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/
