ArticlesPiriformis syndrome: Correlation of muscle morphology with symptoms and signs
Section snippets
Methods
Patients for the study were selected from people who presented with lumbosacral and buttock pain at a tertiary musculoskeletal referral center. All patients had not improved with conservative management, and none had been suspected of having piriformis pain. These patients, selected over a 1-year period, had a mixture of symptoms that included deep-seated buttock pain, which was made worse by sitting for short periods and by walking up inclines or stairs, and that often referred down the back
Results
Twenty-seven patients were included in the study (26 women, 1 man; mean age, 48y). In 18 patients (67%), an abnormal piriformis muscle was identified by comparison with the asymptomatic side using ultrasound. The median age of those with abnormal morphology was 46 years and it was 52 years for patients without such abnormality. The average ages in the 2 groups did not differ significantly (P=.58).
Data for all presenting symptoms and signs are shown in table 1 and indicate that 76% of patients
Discussion
We recognize that this is a comparatively small sample and hence CIs for the ORs are wide. Nonetheless, we believe that the absolute size of the ORs warrants confidence in the findings. Our study found evidence that abnormal morphology may not be seen in one third of patients with buttock pain, although abnormal morphology was found in two thirds of symptomatic muscles when compared with the pain-free side. The signs and symptoms regarded as features of piriformis syndrome have variable ORs
Conclusions
Patients presenting with lumbosacral or buttock pain, and who have pain when ascending inclines, referred pain to the thigh in the symptomatic side, and reproduction of the pain on needling, provide tacit support for recognizing the piriformis muscle as a contributing factor to the pain. The quest for a criterion standard must continue. Our study’s results have demonstrated abnormal piriformis morphology in a significant number of patients with chronic LBP and buttock pain who failed to improve
References (13)
- et al.
Piriformis muscle syndromean underdiagnosed cause of sciatica
J Pain Symptom Manage
(1991) - et al.
Piriformis syndrome: diagnosis, treatment and outcome—a ten-year study
Arch Phys Med Rehabil
(2002) The relation of arthritis of the sacroiliac joint to sciatica
Lancet
(1928)Sciatic pain and the piriformis muscle
Postcard Med
(1983)Chronic pain syndromes and their treatment. III. The piriformis syndrome
Can Anaesth Soc J
(1979)The piriformis muscle syndromea simple diagnostic manoeuvre
Neurosurgery
(1994)
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