a tight piriformis muscle may compress the sciatic nerve
nerve impingement may result from overuse or hypertrophy of the piriformis muscle
nerve impingement may cause features such as radicular pain, numbness, or weakness of the lower extremity
clinical examination
reveals point tenderness over the buttocks medial to the greater trochanter
pain may be exacerbated by internal rotation of the hip may exacerbate the pain
differential diagnosis includes
trochanteric bursitis
sacroiliac joint pain
treatment
rest, ice, and stretching of the muscle (toe touching with the legs crossed)
if non-invasive measures fail, local anaesthetic and corticosteroid injections can be tried
failure of conservative measures may require open or arthroscopic surgical release of the piriformis muscle/tendon
sciatic neurolysis has been used in this condition
Notes:
piriformis muscle
originates from the pelvic surface of the sacrum, exits through the greater sciatic notch and inserts onto the apex of the greater trochanter of the femur. It functions as an external rotator of the hip when the hip is extended and as a hip abductor when the hip is flexed at 90 degrees
in the majority of cases the sciatic nerve runs distal to the piriformis muscle. However, there are variations involving a split or single sciatic nerve passing proximal, through or distal to a split or single piriformis muscle
Reference:
(1) Noesberger B, Eichenberger AR. Overuse injuries of the hip and snapping hip syndrome. Operative Techniques in Sports Medicine 1997; 5 (3):138-142.
(2) Kobbe P, Zelle BA, Gruen GS. Case report: recurrent piriformis syndrome after surgical release. Clin Orthop Relat Res 2008; 466: 1745-8.
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