Piriformis syndrome
Dechasa Imiru, MSc PT
Department of Physiotherapy
Institutes of Health
Jimma University
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Objectives
Anatomical variation of piriformis and sciatic nerve
Describe piriformis syndrome
Discuss on clinical patterns of piriformis syndrome
Diagnostic procedure piriformis syndrome
Explain treatments of piriformis syndrome
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Where is piriformis muscle?
It originates from the anterior aspect of sacral vertebrae
2 - 4 and It inserts on the greater trochancter (GT).
Action :- lateral rotation and abduction of hip joint.
Sciatic nerve usually exits the greater sciatic notch below
the inferior border of the piriformis muscle.
In about 7% to 21% of populations, the sciatic nerve (or
a division of it), actually penetrates the muscle.
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Anatomical variations
There are four anatomical variations of the relation of
piriformis muscle and sciatic nerve.
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Variation 1
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Variation 2
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Variation 3
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Variation 4
True sciatic irritation/pinching
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What is piriformis syndrome?
Piriformis syndrome is defined as neuritis of
branches of the sciatic nerve caused by pressure of an
injured or irritated piriformis muscle.
neuritis :- inflammation of nerve
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What causes piriformis syndrome
The cause of spasm of the piriformis muscle
has been most attributed to:
– Direct trauma
– Overuse
– Reduced flexibility
– Some times associated inflammation of the SI joint.
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What are the symptoms?
Increased by sitting (especially on hard surface )
or driving.
Running
Tenderness at the sciatic notch
May follow sciatic pain pattern of LL
Referred pain to the lateral or anterior hip area.
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How to diagnose?
NB:-
High index of suspicion in a patient with
buttock or leg pain in the absence of lumbar
radiculopathy.
This pain is increased while sitting with
minimal or no back pain.
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Cont …
Weakness of the hip EXT, ABD, and ER muscles
Excessive motions of hip ADD and IR observed during
functional movement tests will putting eccentric strain.
Limited control of the hip and pelvis during functional
movement testing
Reproduction of symptoms with passive stretching
and activation of the piriformis muscle
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Special tests
Piriformis stretch tests,
the FAIR test
Piriformis contraction test
Positive result
The patient was found to have reproduction of
buttock and thigh symptoms with both tests.
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the FAIR test
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Hip abduction resistance
(contraction test)
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ER resistance at different range
(contraction test)
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Piriformis Strech test
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Treatments
Stretching
soft tissue mobilization
injections
Physical therapy interventions focusing on
strengthening of hip musculature to reduce excessive
hip motions.
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Reference
Jasonasonason C. Tonleyonley, Steven M. Yun, Ronald J. et al.
Treatment of an Individual With Piriformis Syndrome Focusing
on Hip Muscle Strengthening and Movement Reeducation: A
Case Report. J Orthop Sports Phys Ther 2010;40(2): 103-11
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Questions?
Comments?
Thank you!!
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