Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-25T20:24:56.446Z Has data issue: false hasContentIssue false
  • English
  • Français

The Diagnosis and Management of Piriformis Syndrome: Myths and Facts

Published online by Cambridge University Press:  02 December 2014

T. A. Miller ,
K. P. White  and
D. C. Ross
T. A. Miller*
Affiliation:
From the Departments of Physical Medicine and Rehabilitation and Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario Canada
K. P. White
Affiliation:
From the Departments of Physical Medicine and Rehabilitation and Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario Canada
D. C. Ross
Affiliation:
From the Departments of Physical Medicine and Rehabilitation and Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario Canada
*
Schulich School of Medicine and Dentistry, University of Western Ontario, St. Joseph's Health Care, Room 066, 21 Grosvenor Street, London, Ontario, N6A 1Y6, Canada. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Piriformis Syndrome (PS) is an uncommon, controversial neuromuscular disorder that is presumed to be a compression neuropathy of the sciatic nerve at the level of the piriformis muscle (PM). The diagnosis is hampered by a lack of agreed upon clinical criteria and a lack of definitive investigations such as imaging or electrodiagnostic testing. Treatment has focused on stretching, physical therapies, local injections, including botulinum toxin, and surgical management. This article explores the various sources of controversy surrounding piriformis syndrome including diagnosis, investigation and management. We conclude with a proposal for diagnostic criteria which include signs and symptoms, imaging, and response to therapeutic injections.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 5 , September 2012 , pp. 577 - 583
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1.Jroundi, L, El, QA, Chakir, N, El Hassani, MR, Jiddane, M.[The piriformis syndrome: a rare cause of non discogenic sciatica. A case report]. J Radiol. 2003;84(6):715–7.Google ScholarPubMed
2.McCrory, P.The “piriformis syndrome”-myth or reality? Br J Sports Med. 2001;35(4):209–10.CrossRefGoogle ScholarPubMed
3.Read, MT.The “piriformis syndrome”-myth or reality? Br J Sports Med. 2002;36(1):76.Google Scholar
4.Stewart, JD.The piriformis syndrome is overdiagnosed. Muscle Nerve. 2003;28(5):644–6.CrossRefGoogle ScholarPubMed
5.Tiel, RL.Piriformis and related entrapment syndromes: myth & fallacy. Neurosurg Clin N Am. 2008;19(4):623–7, vii.CrossRefGoogle ScholarPubMed
6.Parziale, JR, Hudgins, TH, Fishman, LM.The piriformis syndrome. Am J Orthop. 1996;25(12):819–23.Google Scholar
7.Silver, JK, Leadbetter, WB.Piriformis syndrome: assessment of current practice and literature review. Orthopedics. 1998;21(10): 1133–5.CrossRefGoogle ScholarPubMed
8.Campbell, WW, Landau, ME.Controversial entrapment neuropathies. Neurosurg Clin N Am. 2008;19(4):597–vii.CrossRefGoogle ScholarPubMed
9.Kirschner, JS, Foye, PM, Cole, JL.Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 2009;40(1):10–8.CrossRefGoogle ScholarPubMed
10.Porta, M.A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain. 2000;85((1-2)):101–5.Google Scholar
11.Boyajian-O’Neill, LA, McClain, RL, Coleman, MK, Thomas, PP.Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008;108(11): 657–64.Google ScholarPubMed
12.Windisch, G, Braun, EM, Anderhuber, F.Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat. 2007;29(1):37–45.CrossRefGoogle ScholarPubMed
13.Pecina, HI, Boric, I, Smoljanovic, T, Duvancic, D, Pecina, M.Surgical evaluation of magnetic resonance imaging findings in pririformis muscle syndrome. Skeletal Radiol. 2008;37:1019–23.Google Scholar
