Piriformis syndrome is characterized by pain caused when the piriformis muscle impinges the sciatic nerve. Pain may be felt in the affected buttock, thigh and leg because the pain travels within the distribution of the sciatic nerve. The sciatic nerve branches out from the lumbar (low back) spine and passes through the piriformis muscle.
The piriformis muscle runs from the sacrum to the greater trochanter, which is the outer part of your upper femur (thigh). The sciatic nerve runs either through or under the piriformis muscle as it leaves the spine. Spasm or irritation of the piriformis muscle can impinge the sciatic nerve and cause pain.
Piriformis syndrome affects many different people such as athletes, patients who have undergone surgery in or near the area of the piriformis muscle. Sometimes the cause is not known.
Diagnosis
- History and physical exam.
- X-rays of the lumbar spine and hips may help rule out other problems
- Magnetic resonance imaging (MRI) is performed to view the lumbar spine and pelvic structures in much more detail.
- Fluoroscopic (x-ray) guided injections. The most accurate way to tell if the piriformis muscle is the cause of pain is with an injection into the muscle. Once the needle is placed in the muscle, an anesthetic can be injected into the muscle to paralyze the piriformis muscle. If the pain goes away after the injection, your physician can be reasonably sure that the pain you are feel is from piriformis syndrome.
Treatment
Most cases of piriformis syndrome may be treated without surgery. Treatment for piriformis syndrome focuses on trying to restore the normal pathway of the sciatic nerve through or around the muscle. Typical treatments for piriformis syndrome include:
- Physical therapy and exercise: Beneficial in restoring pelvic muscle balance by achieving improved flexibility and strength of the pelvic, abdominal, and lower extremity musculature. Typically, patients will begin physical therapy and achieve their best results following their first piriformis muscle injection.
- Chiropractic manipulations may be beneficial in restoring pelvic muscle balance
- Piriformis muscle injections: Injections of local anesthetic and steroid under live x-ray guidance temporarily paralyzes the muscle and relieves the compression of the sciatic nerve. Often, the injection must be repeated over a 6 to 8 week period while the patient simultaneously participates in physical therapy.
Surgery
It may take months of intensive therapy to restore normal function to your pelvis. For only the most resistant cases, patients may benefit from surgery. Surgery may be considered but usually only as a last resort. The piriformis tendon may be cut where it attaches on the greater trochanter (the bump on the side of your hip). Another approach is to cut through the piriformis muscle to take pressure off the sciatic nerve.
To Learn More
If you have been diagnosed with piriformis syndrome, or are interested in learning about treatment options to manage your pain, please contact our pain management experts at the California Spine and Pain Institute. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.
