Piriformis Syndrome.pdf

Piriformis Syndrome is a clinical condition of sciatic nerve entrapment at the level of ischial tuberosity.
I hope this content helps you in understanding this condition. Thank You for sparing your precious time and going through this PowerPoint presentation.

1. Piriformis Syndrome
Presented By: Rutvi Raualji (MPT)

2. Contents
•Anatomy of Piriformis muscle
•Introduction
•Clinical picture
•Aetiology
•Pathophysiology
•History and Evaluation
•Management

3. Anatomy of Piriformis muscle
❑Piriformismuscleisflat,oblique,
andpyramidal-shaped.
❑Origin:Anteriortothevertebrae
(S2-S4),superiormarginofgreater
sciaticforamen,andSacrotuberous
ligament.
❑Crossesgreatersciaticnotch
❑Insertion:Attachestogreater
trochanterofhipbone.
❑Nervesupply:L5,S1,andS2.
❑Action:Extensionofhip,prime
moverforexternalrotationwhen
flexedhip,hipadductor.

4. Introduction
❑PiriformisSyndromeisaclinical
conditionofsciaticnerveentrapmentat
thelevelofischialtuberosity.
❑Thereby,resultingininflammation.
❑Thisconditionisnotseenvery
commonly.It’sprevalencerangesfrom
0.3%to6%inlowerbackpaincases.
❑Usuallyoccursinmiddleaged
individualsandtheratioforfemale:
maleis1:6.

5. Clinical Picture
❑Isfairlyconsistent,withpatientsreporting
painingluteal/buttockregionthatmay
“shoot”,burn,orachedownthebackof
theleg(similartosciaticpain).
❑Numbnessinbuttocksandtingling
sensationsalongthedistributionofsciatic
nerve(Reason:Thenerverunsadjacentto
themuscle;andwheninflamedorirritated,
italsoaffectssciaticnerve)

6. Difference between Sciatica and
Piriformis Syndrome
Sciatica
➢Itiscausedbyherniateddiskor
spinalcanalstenosis.
➢Itaffectslowerbackandcantravel
downthroughbuttocksandleg.
Piriformis Syndrome
➢Piriformismuscleiscompression
oneareaofsciaticnerveinthe
buttock.

7. Types
Primary Piriformis Syndrome
•Ithasananatomicalcause,with
variationssuchasasplitpiriformis
muscle,splitsciaticnerve,or
anomaloussciaticnervepath.
Secondary Piriformis Syndrome
•Usuallyoccursasaresultofa
precipitatingcause,including
microtrauma,ischemicmasseffect,
orlocalischemia.

8. Aetiology
1.Traumatothehiporbuttockarea
2.Piriformismusclehypertrophy(especiallyinathletes)
3.Sittingforprolongperiod
4.Anatomicanomalies

9. Pathophysiology
Piriformis muscle is overused, irritated, inflamed,
stresseddue to poor body posture chronically or
sudden acute injury
Irritatesthe adjacent sciatic nerve
Entrappedanteriorly to muscle or posteriorlyto
gemelli-obturator internuscomplex.

10. History and Evaluation
•Patientmaypresentwith:
1)Chronicpaininbuttockandhiparea
2)Painwhengettingoutofbed
3)Inabilitytositforprolongedtime
4)Paininthebuttocksthatisworsenedbyhipmovements
•Patientswilloftenpresentwithsciaticasymptoms-radiatingintotheback
ofthethigh,butcanoccurinlowerlegatdermatomesL5-S1.
•Complainforbuttockpain
•ONPALPATION-Mildtomoderatetendernessatsciaticnotch

11. Special test: Piriformis test
✓Patient position-Side lying with the leg uppermost.
Patient flexes
the test hip to
60 degrees
with knee
flexion.
Examiner
stabilises the
hip and gives
downward
pressure to the
knee.
Tight
piriformis-
pain elicited in
the muscle; if it
pinches sciatic
nerve-buttock
pain and
sciatica may be
experienced.

12. Diagnostic Tests
i.Ultrasound
ii.CT
iii.EMG
iv.Toruleoutfacetarthropathy,herniatednucleuspulposus,lumbarmuscle
strain,andspinalstenosis.

13. Management
I.Short-termrest(notmorethan
hours)
II.Musclerelaxants
III.NSAIDS
IV.Physicaltherapy-Stretchingof
piriformismuscle,rangeofmotion
exercises,anddeeptissuemassage)