Piriformis Syndrome: Epidemiology, Clinical features, Diagnosis, and Treatment

Piriformis syndrome (PS) is an example of extra-spinal sciatica that is often confused with spinal sciatica (prolapsed lumbar intervertebral disc), which makes diagnosis and treatment delay. The condition is not as rare as we believe; its prevalence is reported to vary between 0.3% and 36% among patients complaining of radiating low back pain. The female has a higher disease predilection; however, men also get the disease significantly. The most common complaint is a deep-seated gluteal pain that gets worse when sitting for a long time; walking usually intensifies the pain, but in chronic PS cases, ambulation may lessen pain. Moreover, Pace sign, FAIR (Flexion- Adduction-Internal Rotation of hip) test, Freiberg test, and Beatty tests are positive. Pain responds partially with analgesics and therapeutic exercise (stretching of piriformis muscle, PM), some may require ultrasound or fluoroscopy-guided steroid and botulinum toxin injections in PM. PS refractory to the above interventions may require surgery. PS is considered a chronic benign condition; however, deep-seated gluteal pain with raised ESR (Erythrocyte Sedimentation Rate), and CRP (C-Reactive Protein) because of piriformis pyomyositis as seen following vaginal delivery is an emergency and should be treated with judicial antibiotics and surgical drainage, where appropriate.