What is Piriformis Syndrome?

It was a really odd sensation, as if an electric current ran down Sarah's right leg. It bothered her so much, she had trouble sitting for any extended period. A specialist diagnosed the problem as piriformis syndrome.

Overview of Piriformis Syndrome

It's a rare neuromuscular condition that arises when the piriformis muscle compresses or just irritates the sciatic nerve, according to the National Institute of Neurological Disorders and Stroke (NINDS). The piriformis is a narrow muscle in the buttocks. The sciatic nerve is the largest nerve in the body. When it's compressed, an individually feels pain in the buttocks and sometimes down the associated leg.

The piriformis muscle originates inside the pelvis. It's one of the external rotators of the hip and leg, eOrthopod indicates. The sciatic nerve runs underneath and sometimes through this muscle as it exits the pelvis. When the piriformis muscle exerts pressure on the sciatic nerve, the result can be piriformis syndrome. This in turn can lead to sciatica.

Symptoms

Compression of the sciatic nerve typically results in discomfort in the form of tingling or numbness. Patients experience it in the buttocks and along the nerve. They frequently complain that the discomfort extends all the way into the associated leg. Sometimes they feel pain in both legs.

Piriformis.org reports that symptoms vary from one case to another. Additional signs of piriformis syndrome can include difficulty sitting, leg weakness and significant nerve pain. While experts don't know what prompts the piriformis muscle to irritate the sciatic nerve on specific occasions, they commonly associate the disorder with injuries that involve falling or certain abnormal positioning of the food when walking.

The whole process of irritation to the sciatic nerve can end up being a circular event. Once the piriformis muscle heals, scar tissue replaces some of the internal muscle tissue. Because scar tissue lacks flexibility and elasticity, the muscle might tighten. When this occurs, the end result is constant pressure against the individual's sciatic nerve.

Diagnosis and Treatment

A diagnosis of piriformis syndrome always starts with a physical exam, review of a patient's medical history and discussion of the individual's symptoms with a doctor. The most common diagnostic tools include X-rays, MRIs, neurography (a kind of MRI), bone scans and a diagnostic injection using a fluoroscope.

Treatment varies by case. Doctors initially try nonsurgical treatment whenever possible. For some patients, the first steps include monitoring the symptoms or taking anti-inflammatory medications. Botox injections paralyze the piriformis muscle, causing it to relax, but usually last only a few months.

Physicians often prescribe stretching exercises and other methods to try to relieve spasms of the piriformis muscle. Sometimes they combine injections of local anesthetics with anti-inflammatory drugs.

Surgery is considered the last option and occurs only when other treatment methods fail to provide sufficient temporary relief of symptoms. Surgeons use one of two procedures to treat the disorder. The first involves cutting the piriformis tendon where it attaches to the bump on the side of the hip. With the second procedure, surgeons cut through the piriformis muscle to relieve pressure on the sciatic nerve.

Prognosis

For most patients who receive a diagnosis of piriformis syndrome, the prognosis is good. They are usually able to go back to their normal routines and activities after receiving treatment for their symptoms. It might be necessary to modify the exercise regimens of some patients from time to time to lower the risk of recurrence or worsening of the disorder.

Sources:

http://www.ninds.nih.gov/disorders/piriformis_syndrome/piriformis_syndrome.htm

http://www.eorthopod.com/node/10936

http://www.piriformis.org/