Characterized by pain and tingling in the buttocks often radiating down the leg, Piriformis Syndrome is a neuromuscular disorder caused by the compression of the sciatic nerve trunk by the piriformis muscle.1 Additionally, patients may experience tenderness in the hip external to the greater sciatic notch. Activities such as running, climbing stairs, or sitting for long periods often exacerbate sciatica associated with Piriformis Syndrome.2
The sciatic nerve is the largest peripheral nerve in the body, originating from the lumbosacral plexus and running through the buttocks and down the posterior leg. In approximately 17% of the population, anatomic variations are seen where portions of the sciatic nerve actually pierce through the belly of the piriformis muscle.3 The piriformis often becomes tight in athletes, especially runners, or in people who sit for long periods due to decreased circulation in the gluteal region. Tension or inflammation in the piriformis muscle can lead to painful impingement of the sciatic nerve.
There are other common causes of similar pain. A thorough evaluation with hands on examination by our physician is an important component in your treatment.
There are a number of effective treatments for Piriformis Syndrome. Conservative treatments include stretching exercises and systemic anti-inflammatories. In persistent cases, an ultrasound guided localized injection of corticosteroid and local anesthetic surrounding the inflamed nerve can target the source, providing pain relief. Dr. Urban has modified this technique building upon his experience as an anesthesiologist treating surgical pain in patients that have had failures elsewhere.
1 Hopayian, K., Song, F., Riera, R. & Sambandan, S. The clinical features of the piriformis syndrome: a systematic review. European spine journal 19,2095–109 (2010)
2 National Institute of Neurological Disorders and Stroke. NINDS Piriformis Syndrome Information Page http://www.ninds.nih.gov/disorders/piriformis_syndrome/piriformis_syndrome.htm. Accessed July 24, 2014
3 Smoll, N. Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clinical anatomy (New York, N.Y.) 23,8–17 (2010).