What is the difference between piriformis syndrome and sciatica

The patient may also experience intense pain while sitting, squatting or climbing stairs. Tenderness to palpation in the area of the sciatic notch may be detected on exam, corresponding to the piriformis muscle [2] Figure 2.

A high index of suspicion is needed for diagnosis. A thorough medical history and physical examination are essential, followed by diagnostic testing to differentiate piriformis syndrome from other causes of sciatica.

An MRI could show an enlarged piriformis, anomalies of the vessels, and compression of the nerve. However, imaging studies are commonly performed to rule out other causes of sciatic nerve and gluteal pain. Physical examination techniques are often used to determine the underlying causes of sciatica.

The FAIR test is a sensitive and specific test for piriformis syndrome. FAIR stands for flexion, adduction and internal rotation. The purpose of this test is to stretch the piriformis muscle compressing the sciatic nerve. To perform, have the patient lie with the affected side up, the examiner stabilizes the flexed hip and applies downward pressure to the knee to internally rotate and adduct the hip.

This is a passive test used to reproduce pain along the sciatic nerve distribution by flexing the hip while keeping the knee extended. First-line treatment consists of non-steroidal anti-inflammatory medications NSAID , however continued use of NSAIDs can have adverse renal and gastrointestinal effects and the patient must be educated. Additional conservative measures include physical therapy using piriformis stretching and isometric strengthening.

Physical therapists often use the FAIR maneuver as treatment. If these measures are unsuccessful, consider local nerve block injections under ultrasound or fluoroscopy guidance into the piriformis muscle, which is considered both therapeutic and diagnostic if the etiology remains unclear after initial evaluation.

Injections may include local anesthetic and steroid or botulinum toxin BTX. Surgery may include the release of the piriformis muscle from the greater trochanter with or without sciatic nerve neurolysis [4]. Piriformis syndrome should be differentiated from other causes of sciatica. It is often an underappreciated diagnosis, but remains a diagnosis of exclusion.

Sciatica should be evaluated by differentiating between spinal causes, such as compression of the nerve root, or compression of the sciatic nerve itself as in piriformis syndrome. The main cause of true sciatica is a lumbar disc herniation. Conservative treatment is often successful, but more invasive measures remain as treatment options.

Patients should consult with their doctor before determining a course of treatment. Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider.

To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup. Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography not possible with MRI. Separation of muscle ends due to tear elicited on dynamic sonography examination.

Sciatica versus Piriformis Syndrome: What is the Difference? About the Author. Certificates and Postgraduate Education. We accept insurance. Contact Us Name Phone. Failure to accurately diagnose a condition in its early stages can lead to chronic problems and sometimes devastating results Diagnostic musculoskeletal sonography MSUS provides the perfect tool for the rehab practitioner.

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Females are more likely to be affected by the disorder than men by a ratio. Prolonged sitting is also thought to be a cause of piriformis syndrome.

Those who live sedentary lifestyles, or hold occupations that require them to sit a majority of the time, maybe putting undue pressure on the nerve. There is no set standard or first-line treatment for piriformis syndrome. Some patients find success with home remedies such as ice packs or heat or avoiding strenuous and repetitive activity.

Beyond the obvious home remedies, many doctors will opt for non-steroidal anti-inflammatory drugs, better known as NSAIDs. These include pain relievers such as aspirin, ibuprofen, or naproxen. Muscle relaxants are also commonly prescribed for nerve pain. Injections directly to the muscle are often considered if other treatments fail to work.

Physical therapy or myofascial release techniques are also recommended as a regular course of treatment.

If all conventional therapies fail, and the patient is still experiencing severe pain, surgery is an option. The surgery will essentially adjust the piriformis muscle to take the pressure off the sciatic nerve. However, this is always performed as a last resort. The prognosis for piriformis syndrome varies for every patient. That is why you should seek the care of a specialist at NS2 if you are experiencing recurring pain. Piriformis syndrome can worsen over time and become chronic, which makes it harder to treat.

If it is caught in the early stages of the condition, then more conventional therapies are likely to help, such as home remedies, physical therapies, and NSAIDs. If you need more information about piriformis syndrome or would like to be evaluated by a physician, request an appointment with the physicians at NewSouth NeuroSpine. We have over highly trained medical professionals on staff with expertise in orthopedic spine surgery, spinal intervention, physical medicine and rehabilitation, and neurosurgery fields.