Piriformis Syndrome

Department of Anaesthesia, Royal Free Hospital, London, UK


It is a neuropathy which presents with pain, numbness and paraesthesias in the distribution of sciatic nerve. Sciatic nerve is compressed against the sciatic notch, giving rise to pain. Direct trauma to the sciatic notch may cause the pain. Certain sports like cycling, table tennis and ballet dancing may predispose to this syndrome.

48.1 Anatomy

The muscle extends from the anterior surface of the lateral sacrum (2nd–4th sacral foramina) to the greater trochanter of the femur. It is innervated by S1 and S2 nerve roots. It externally rotates the thigh at the hip and abducts the thigh if the hip is flexed. Sciatic nerve exits inferior to the muscle belly. During the internal rotation, the muscle compresses the sciatic nerve which can lead to entrapment causing pain.

48.2 Clinical Features

Patients present with pain in the buttocks which may radiate to the lower extremity but rarely goes down below the knee. Alteration of gait may be seen. On examination, pain is elicited on compression of the sciatic notch. The muscle may be swollen and tender. Squatting, prolonged sitting, climbing stairs, bending and lifting worsens the pain. Straight leg raising is positive. Wasting of gluteal muscles can be seen in chronic cases.

Mar 20, 2017 | Posted by in PAIN MEDICINE | Comments Off on Piriformis Syndrome
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