Piriformis Syndrome

Jon Hyman, MD, providing Truly Advanced Orthopedic care in Atlanta, Georgia, is a specialist in diagnosing and treating Piriformis Syndrome. Piriformis syndrome is a neuromuscular condition which can cause posterior hip pain, deep buttock pain and even shooting pain down the back of the leg. The piriformis is a muscle located posteriorly which functions to rotate the hip. The piriformis muscle is located just superficial to the sciatic nerve. The sciatic nerve runs down the back of the leg with nerve endings leading all the way to the foot.

Symptoms

Inflammation of the piriformis can compress the nerve, causing shooting pain down the leg, numbness and tingling in the lower extremity and deep posterior buttock pain. The pain may also extend down along the nerve and involve the leg as well (extraspinal sciatica).

Pain is usually exaggerated by activities which exert pressure over the piriformis muscle such as sitting for long hours, running or climbing stairs. Other symptoms may include tingling and numbness, and sciatic nerve irritation.

Diagnosis

Piriformis Syndrome is commonly misdiagnosed. The diagnosis of piriformis syndrome involves a combination of the following:

• Careful History: interview with the patient
• Detailed Physical Examination: combination of physical examination employing different movements of the hip and the leg, which may trigger characteristic pain in the buttock and leg.
• Ultrasound evaluation in the sciatic notch
• MRI (Magnetic Resonance Imaging): to rule out other causes of sciatic nerve compression such as degenerative disc disease, spondylolisthesis, spinal stenosis or arthritis of the spine
• MRN (Magnetic Resonance Neurography)
• EMG/NCS (Electromyogram / Nerve Conduction Studies)
• Diagnostic Injection with anesthetic / cortisone

Treatment

Piriformis Syndrome can be treated with conservative measures including activity modification, physical therapy, anti-inflammatories and local ultrasound-guided injections. Other conservative methods include:

• Rest, ice and heat packs
• Muscle relaxants
• Weight loss
• Rolling it on lacrosse ball
• ART / Graston technique
• Platelet Rich Plasma injection
• Dry Needling / Acupuncture

In patients with severe pain, corticosteroid or anesthetic injections can also be used.

In a few cases, Botulinum toxin injections and electrotherapy can also be considered. These help reduce the muscle tightness.

Occasionally it is necessary to make sure the pain is not referred pain from the lumber spine. Many patients may need to see a spine specialist at some point during management of this condition.

In the rare case that a patient’s piriformis syndrome is not improved with conservative measures, hip arthroscopy to release the piriformis may be indicated. This involves the surgical release of the piriformis muscle and decompression of the sciatic nerve.

Dr. Hyman specializes in a minimally invasive, endoscopic sciatic nerve decompression. With this technique, two small, less than 1 cm incisions are placed in the gluteal crease and all areas of possible sciatic nerve impingement are released.

How do we have such great results in treating Piriformis Syndrome?

We do it by listening carefully to you and your story and creating a tailored treatment regimen, which is customized for your success. We use state of the art technology, but use it with compassion and clear explanation of what we’re doing and why. While we use techniques influenced by ‘Eastern’ and ‘Western’ medicine, our scientifically-based minimally invasive approaches to your well-being give us the best results at relieving your pain.

When surgery is needed, Dr. Hyman is one of the few surgeons in the nation with experience performing advanced hip arthroscopic piriformis decompressions of the sciatic nerve. His expertise has allowed us to care for patients by delivering superior outcomes, accelerating faster recovery times and avoiding complications.

It’s our privilege to help you get rid of your nagging pain and get you back to the active life you desire.

We have successfully helped many patients return to active lifestyles, without pain. Improved Quality of Life is our objective.