Post on 04-Feb-2015
description
Piriformis Syndrome
By Laura Sandve&
Andy Coleman
• Sciatica symptoms due to an involvement of the piriformis muscle
• Often referred to as “Wallet Sciatica” or “Fat Wallet Syndrome”
• Entrapment of one or more nerves– Sciatic– Pudendal
Pathophysiology
• Tightness or spasms of the piriformis• Trauma to the piriformis• Weak gluteals• Sitting on thick wallet for long
periods of time
Possible Causes
• Higher incidence in females– 6:1 ratio
• Total hip arthroplasty• Excessive pronation• Strengthening without stretching• Sciatic nerve passing through the
piriformis– About 15-30% of the population
Risks
• Sciatic Entrapment– Pain, tingling, numbness• Buttocks, posterior thigh, hip, leg
– Radiating
• Tenderness in the area of the sciatic notch
Signs and Symptoms
• Pudendal Entrapment– Pain, tingling, numbness• Coccyx, groin
–May cause bowel and/or bladder incontinence
Signs and Symptoms
• Beatty Maneuver
• Freiberg Test– Pictured
• Pace Test
• Muscle injections– Usually an anesthetic and Cortizone
Diagnosing
• Generally very easy to treat• Surgery is rarely recommended but is
generally very successful• Patient’s whose sciatic nerve runs
through the piriformis muscle are more susceptible to repetitive piriformis syndrome
Prognosis
• Non-operative–Modalities
• Massage, Ultrasound ice, heat
– Gait training– Stretching
• Piriformis, external rotators, IT band
– Strengthening• Gluteals, Adductors, Abductors
– NSAID’s
Treatment
• Operative– Not common– Surgical release of the piriformis– Generally a posterior approach–WBAT post surgery for 2 weeks
Treatment
Bibliography• Kisner, Carolyn. Colby, Lynn Allen. Therapeutic Exercise:
Fifth Edition. Philadelphia: F.A. Davis Company, 2007• Mid-Tennessee Bone & Joint Clinic P.C. 2006. 22 November
2010 <http://www.mtbj.net/pdf/PiriformisSyndrome.pdf>• eMedicine: Piriformis Syndrome. 31 March 2010. 22
November 2010 <http://emedicine.medscape.com/article/308798-overview>
• Piriformis Syndrome. 9 November 2010. 19 November 2010 <http://en.wikipedia.org/wiki/Piriformis_syndrome>