14.Stewart, JD.Focal Peripheral Neuropathies. In: Anon. West Vancouver: JBJ Publishing; 2010. p. 443–8.Google Scholar
15.Wilbourn, AJ.Thoracic outlet syndrome is overdiagnosed. Muscle Nerve. 1999;22(1):130–6.Google Scholar
16.Benzon, HT, Katz, JA, Benzon, HA, Iqbal, MS.Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology. 2003;98(6):1442–8.Google Scholar
17.Bernard, TN Jr, Kirkaldy-Willis, WH.Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. 1987;217:266–80.Google Scholar
18.Fanucci, E, Masala, S, Sodani, Get al.CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process. Eur Radiol. 2001;11(12):2543–8.Google Scholar
19.Hallin, RP.Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74(2):69–72.CrossRefGoogle ScholarPubMed
20.Huerto, AP, Yeo, SN, Ho, KY.Piriformis muscle injection using ultrasonography and motor stimulation-report of a technique. Pain Physician. 2007;10(5):687–90.CrossRefGoogle ScholarPubMed
21.Lang, AM.Botulinum toxin type B in piriformis syndrome. Am J Phys Med Rehabil. 2004;83(3):198–202.Google Scholar
22.Papadopoulos, EC, Khan, SN.Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am. 2004;35(1):65–71.Google Scholar
23.Rodrigue, T, Hardy, RW.Diagnosis and treatment of piriformis syndrome. Neurosurg Clin N Am. 2001;12(2):311–9.Google Scholar
24.Anon., Gray’s Anatomy. The anatomical basis of clinical practice. Amsterdam: Elsevier; 2005.Google Scholar
25.Russell, JM, Kransdorf, MJ, Bancroft, LWet al.Magnetic resonance imaging of the sacral plexus and piriformis muscles. Skeletal Radiol. 2008;37(8):709–13.CrossRefGoogle ScholarPubMed
26.Guvencer, M, Akyer, P, Iyem, C, Tetik, S, Naderi, S.Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve. Surg Radiol Anat. 2008;30(6): 467–74.Google Scholar
27.Pecina, M.Contribution to the etiological explanation of the piriformis syndrome. Acta Anat (Basel). 1979;105(2):181–7.CrossRefGoogle Scholar
28.Barton, PM.Piriformis syndrome: a rational approach to management. Pain. 1991;47(3):345–52.CrossRefGoogle ScholarPubMed
29.Hopayian, K, Song, F, Riera, R, Sambandan, S.The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010; 19(12):2095–109.CrossRefGoogle ScholarPubMed
30.Beatty, RA.The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurgery. 1994;34(3):512–4.CrossRefGoogle ScholarPubMed
31.Childers, MK, Wilson, DJ, Gnatz, SM, Conway, RR, Sherman, AK.Botulinum Toxin Type A Use in Piriformis Muscle Syndrome A Pilot. Am J Phys Med Rehabil. 2002;81(10):751–9.Google Scholar
32.Fishman, LM, Dombi, GW, Michaelsen, Cet al.Piriformis syndrome: diagnosis, treatment, and outcome-a 10-year study. Arch Phys Med Rehabil. 2002;83(3):295–301.CrossRefGoogle Scholar
33.Jankiewicz, JJ, Hennrikus, WL, Houkom, JA.The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature. Clin Orthop Relat Res. 1991;(262):205–9.Google ScholarPubMed
34.Karl, RD Jr, Yedinak, MA, Hartshorne, MEet al.Scintigraphic appearance of the piriformis muscle syndrome. Clin Nucl Med. 1985;10(5):361–3.Google Scholar
35.Lee, EY, Margherita, AJ, Gierada, DS, Narra, VR.MRI of piriformis syndrome. AJR Am J Roentgenol. 2004;183(1):63–4.Google Scholar
36.Rossi, P, Cardinali, P, Serrao, Met al.Magnetic resonance imaging findings in piriformis syndrome: a case report. Arch Phys Med Rehabil. 2001;82(4):519–21.CrossRefGoogle ScholarPubMed
37.Sayson, SC, Ducey, JP, Maybrey, JB, Wesley, RL, Vermilion, D.Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain. 1994;59(1):149–52.CrossRefGoogle ScholarPubMed
38.Filler, AG, Kliot, M, Howe, FAet al.Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg. 1996;85(2):299–309.CrossRefGoogle ScholarPubMed
39.Filler, AG, Maravilla, KR, Tsuruda, JS.MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin. 2004;22(3): 643–82.CrossRefGoogle ScholarPubMed
