The Pace maneuver: in the seated position, the patient abducts the hip against resistance, activating the piriformis muscle. The Freiberg maneuver: with the patient lying supine, the examiner forcefully internally rotates the leg, stretching the piriformis muscle.
Resultant pain from the buttock down the sciatic nerve, but without any back pain, is said to be consistent with piriformis syndrome. In each, the piriformis muscle is either stretched or voluntarily contracted. Several physical examination maneuvers are reported to be useful in suspected piriformis syndrome. There are very few reported cases of patients who meet the criteria for definite piriformis syndrome, which include (1) sciatic neuropathy clinically, (2) electrophysiologic evidence of sciatic neuropathy, (3) surgical exploration showing entrapment of the sciatic nerve within a hypertrophied piriformis muscle, and (4) subsequent improvement following surgical decompression.Ĭlinically, piriformis syndrome should be suspected when a patient has more pain while sitting than standing worsening of symptoms with flexion, adduction, and internal rotation of the hip a history of trauma or unusual body habitus (especially very thin) and tenderness in the mid-buttock that reproduces the pain and paresthesias. Piriformis syndrome is considered by many to be a controversial entity. However, most, if not all, cases of sciatica are due to lumbosacral radiculopathy and not sciatic neuropathy from piriformis syndrome. In the past, many cases of “sciatica” were attributed to piriformis syndrome. Theoretically, a hypertrophied piriformis muscle could compress the sciatic nerve ( piriformis syndrome), somewhat comparable to compression of the median nerve by the pronator teres muscle in pronator teres syndrome. When the hip is in a flexed position, it also acts as a partial hip abductor. The main action of the piriformis is to externally rotate the hip. The piriformis muscle originates from the sacrum, the sciatic notch, and the sacrotuberous ligament and then runs through the greater sciatic foramen to attach to the greater trochanter of the femur.
Preston MD, in Electromyography and Neuromuscular Disorders, 2021 Piriformis SyndromeĪs the sciatic nerve leaves the pelvis, it runs under or through the piriformis muscle ( Fig.