Piriformis Syndrome is a clinical condition of sciatic nerve entrapment at the level of ischial tuberosity.
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2. Contents
• Anatomy of Piriformis muscle
• Introduction
• Clinical picture
• Aetiology
• Pathophysiology
• History and Evaluation
• Management
3. Anatomy of Piriformis muscle
❑ Piriformis muscle is flat, oblique,
and pyramidal-shaped.
❑ Origin: Anterior to the vertebrae
(S2-S4), superior margin of greater
sciatic foramen, and Sacro tuberous
ligament.
❑ Crosses greater sciatic notch
❑ Insertion: Attaches to greater
trochanter of hip bone.
❑ Nerve supply: L5, S1, and S2.
❑ Action: Extension of hip, prime
mover for external rotation when
flexed hip, hip adductor.
4. Introduction
❑ Piriformis Syndrome is a clinical
condition of sciatic nerve entrapment at
the level of ischial tuberosity.
❑ Thereby, resulting in inflammation.
❑ This condition is not seen very
commonly. It’s prevalence ranges from
0.3% to 6% in lower back pain cases.
❑ Usually occurs in middle aged
individuals and the ratio for female :
male is 1:6.
5. Clinical Picture
❑ Is fairly consistent, with patients reporting
pain in gluteal/ buttock region that may
“shoot”, burn, or ache down the back of
the leg (similar to sciatic pain).
❑ Numbness in buttocks and tingling
sensations along the distribution of sciatic
nerve ( Reason: The nerve runs adjacent to
the muscle; and when inflamed or irritated,
it also affects sciatic nerve)
6. Difference between Sciatica and
Piriformis Syndrome
Sciatica
➢ It is caused by herniated disk or
spinal canal stenosis.
➢ It affects lower back and can travel
down through buttocks and leg.
Piriformis Syndrome
➢ Piriformis muscle is compression
one area of sciatic nerve in the
buttock.
7. Types
Primary Piriformis Syndrome
• It has an anatomical cause, with
variations such as a split piriformis
muscle, split sciatic nerve, or
anomalous sciatic nerve path.
Secondary Piriformis Syndrome
• Usually occurs as a result of a
precipitating cause, including
microtrauma, ischemic mass effect,
or local ischemia.
8. Aetiology
1. Trauma to the hip or buttock area
2. Piriformis muscle hypertrophy (especially in athletes)
3. Sitting for prolong period
4. Anatomic anomalies
9. Pathophysiology
Piriformis muscle is overused, irritated, inflamed,
stressed due to poor body posture chronically or
sudden acute injury
Irritates the adjacent sciatic nerve
Entrapped anteriorly to muscle or posteriorly to
gemelli- obturator internus complex.
10. History and Evaluation
• Patient may present with:
1) Chronic pain in buttock and hip area
2) Pain when getting out of bed
3) Inability to sit for prolonged time
4) Pain in the buttocks that is worsened by hip movements
• Patients will often present with sciatica symptoms- radiating into the back
of the thigh, but can occur in lower leg at dermatomes L5-S1.
• Complain for buttock pain
• ON PALPATION- Mild to moderate tenderness at sciatic notch
11. Special test: Piriformis test
✓Patient position- Side lying with the leg uppermost.
Patient flexes
the test hip to
60 degrees
with knee
flexion.
Examiner
stabilises the
hip and gives
downward
pressure to the
knee.
Tight
piriformis-
pain elicited in
the muscle; if it
pinches sciatic
nerve- buttock
pain and
sciatica may be
experienced.
12. Diagnostic Tests
i. Ultrasound
ii. CT
iii. EMG
iv. To rule out facet arthropathy, herniated nucleus pulposus, lumbar muscle
strain, and spinal stenosis.
13. Management
I. Short-term rest (not more than
hours)
II. Muscle relaxants
III. NSAIDS
IV. Physical therapy- Stretching of
piriformis muscle, range of motion
exercises, and deep tissue massage)
