The “Cure” and Diagnosis of Piriformis Syndrome
The “cure” for piriformis syndrome is to find the cause of the nerve pain. This typically will be a good physical examination and identification of the spinal nerve root responsible for the radiation of pain. X-rays and MRI evaluations are part of the diagnostic testing. Finally, if there is any doubt of the origin of pain, a selective nerve root block (see website) can be diagnostic.
Does piriformis syndrome really exist? The answer is yes but it is an extremely rare condition. In 30 years of practice, I have seen this syndrome twice. If every other cause of nerve pain has been ruled out and the only potential cause left is piriformis syndrome, then this diagnosis can be looked into.
The diagnosis is made by again by first ruling out every other type of nerve disorder. Only after that, provocation of the piriformis muscle can be induced by stretching this muscle. If sciatic nerve symptoms are evoked by this maneuver, consideration of the diagnosis of piriformis syndrome can be entertained.
The piriformis muscle’s action when contracting is to externally rotate the hip. Therefore, the piriformis muscle is stretched (tightened) by internally rotating the hip. Hip internal rotation with flexion while the patient is supine (lying on their back) will reproduce buttocks and leg pain if piriformis syndrome is present.
Conformation is made by a local injection of anesthetic (Lidocaine) and steroid performed under ultrasound guidance with good relief of symptoms. This injection can also yield long-term relief of symptoms.
If the patient has confirmed piriformis syndrome and had failed all the other therapies, a surgical release of this muscle can give long-term relief.
I have yet to consider a patient for this type of surgery.
For more resources on nerve pain and piriformis syndrome, please contact the office of Dr. Donald Corenman, spine specialist and back doctor in the Vail, Aspen, Denver and Grand Junction, Colorado area.