What is Piriformis Syndrome?

Piriformis syndrome is a common disease that causes acute and chronic sciatica. It is generally believed that the common peroneal nerve branches from the piriformis muscle bundle or the sciatic nerve exits from the piriformis muscle abdomen. When the piriformis is damaged and congestion, edema, convulsions, adhesions, and contracture occur, the muscle space or the upper and lower holes of the muscle become narrow, and the nerves and blood vessels passing through it are squeezed, resulting in a series of clinical symptoms The syndrome is called piriformis injury syndrome.

Basic Information

English name

pyriformis syndrome

Visiting department

Orthopedics, general surgery

Common causes

Often due to hip trauma bleeding, adhesions, scarring

Common symptoms

pain

Causes of piriformis syndrome

Hip trauma bleeding, adhesions, scar formation; injection of drugs to degeneration of piriformis, fibrillary contractures; displacement of the upper posterior acetabular fracture, and excessive callus can make the sciatic nerve compressed at the piriformis. In addition, a small number of patients traverse the piriformis due to sciatic nerve exiting the pelvis, but strong contraction of the muscles during hip external rotation can cause excessive pressure on the sciatic nerve, which will cause chronic sciatic nerve injury in the long run.

Clinical manifestations of piriformis syndrome

Pain is the main manifestation of this disease. It is dominated by the hips and can be radiated to the lower limbs. In severe cases, it is impossible to walk or after walking for a long distance, the pain is severe, and you need to rest for a while to continue walking. Patients may feel the pain is deep, and the radiation is mainly to the back or posterolateral of the lower limb of the same side, and some are accompanied by numbness of the lower leg and perineal discomfort. In severe cases, there is "knife-like" or "burning" pain in the buttocks, difficulty in flexing legs, lying on knees, and difficulty sleeping at night. Increased abdominal pressure when urinating, coughing, or sneezing will increase the pain in the affected limb.

Piriformis syndrome test

1. Straight leg lift test

Pain in straight leg elevation before 60 ° was positive for the test.

2. Piriformis tension test

It is a method for detecting piriformis injury. The specific steps are as follows: the patient lies on the examination bed, straightens the affected limb, performs adduction and internal rotation, such as radiation pain of the sciatic nerve, and then abducts the affected limb quickly. The pain eased immediately, which was positive for the piriformis test. This is a common test for piriformis syndrome.

Diagnosis of piriformis syndrome

According to the main clinical manifestations of piriformis syndrome: pain in the buttocks and radiation to the back or back of the lower limbs on the same side; stool, cough, and sneezing can aggravate the pain. In addition, the diagnosis of piriformis syndrome requires the support of some tests: tenderness on the affected hip is obvious, especially in the piriformis area, which can be associated with atrophy, and palpation can touch diffuse blunt, stranded Local or stiffening of the piriformis or piriformis muscle bundles.

The pain of the straight leg raised before 60 ° is positive for the test, because the piriformis is stretched to a tense state, which makes the injured piriformis more severe to stimulate the sciatic nerve, so the pain is obvious. But after 60 °, the piriformis is no longer stretched, and the pain is reduced. In addition, in addition to the straight leg elevation test, a piriformis tension test is also performed. Piriformis syndrome is usually also positive in piriformis syndrome.

Piriformis Syndrome Treatment

Non-surgical methods include massage manipulation, local closure, intramuscular injection, physical therapy, Chinese herbal medicine, acupuncture, and so on. Massage manipulation is the main method to treat piriformis syndrome, which can obviously improve the symptoms and relieve the pain of patients. When using manual treatment, you must first select the correct location. The patient can take a prone position with both lower limbs stretched back to relax the waist and hip muscles. The surgeon makes a connection from the upper spine to the femoral trochanter from the posterior condyle. The middle point of the connection is 2cm below the piriformis from the sciatic nerve, and the piriformis is on both sides. Local closure has a certain effect on pain relief.