Piriformis syndrome: a cause of nondiscogenic sciatica

Area of Science:

• Neurology
• Orthopedics
• Pain Medicine

Background:

• Piriformis syndrome is a common cause of sciatica, distinct from spinal disc issues.
• Characterized by sciatic nerve compression within or near the piriformis muscle.
• Symptoms include sciatica, buttock pain, and exacerbation with sitting.

Purpose of the Study:

• To review the diagnosis and management of piriformis syndrome.
• To highlight key clinical findings and diagnostic challenges.
• To outline conservative and interventional treatment options.

Main Methods:

• Clinical presentation and diagnostic signs (e.g., Freiberg, Pace signs).
• Role of imaging and neurodiagnostic studies in excluding other causes.
• Review of conservative therapies (medication, physiotherapy) and interventional procedures.

Main Results:

• Neurological examinations and straight leg raise tests are typically normal.
• Physical maneuvers involving hip flexion, adduction, and internal rotation can elicit pain.
• Conservative treatments are effective for most patients; injections and surgery are for refractory cases.

Conclusions:

• Piriformis syndrome requires differentiation from other sciatica etiologies.
• A combination of clinical assessment and targeted interventions guides management.
• Surgical options like tenotomy offer solutions for non-responsive conditions.