Piriformis Syndrome

By Laura Sandve&

Andy Coleman

• Sciatica symptoms due to an involvement of the piriformis muscle

• Often referred to as “Wallet Sciatica” or “Fat Wallet Syndrome”

• Entrapment of one or more nerves– Sciatic– Pudendal

Pathophysiology

• Tightness or spasms of the piriformis• Trauma to the piriformis• Weak gluteals• Sitting on thick wallet for long

periods of time

Possible Causes

• Higher incidence in females– 6:1 ratio

• Total hip arthroplasty• Excessive pronation• Strengthening without stretching• Sciatic nerve passing through the

piriformis– About 15-30% of the population

Risks

• Sciatic Entrapment– Pain, tingling, numbness• Buttocks, posterior thigh, hip, leg

– Radiating

• Tenderness in the area of the sciatic notch

Signs and Symptoms

• Pudendal Entrapment– Pain, tingling, numbness• Coccyx, groin

–May cause bowel and/or bladder incontinence

Signs and Symptoms

• Beatty Maneuver

• Freiberg Test– Pictured

• Pace Test

• Muscle injections– Usually an anesthetic and Cortizone

Diagnosing

• Generally very easy to treat• Surgery is rarely recommended but is

generally very successful• Patient’s whose sciatic nerve runs

through the piriformis muscle are more susceptible to repetitive piriformis syndrome

Prognosis

• Non-operative–Modalities

• Massage, Ultrasound ice, heat

– Gait training– Stretching

• Piriformis, external rotators, IT band

– Strengthening• Gluteals, Adductors, Abductors

– NSAID’s

Treatment

• Operative– Not common– Surgical release of the piriformis– Generally a posterior approach–WBAT post surgery for 2 weeks

Treatment

Bibliography• Kisner, Carolyn. Colby, Lynn Allen. Therapeutic Exercise:

Fifth Edition. Philadelphia: F.A. Davis Company, 2007• Mid-Tennessee Bone & Joint Clinic P.C. 2006. 22 November

2010 <http://www.mtbj.net/pdf/PiriformisSyndrome.pdf>• eMedicine: Piriformis Syndrome. 31 March 2010. 22

November 2010 <http://emedicine.medscape.com/article/308798-overview>

• Piriformis Syndrome. 9 November 2010. 19 November 2010 <http://en.wikipedia.org/wiki/Piriformis_syndrome>