstrated a bigastric appearance of the piriformis muscle with a tendinous portion between the muscle heads and the course of the common peroneal nerve through the muscle between the tendinous portions of the muscle. In one female patient, the common peroneal nerve passed through the hypertrophied piriformis muscle. In four patients, the MRI showed a hypertrophied aspect of the piriformis muscle and an anteriorly displaced sciatic nerve. All MRI findings were confirmed surgically. In three patients, no apparent abnormalities could be observed, but after a surgical treatment, i.e., a tenotomy of the piriformis muscle and neurolysis of the sciatic nerve, all symptoms disappeared.

Conclusion

In piriformis muscle syndrome, MRI may demonstrate signal abnormalities of the sciatic nerve as well as its relationship with the normal and abnormal piriformis muscle.

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

Similar content being viewed by others

References

  1. Pecina MM, Krmpotic-Nemanic J, Markiewitz AD. Tunnel syndromes. Peripheral nerve compression syndromes. Boca Raton: CRC Press; 2001.

    Google Scholar 

  2. Pecina M. Contribution to the etiological explanation of the piriformis muscle syndrome. Acta Anat (Basel) 1979; 105: 181–187.

    Article  CAS  Google Scholar 

  3. Parziale JR, Hudgins TH, Fishman LM. The piriformis syndrome. Am J Orthop 1996; 25: 819–823.

    CAS  PubMed  Google Scholar 

  4. Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am 1999; 81: 941–949.

    Article  CAS  Google Scholar 

  5. Barton PM. Piriformis syndrome: a rational approach to management. Pain 1991; 47: 345–352.

    Article  CAS  Google Scholar 

  6. Jankiewicz JJ, Hennrikus WL, Houkom JA. The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature. Clin Orthop Relat Res 1991; 262: 205–209.

    Google Scholar 

  7. Kosukegawa I, Yoshimoto M, Isogai S, Nonaka S, Yamashita T. Piriformis syndrome resulting from a rare anatomic variation. Spine 2006; 31: E664–E666.

    Article  Google Scholar 

  8. Lee EY, Margherita AJ, Gierada DS, Narra VR. MRI of piriformis syndrome. AJR Am J Roentgenol 2004; 183: 63–64.

    Article  Google Scholar 

  9. Lewis AM, Layzer R, Engstrom JW, Barbaro NM, Chin CT. Magnetic resonance neurography in extraspinal sciatica. Arch Neurol 2006; 63: 1469–1472.

    Article  Google Scholar 

  10. Rossi P, Cardinali P, Serrao M, Parisi L, Bianco F, De Bac S. Magnetic resonance imaging findings in piriformis syndrome: a case report. Arch Phys Med Rehabil 2001; 82: 519–521.

    Article  CAS  Google Scholar 

  11. Sayson SC, Ducey JP, Maybrey JB, Wesley RL, Vermilion D. Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain 1994; 59: 149–152.

    Article  CAS  Google Scholar 

  12. Yeoman W. The relation of arthritis of the sacroiliac joint to sciatica. Lancet 1928; 2: 1119–1122.

    Article  Google Scholar 

  13. Freiberg AH, Vinke TH. Sciatica and the sacroiliac joint. J Bone Joint Surg Am 1934; 16: 126–136.

    Google Scholar 

  14. Robinson D. Piriformis syndrome in relation to sciatic pain. Am J Surg 1947; 73: 355–358.

    Article  CAS  Google Scholar 

  15. Pace JB, Nagle D. Piriformis syndrome. West J Med 1976; 124: 435–439.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Ozaki S, Hamabe T, Muro T. Piriformis syndrome resulting from an anomalous relationship between the sciatic nerve and piriformis muscle. Orthopedics 1999; 22: 771–772.

    CAS  PubMed  Google Scholar 

  17. Spinner RJ, Thomas NM, Kline DG. Failure of surgical decompression for a presumed case of piriformis syndrome. Case report J Neurosurg. 2001; 94: 652–654.

    CAS  PubMed  Google Scholar 

  18. Vandertop WP, Bosma NJ. The piriformis syndrome. A case report. J Bone Joint Surg Am 1991; 73: 1095–1097.

    Article  CAS  Google Scholar 

  19. Beatty RA. The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurgery 1994; 34: 512–514.

    Article  CAS  Google Scholar 

  20. Fishman LM, Zybert PA. Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil 1992; 73: 359–364.

    Article  CAS  Google Scholar 

  21. Rosenberg SZ, Cavalcanti CFA. Entrapment neuropathy of the lower extremity. In: Stoller, DW, editors. Magnetic resonance imaging in orthopaedics and sports medicine. Philadelphia: Lippincott Williams and Wilkins/Wolters Kluwer Business; 2007. p. 1061–1065.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Clinical Hospital “Sestre Milosrdnice”, Vinogradska 29, 10000, Zagreb, Croatia

    Hrvoje Ivan Pecina & Igor Boric

  2. Department of Orthopedic Surgery, School of Medicine, University of Zagreb, Salata 7, 10000, Zagreb, Croatia

    Tomislav Smoljanovic & Marko Pecina

  3. Outpatients Clinic and Clinic for Diagnostic Procedures, Nemetova 2, 10000, Zagreb, Croatia

    Davor Duvancic

Authors
  1. Hrvoje Ivan Pecina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Igor Boric
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomislav Smoljanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Davor Duvancic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marko Pecina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marko Pecina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pecina, H.I., Boric, I., Smoljanovic, T. et al. Surgical evaluation of magnetic resonance imaging findings in piriformis muscle syndrome. Skeletal Radiol 37, 1019–1023 (2008). https://doi.org/10.1007/s00256-008-0538-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-008-0538-0

Keywords

Search

Navigation