Piriformis syndrome is caused by the abnormal condition of the piriformis muscle resulting in peripheral neuritis of the sciatic nerve. This means that the symptoms experienced are due to the compression of the sciatic nerve around the piriformis muscle. Piriformis syndrome is often misdiagnosed or unrecognized in clinical settings. It is commonly misdiagnosed as sciatica, intervertebral discitis, primary sacral dysfunction, or lumbar radiculopathy. It has even been estimated that a minimum of six percent of patients diagnosed with low back pain have piriformis syndrome.
Causes of piriformis syndrome include spasms of the piriformis muscle, trauma to the gluteal muscle, overuse injury, and anatomical variation. The diagnosis of piriformis syndrome is difficult as there is no standardized or definitive test. However, there are some physical exam maneuvers that can help support the diagnosis. Diagnosis of piriformis syndrome is important as a delay in diagnosis can result in chronic somatic dysfunction, pathologic conditions of the sciatic nerve, hyperesthesia, paresthesia, and muscle weakness. However, it can be challenging for physicians to recognize symptoms unique to piriformis syndrome.
The treatment of piriformis syndrome involves avoiding triggers, physiotherapy, stretching, the use of medication such as non-steroidal anti-inflammatory drugs (NSAIDs), and the injection of botulinum toxin or steroid. This condition is most commonly seen in the fourth to fifth decades of life. It has been observed to affect all individuals regardless of activity levels or occupation. However, it is more common in women and this has been attributed to the biomechanics of the wider quadriceps femoris muscle angle in the pelvis of women.
Symptom #1: Paresthesia
Paresthesia can be defined as an abnormal sensation where there is a tingling, burning, chilling, or pricking sensation on the skin without any apparent physical cause. Paresthesia can be chronic or transient. There are many causes of paresthesia such as hyperventilation, panic attacks, herpes simplex virus infection, shingles, and reactive hyperemia, among others.
The most common kind of paresthesia is the sensation that is often referred to as “pins or needles” or a limb that has “fallen asleep”. In piriformis syndrome, the paresthesia is often felt radiating from the sacrum through the gluteal area and the posterior aspect of the thigh, above the knee.