The piriformis is a small but important muscle in the gluteal (buttock) area, and piriformis syndrome is the subject of this blog.
It originates from sacrum(base of lumbar spine), exits the pelvis through the sciatic foramen and inserts on the greater trochanter of the femur(hip bone).
The piriformis muscle functions to laterally rotate the hip.
Piriformis syndrome is a condition in which the piriformis muscle irritates the traversing sciatic nerve causing pain, tingling and numbness in the buttock and leg.
Common causes of pirifromis syndrome include weak abductors combined with tight adductors, SI joint dysfunction and overpronation of the foot. Runners, bicyclist and other athletes engaged in forward moving activities are particularly susceptible.
Comon referral pain pattern is:
Treatment involves stretching exercises and massage, and avoidance of contributory activities,
When conservative treatments fail, injection of local anesthetics and low dose steroids are a viable option.
Are all injections the same? NO
At the Centeno-Schultz Clinic we have both x-ray and ultrasound within our clinic. Our practice is to use ultrasound as it has been demonstrated to be superior to x-ray in placing the medication directly into the piriformis muscle. Finnoff found that most of the fluoroscopically attempted piriformis injections were placed superficially within the gluteus maximus and therefore did not reach the targeted piriformis.