Author Archives: Tigran Garabekyan, M.D.

The piriformis muscle is located deep in the hip and extends in close proximity to the sciatic nerve. Upon becoming tight and/or swollen, it can lead to irritation of the sciatic nerve. This irritation causes sciatica-like pain, numbness, and tingling.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding communities.

Treatment Options

Various treatment options may be recommended by a medical care professional, depending on the severity of the sciatica-type pain that the patient is experiencing and other symptoms.

A thorough approach to piriformis syndrome management may include a combination of the below mentioned non-surgical treatments:

• Ice Packs and Ice Massage.
• Ice and Heat Therapy for Piriformis Syndrome.
• When the pain initiates, the patient may lie in a comfortable position on the stomach and apply an ice pack on the painful site for around 20 minutes. Repeat as necessary every two to four hours.

Combining a gentle massage with the ice may be more helpful. The patient should lie on their stomach and ask someone to massage the painful site with a large ice cube gently.

If the ice is placed on the skin directly (rather than using a cold pack), the application should be restricted to 8 to 10 minutes to prevent ice burn. If the pain increases after specific activities, it may be advisable to apply ice right after the activity.

Heat Therapy

Alternating cold with heat is also beneficial for some patients. If the patient uses a heat pad, they should lie on their stomach and apply the heating pad on the painful region for up to 20 minutes. Patients should be cautious to avoid sleeping on the heating pad as this can cause skin burns.

Medications for Sciatica Pain

As a majority of episodes of pain occur due to some type of swelling, non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen or ibuprofen, may help reduce inflammation in the impacted area.

Piriformis Injections

An injection may be part of the treatment for severe sciatica pain due to piriformis syndrome.

The doctor may inject a local anesthetic and corticosteroid directly into the piriformis muscle to help reduce the pain and spasm. The reason for administering an injection is often to reduce acute pain and allow progress in physical therapy.

Botox Injection

In case of a persistent piriformis spasm that is unresponsive to treatment with anesthetic/corticosteroid injections, an injection of botulinum toxin (for example, Botox), a muscle paralyzing agent, may be helpful. The objective of the injection is to enable the muscle to relax and help decrease pressure on the sciatic nerve.

Electrotherapy for Piriformis Syndrome

Electrical stimulation application to the buttock with a transcutaneous electrical nerve stimulation (TENS) unit or interferential current stimulator (IFC) can assist in blocking pain and reducing piriformis syndrome-related muscle spasms.

The piriformis muscle can be cut to alleviate symptoms in persistent cases. However, this is undertaken only in rare cases.

Piriformis Muscle Stretches

It is almost always necessary to stretch the piriformis muscle to relieve the pain along the sciatic nerve, and it can be performed in various positions.  

Many stretching exercises for the piriformis muscle, hamstring muscles, and hip extensor muscles may be done to help reduce the painful symptoms along the sciatic nerve and restore the patient’s range of movement.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

The piriformis is a muscle that lies behind the hip joint in the buttocks. The piriformis muscle is tiny in comparison to other muscles around the thigh and hip. This muscle helps in external rotation (turning out) of the hip joint.

The piriformis muscle and its tendon are closely related to the sciatic nerve (the largest nerve in the body), which provides the lower extremities with sensory and motor function.

The piriformis tendon and sciatic nerve cross one another behind the hip joint, within the deep buttock. Both of these structures are around one cm in diameter.

Piriformis syndrome is a condition that has been described as an irritation of the sciatic nerve from the piriformis muscle. It remains controversial whether or not this represents a distinctive diagnostic entity. However, it has been described multiple times in medical literature.  

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

Potential Causes

If an individual is diagnosed with piriformis syndrome, it is considered that piriformis tendon may be impinging the sciatic nerve, leading to nerve irritation.

It has not been proven, but the theory supported by many doctors is that when the piriformis muscle and its tendon are excessively tight, the sciatic nerve is compressed. This may reduce the blood supply to the nerve and irritate the nerve due to pressure.

A majority of individuals who suspect piriformis syndrome think that it develops due to anatomic variation of the muscle and tendon. In some people, it is believed that this relationship leads to irritation of the nerve causing sciatica symptoms.

The recognized reasons for piriformis syndrome are as follows:

• Injury
• Abnormal location or development of the piriformis muscle or sciatic nerve
• Abnormal spine alignment, such as scoliosis
• Leg-length discrepancy (when the length of the legs varies)
• Extended periods of sitting, particularly if carrying a thick wallet in a pocket right behind the piriformis muscle
• Before hip surgery
• Unusually aggressive exercise
• Foot problems, such as Morton’s neuroma

The cause cannot be determined in many cases.

Prevention

There is no reliable method to prevent the occurrence of piriformis syndrome.

The standard recommendations for individuals who have had this or other back issues include a heel-lift (in case the legs are of varying lengths, home exercises and stretching, not carrying a wallet in the back pocket, avoiding extended periods of sitting, and undergoing treatment for other contributory conditions, such as foot problems or spinal arthritis.

Prognosis

Timely diagnosis and treatment enable the prognosis to be quite good. But the condition may become long-lasting. A poor result may be likely in case of delayed diagnosis and treatment.

The Bottom Line

Piriformis syndrome may be the most commonly occurring cause of sciatic-type back pain that people have never heard of. On the other hand, it may be rare.

But no one is really certain. In case a person has persistent, unexplained buttock main that extends into the leg, they should stop carrying their wallet in their back pocket, try not to sit too much, and consult their physician.

