Piriformis syndrome: causes, symptoms, diagnosis and


The piriformis muscle is a muscle located behind the hip joint in the buttocks. The piriformis muscle is small compared to other thigh and thigh muscles, and it aids in external rotation (eversion) of the hip joint. The piriformis muscle and its tendon are closely associated with the sciatic nerve, the largest nerve in the body that provides motor and sensory functions to the lower extremities . The piriformis tendon and sciatic nerve cross behind the hip joint, in the deep buttock. Both designs have a diameter of approximately one centimeter. The piriformis syndrome condition has been described as irritation of the sciatic nerve by the piriformis muscle. There is disagreement as to whether this represents a specific diagnostic element, although it has been reported numerous times in the medical literature.

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When people are diagnosed with piriformis syndrome, it is believed that the piriformis tendon can attach to the sciatic nerve and cause irritation of the nerve. While this has not been proven, a theory supported by many physicians is that when the piriformis muscle and its tendon get too tight, the sciatic nerve becomes pinched. This can reduce blood flow to the nerve and irritate it as a result of pressure. Most doctors believe that piriformis syndrome occurs as a result of anatomical changes in the muscle and tendon. In some people, this connection is believed to irritate the nerve and cause sciatica symptoms.


Common signs and symptoms experienced by people who have been diagnosed with piriformis syndrome include :

  • Pain behind the hip in the buttocks.
  • Electric shock pain radiating to the back of the lower limb
  • Numbness in the lower limb
  • Pain when pressing the piriformis muscle (often causes pain when sitting in hard chairs)

Some people develop symptoms suddenly, while others see a gradual worsening of symptoms in the back of the thigh. Most people who are diagnosed with piriformis syndrome are usually active people who have increasing difficulty with certain sports activities as a result of symptoms of discomfort in the back of the thigh.


There are no specific tests that can accurately diagnose piriformis syndrome. Many doctors order tests, including MRIs and nerve conduction studies, but this is usually normal. Because piriformis syndrome is difficult to diagnose, there are many cases of misdiagnosis. This means that some people with this condition do not have a piriformis muscle diagnosis. Also, some people with vague hip pain can receive this diagnosis even if they do not have the condition .

Other causes of this type of pain, sometimes referred to as "pain deep in the buttocks," include spinal problems such as herniated disc, spinal stenosis , and radiculopathy ( sciatica ), as well as other problems such as hip bursitis . The diagnosis of piriformis syndrome is often made when all of these diagnoses have been eliminated as possible causes of pain.

When the diagnosis is uncertain, the injection is often given in the area of the piriformis muscle. Different medications can be given, but often the injection can help identify a specific area of discomfort. Usually when an injection is given into the piriformis muscle or tendon, it is done under ultrasound guidance so that the needle delivers the medicine to the correct place .

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Unfortunately, the treatment for piriformis syndrome is fairly general and often difficult to treat. Common treatment suggestions include the following .

  • Rest: Avoid activities that cause symptoms for at least a few weeks.
  • Physical therapy: emphasize stretching and strengthening of the rotator muscles.
  • Anti-inflammatory drugs: to reduce inflammation around the tendons.
  • Deep massage: Recommended by some doctors.
  • Cortisone injections: Injections in the piriformis tendon area can reduce inflammation and swelling.
  • Botulinum toxin injections: Botulinum toxin injections can paralyze muscles and reduce pain and discomfort.

In rare cases, surgery may be done to loosen the piriformis tendon, which is called a piriformis release. This surgical procedure should only be considered if simple treatments have been tried for at least 6 months and other common causes of pain have emerged. were evaluated and excluded. The operation is simple but invasive and recovery takes several months.

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Piriformis syndrome is an ambiguous diagnosis. Some doctors treat this condition regularly, while others do not believe that it exists as a specific diagnostic target. There are no agreed criteria for the diagnosis of piriformis syndrome, and the procedural test is typically performed to rule out other possible diagnoses rather than confirm the presence of piriformis syndrome. Most treatment protocols focus on improving hip flexibility and range of motion, as well as reducing inflammation around the sciatic nerve.

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