Piriformis Syndrome

Piriformis syndrome is characterized by entrapment of the sciatic nerve resulting from pathology of the piriformis muscle which extends from the sacrum to the greater trochanter of the femur. The condition produces buttock pain that may radiate down the leg mimicking lumbar radiculopathy. Anatomic variants where the sciatic nerve passes through or above the muscle contribute to susceptibility.

The condition typically develops from prolonged sitting on hard surfaces direct trauma to the buttock repetitive overuse in sports or excessive hip rotation. Patients describe deep aching buttock pain worsened by sitting climbing stairs or hip rotation. Pain may extend to the posterior thigh and rarely below the knee distinguishing it from true lumbar radiculopathy.

Diagnosis is primarily clinical based on tenderness over the piriformis muscle positive provocative tests including Pace and Freiberg maneuvers and exclusion of lumbar spine pathology. Imaging is reserved for atypical presentations. Treatment combines stretching exercises physical therapy nonsteroidal anti inflammatory drugs and image guided injections in refractory cases. Surgery is rarely needed and considered for failed conservative therapy.