Piriformis Syndrome and Wallet Neuritis: Are They the Same?

Piriformis syndrome (PS) involves the piriformis muscle and adjacent sciatic nerve, producing features similar to true sciatica of lumbar spine origin, for example, lumbar disc prolapse, thereby confusing pain physicians about the diagnosis. Synonyms that are used frequently for PS are deep gluteal syndrome, extra-spinal sciatica, wallet neuritis, etc. Commonly presenting symptoms of PS include gluteal pain which increases with affected side sitting/per-rectal manoeuvre, and improves with ambulation/intra-lesional steroid, etc. Among various PS associations, wallet neuritis is one of them. However, the latter condition can present with even without the typical features for PS, such as positive flexion adduction internal rotation (FAIR) test, pace sign, etc. In a situation like this, mere discontinuation with fatty buttock wallet is often sufficient for relieving patients' discomfort, making other approaches unnecessary for the patient (though these approaches are warranted for many PS manifestations). Thus, it would not be wise to use piriformis syndrome and wallet neuritis terminology interchangeably as depicted in many published papers.