Lehigh County Health & Medicine Spring 2020 - 18

FEATURE

syndrome. Entrapment of the sciatic nerve
may develop following a piriformis muscle
strain or trauma to the buttocks causing scarring and fibrosis around the nerve. During
downhill running or sprinting, the piriformis
muscle contracts and can cause similar issues
leading to piriformis syndrome. The most
common presenting symptom of piriformis
syndrome is buttocks pain of gradual onset
that increases with sitting for 15-20 minutes.
The "wallet sign" is associated with piriformis
syndrome and is when patients finds they can
no longer sit on their wallet without causing
symptoms. Piriformis syndrome is however
more common in women than men, possibly
because of biomechanics associated with the
wider quadriceps femoris muscle angle or "Q
angle" in their pelvis. Piriformis syndrome
occurs most frequently during the fourth and
fifth decades of life and affects individuals of
all occupations and activity levels.
The diagnosis of piriformis syndrome is
considered when the classic signs of a lumbar
radiculopathy elicited by provocative testing
are absent, neurologic examination is normal,
and other causes of gluteal and sacroiliac pain
are ruled out. When examining a patient, a
contracted piriformis muscle can be seen
causing an externally rotated foot on the same
side when the patient is relaxed in the supine
position. Lasègue sign is localized pain when
pressure is applied over the piriformis muscle
and its tendon, especially when the hip is
flexed at 90 degrees and the knee is extended.
Freiberg's test is localized pain with the hip in
extension and internal rotation, and the patient
resisting external rotation. Pace sign is localized
pain when the patient is in a lateral recumbent
position and the examiner internally rotates
and adducts the hip by applying downward
pressure to the knee. Ultrasound assessment
of piriformis thickness and cross-sectional area
may assist in diagnosis of piriformis syndrome.
When necessary, imaging of the hip and pelvis
can be obtained to rule out disc and vertebral
pathologic conditions. Nerve conduction studies
are rarely positive in piriformis syndrome, but
can be useful for eliminating intervertebral
disc herniation.
Early conservative treatment is the most
effective treatment, with a majority of patients
18 Lehigh County Health & Medicine | SPRING 2020

PIRIFORMIS SYNDROME

REHABILITATION EXERCISES

with piriformis syndrome receiving symptom
reduction with the use of nonsteroidal anti-inflammatory drugs, muscle relaxants, ice, and
rest. Patients with piriformis syndrome may be
treated with physical therapy involving a variety
of motion exercises and stretching techniques
involving strengthening of the pelvic and hip
region. Ultrasound-guided glucocorticoid
injections have been beneficial in some cases,
and botulinum toxin injections have also been
used. Surgery, typically a piriformis tenotomy,
may be considered if symptoms are debilitating
and persist despite conservative therapy. So while
piriformis syndrome may be.

SOURCES:

https://www.uptodate.com
contents/approach-to-hip-and-groin-pain-in-theathlete-and-active-adult?search=piriformis%20
syndrome&source=search_result&selectedTitle=1~29&usage_type=default&display_
rank=1#H59287118 (information and first photo)
https://www.summitmedicalgroup.com/library/
adult_health/sma_piriformis_syndrome_exercises/
(second photo)
https://jaoa.org/article.aspx?articleid=2093614
(information)

https://www.uptodate.com https://www.summitmedicalgroup.com/library/ https://www.jaoa.org/article.aspx?articleid=2093614

Lehigh County Health & Medicine Spring 2020

Table of Contents for the Digital Edition of Lehigh County Health & Medicine Spring 2020