II. Definitions

  1. Piriformis Syndrome
    1. Sciatic nerve impingement by the piriformis Muscle (subset of Deep Gluteal Syndrome)

III. Causes

  1. Anatomic variant (sciatic nerve passes through piriformis Muscle in 15% of patients)
  2. Decreased core Muscle Strength (buttocks)
  3. Sacroiliac Joint Dysfunction
  4. Local Trauma to piriformis Muscle
  5. Pressure from wallet in pocket

IV. Symptoms

  1. Posterior Hip Pain and buttock pain
  2. Pain worse with sitting
  3. Sciatica
    1. Burning pain radiating down posterior leg

V. Signs

  1. Pain on Internal rotation of hip against resistance
  2. Seated piriformis stretch may exacerbate pain

VI. Diagnostics

  1. Consider MRI or electrodiagnostic nerve testing to identify entrapment location in refractory cases

VII. Management

  1. Local measures (e.g. ice or heat)
  2. NSAIDs
  3. Core Muscle StrengtheningExercises (see resources below)
  4. Correct comorbid conditions (e.g. Sacroiliac Joint Dysfunction)
  5. Local Corticosteroid Injection

VIII. Resources

  1. Piriformis Syndrome Stretches (Cleveland Clinic)
    1. https://health.clevelandclinic.org/piriformis-syndrome-stretches-exercises
  2. Piriformis Syndrome Exercises (Bob and Brad)
    1. https://www.youtube.com/watch?v=DsHvuYMt45g

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