40.Filler, AG, Haynes, J, Jordan, SEet al.Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine. 2005;2(2):99–115.Google Scholar
41.Filler, AG.Piriformis and related entrapment syndromes: diagnosis & management. Neurosurg Clin N Am. 2008;19(4):609–22, vii.CrossRefGoogle ScholarPubMed
42.Kipervas, IP, Ivanov, LA, Urikh, EA, Pakhomov, SK.[Clinicoelectromyographic characteristics of piriform muscle syndromes]. Zh Nevropatol Psikhiatr Im S S Korsakova. 1976; 76(9):1289–92.Google ScholarPubMed
43.Synek, V.Short latency somatosensory evoked potentials in patients with painful dysaesthesias in peripheral nerve lesions. Pain. 1987;29(1):49–58.CrossRefGoogle ScholarPubMed
44.Benson, ER, Schutzer, SF.Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am. 1999;81(7):941–9.Google Scholar
45.Chang, C-W, Lien, I-N.Spinal nerve stimulation in the diagnosis of lumbosacral radiculopathy. Am J Phys Med Rehabil. 1990;69(6):318–22.Google Scholar
46.Chang, CW, Shieh, SF, Li, CM, Wu, WT, Chang, KF.Measurement of motor nerve conduction velocity of the sciatic nerve in patients with piriformis syndrome: a magnetic stimulation study. Arch Phys Med Rehabil. 2006;87(10):1371–5.Google Scholar
47.Fishman, LM, Zybert, PA.Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil. 1992;73(4):359–64.CrossRefGoogle ScholarPubMed
48.Nakamura, H, Seki, M, Konishi, S, Yamano, Y, Takaoka, K.Piriformis syndrome diagnosed by cauda equina action potentials: report of two cases. Spine. 2003;28(2):E37–E40.Google Scholar
49.Miller, TA, Pardo, R, Yaworski, R.Clinical utility of reflex studies in assessing radiculopathy. Muscle Nerve. 1999;22(8):1075–9.Google Scholar
50.Giesebrecht, S, Martin, PG, Gandevia, SC, Taylor, JL.Facilitation and inhibition of tibialis anterior responses to corticospinal stimulation after maximal voluntary contractions. J Neurophysiol. 2010;103(3):1350–6.Google Scholar
51.Kuwabara, S, Cappelen-Smith, C, Lin, CS, Mogyoros, I, Burke, D.Effects of voluntary activity on the excitability of motor axons in the peroneal nerve. Muscle Nerve. 2002;25(2):176–84.CrossRefGoogle ScholarPubMed
52.Knikou, M, Rymer, Z.Effects of changes in hip joint angle on H-reflex excitability in humans. Exp Brain Res. 2002;143(2): 149–59.Google Scholar
53.Lewit, K, Simons, DG.Myofascial pain: relief by post-isometric relaxation. Arch Phys Med Rehabil. 1984;65(8):452–6.Google ScholarPubMed
54.Retzlaff, EW, Berry, AH, Haight, ASet al.The piriformis muscle syndrome. J Am Osteopath Assoc. 1974;73(10):799–807.Google Scholar
55.Reus, M, de Dios, BJ, Vazquez, V, Redondo, MV, Alonso, J.Piriformis syndrome: a simple technique for US-guided infiltration of the perisciatic nerve. Preliminary results. Eur Radiol. 2008;18(3):616–20.Google Scholar
56.Smith, J, Hurdle, MF, Locketz, AJ, Wisniewski, SJ.Ultrasound-guided piriformis injection: technique description and verification. Arch Phys Med Rehabil. 2006;87(12):1664–7.CrossRefGoogle ScholarPubMed
57.Bennett, JD, Miller, TA, Richards, RS.The use of Botox in interventional radiology. Tech Vasc Interv Radiol. 2006;9(1): 36–9.CrossRefGoogle ScholarPubMed
58.Betts, A.Combined fluoroscopic and nerve stimulator technique for injection of the piriformis muscle. Pain Physician. 2004;7:279–81.CrossRefGoogle ScholarPubMed
59.Fishman, LM, Anderson, C, Rosner, B.Botox and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil. 2002;81(12):936–42.Google Scholar
60.Fishman, LM, Konnoth, C, Rozner, B.Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose-finding study. Am J Phys Med Rehabil. 2004;83(1):42–50.Google Scholar
61.Dezawa, A, Kusano, S, Miki, H.Arthroscopic release of the piriformis muscle under local anesthesia for piriformis syndrome. Arthroscopy. 2003;19(5):554–7.CrossRefGoogle ScholarPubMed