They may have a disc condition or some other common back issue. However, it is possible that they may have piriformis syndrome and prompt diagnosis can make a difference.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

The average patient with piriformis syndrome complains of “sciatica,” which is severe, sharp, radiating pain from the lower buttock or back extending down the leg and into the thigh, calf, and foot.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding communities.

Signs and Symptoms

The symptoms of piriformis syndrome may appear following disc herniation (“slipped disc”) or hip bursitis. However, a thorough examination by the doctor helps sort out the real cause as with piriformis syndrome the patient also experiences the following:

• Challenging to sit or put weight on the posterior on one side
• Muscle spasm of the piriformis muscle
• Pain in the piriformis muscle during a rectal examination
• Sciatica-type pain when the hip moves and rotates outward against resistance

Patients commonly report acute tenderness in the buttock and sciatica-like pain extending down the back of the thigh, calf, and foot. The symptoms of piriformis syndrome may include:

• A dull ache in the butt
• Pain extending down the back of the thigh, calf, and foot (sciatica)
• Pain when walking up inclines or stairs
• Increased pain after an extended period of sitting
• Decreased range of motion of the hip joint

Piriformis syndrome symptoms usually worsen after prolonged periods of walking, sitting, or running, and may feel better upon lying down on the back.

Diagnosing Piriformis Syndrome

A review of the patient’s health history, a physical exam, and diagnostic tests help determine the presence of piriformis syndrome in a patient.

Piriformis syndrome diagnosis is made through a process of eliminating other possible conditions that may be the reason for the patient’s symptoms, such as sacroiliac joint dysfunction or a lumbar disc herniation.

Physical Examination

The physical examination involves an assessment of the hip and legs to check if movement causes an increase in lower extremity pain (sciatica pain) or low back pain.

In general, hip motion will recreate the pain. The examination will also eliminate or identify other potential causes of sciatica pain, such as testing for muscle strength or local tenderness.

Medical History

A health history includes a detailed review of the patient’s symptoms, such as how long they have been experiencing the symptoms, what activities or positions make the symptoms better or worse if they manifested slowly or following an injury, and what treatments have been tried.

This will also include an assessment of conditions that may be in the patient’s family, such as arthritis.

Diagnostic Tests

X-rays and other imaging tests for the spine cannot determine if the sciatic nerve is being compressed by the piriformis muscle. But diagnostic tests (MRI, X-rays, and nerve conduction tests) may be undertaken to rule out other conditions that can cause symptoms that are similar to piriformis syndrome.

To confirm if the piriformis muscle is the cause of the symptoms, an injection of anesthetic with or without steroids may help.

Magnetic Resonance Neurography: This type of magnetic resonance imaging (MRI) test checks for swelling in the nerves.

FAIR Test: The flexion, adduction, and internal rotation test flexes the hip in order to stretch the piriformis and impinge the sciatic nerve. It measures the time lapses in the sciatic nerve signals due to its impingement under the piriformis.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.
Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

Piriformis syndrome refers to a neuromuscular disorder that occurs when the piriformis muscle compresses the sciatic nerve.

The piriformis muscle is a band-like and flat muscle that is located in the butt near the top of the hip joint. This muscle is crucial for lower body movement as it provides stability to the hip joint and lifts and rotates the thigh away from the body.

This allows a person to walk, shift their weight from one foot to another, and maintain balance. It is also vital to performing sports activities involving lifting and rotating the thighs. In fact, it is essential for almost every movement of the legs and hips.

The sciatic nerve is a long, thick nerve in the body. It extends alongside or goes through the piriformis muscle, extends down the back of the leg, and eventually branches off into smaller nerves that end in the feet. A spasm of the piriformis muscle may cause nerve compression.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

Pathophysiology

The piriformis muscle can compress or shorten the sciatic nerve underneath the muscle when it shortens or spasms because of trauma or overuse. In general, these types of conditions are known as nerve entrapment or as entrapment neuropathies.

The specific condition called piriformis syndrome involves sciatica symptoms that do not originate from spinal roots and/or spinal disc compression but occur due to the involvement of the overlying piriformis muscle.

In 17 percent of an assumed normal population, the sciatic nerve goes through the piriformis muscle, instead of passing beneath it. But in patients receiving surgery for suspected piriformis syndrome, such an anomaly was detected only 16.2 percent of the time. This creates doubt about the relevance of the anomaly as a contributing factor in piriformis syndrome.

According to some researchers, the relevance of this relationship in the etiology of the syndrome is not high. However, MRI findings indicate that hypertrophy (unusual largeness), as well as atrophy (unusually smallness) of the piriformis muscle, is related to the supposed condition.

Some theories hypothesize that individuals who exercise routinely by bicycling, running, and other forward moving activities may be more prone to developing piriformis syndrome if they do not perform strengthening exercises and lateral stretching.

But it is also likely that such individuals actually have small herniations in a spinal disc which compress the sciatic nerve and lead to a piriformis spasm secondarily.

There is scant evidence indicating a specific relationship between the strength or weakness of particular hip muscles and sciatic pain centered on the piriformis muscle. Additionally, this sports-related explanation is not useful in understanding the piriformis syndrome in people who are not particularly physically active (which is frequently the case).

A piriformis muscle spasm can result in the impingement of the sciatic nerve as well as the pudendal nerve. The pudendal nerve controls the muscles of the bladder and bowels. Pudendal nerve entrapment symptoms include numbness and tingling in the saddle areas and groin. It can also cause urinary and fecal incontinence.

Piriformis syndrome may also be related to direct injury to the piriformis muscle, such as from a knife wound or in a fall.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/