Skip to main content

Advertisement

Springer Nature Link
Log in

The clinical features of the piriformis syndrome: a systematic review

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Piriformis syndrome, sciatica caused by compression of the sciatic nerve by the piriformis muscle, has been described for over 70 years; yet, it remains controversial. The literature consists mainly of case series and narrative reviews. The objectives of the study were: first, to make the best use of existing evidence to estimate the frequencies of clinical features in patients reported to have PS; second, to identify future research questions. A systematic review was conducted of any study type that reported extractable data relevant to diagnosis. The search included all studies up to 1 March 2008 in four databases: AMED, CINAHL, Embase and Medline. Screening, data extraction and analysis were all performed independently by two reviewers. A total of 55 studies were included: 51 individual and 3 aggregated data studies, and 1 combined study. The most common features found were: buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with manoeuvres that increase piriformis muscle tension. Future research could start with comparing the frequencies of these features in sciatica patients with and without disc herniation or spinal stenosis.

This is a preview of subscription content,log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
€32.70 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Singapore)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Adams JA (1980) The pyriformis syndrome—report of four cases and review of the literature. S Afr J Surg 18:13–18

    CAS PubMed Google Scholar

  2. Banerjee T, Hall CD (1976) Sciatic entrapment neuropathy. Case report. J Neurosurg 45:216–217

    Article CAS PubMed Google Scholar

  3. Barton PM (1991) Piriformis syndrome: a rational approach to management. Pain 47:345–352

    Article CAS PubMed Google Scholar

  4. Beatty RA (1994) The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurgery 34:512–513

    Article CAS PubMed Google Scholar

  5. Beauchesne RP, Schutzer SF (1997) Myositis ossificans of the piriformis muscle: an unusual cause of piriformis syndrome. A case report. J Bone Joint Surg 79:906–910

    CAS PubMed Google Scholar

  6. Benson ER, Schutzer SF (1999) Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am 81:941–949

    Article CAS PubMed Google Scholar

  7. Benzon HT, Katz JA, Benzon HA, Iqbal MS (2003) Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology 98:1442–1448

    Article PubMed Google Scholar

  8. Bernard TN, Kirkaldy-Willis WH (1987) Recognizing specific characteristics of nonspecific low back pain. Clin Orthop 217:266–280

    PubMed Google Scholar

  9. Bossuyt PM, Reitsma JB, Bruns DE et al (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ 326:41–44

    Article PubMed Google Scholar

  10. Broadhurst NA, Simmons DN, Bond MJ (2004) Piriformis syndrome: correlation of muscle morphology with symptoms and signs. Arch Phys Med Rehabil 85:2036–2039

    Article PubMed Google Scholar

  11. Brown JA, Braun MA, Namey TC (1988) Pyriformis syndrome in a 10-year-old boy as a complication of operation with the patient in the sitting position. Neurosurgery 23:117–119

    Article CAS PubMed Google Scholar

  12. Bustamante S, Houlton PG (2001) Swelling of the leg, deep venous thrombosis and the piriformis syndrome. Pain Res Manag 6:200–203

    CAS PubMed Google Scholar

  13. Byrd JWT (2005) Piriformis syndrome. Oper Tech Sports Med 13:71–79

    Article Google Scholar

  14. Carey TS, Boden SD (2003) A critical guide to case series reports. Spine 28:1631–1634

    Article PubMed Google Scholar

  15. Centre for Evidence-based Medicine (2009) Oxford Centre for evidence-based medicine—levels of evidence.http://www.cebm.net/index.aspx?o=1025.Accessed 7 July 2009

  16. Centre for Reviews and Dissemination (2009) Systematic reviews. CRD’s guidance for undertaking reviews in health care.http://www.york.ac.uk/inst/crd/systematic_reviews_book.htm.Accessed 7 July 2009

  17. Chang CW, Shieh SF, Li CM, Wu WT, Chang KF (2006) Measurement of motor nerve conduction velocity of the sciatic nerve in patients with piriformis syndrome: a magnetic stimulation study. Arch Phys Med Rehabil 87:1371–1375

    Article PubMed Google Scholar

  18. Chantraine A, Gauthier C (1990) The pyriformis syndrome. Ann Readapt Med Phys 33:347–353

    Google Scholar

  19. Chen WS (1992) Sciatica due to piriformis pyomyositis. Report of a case. J Bone Joint Surg Am 74:1546–1548

    CAS PubMed Google Scholar

  20. Chen WS (1994) Bipartite piriformis muscle: an unusual cause of sciatic nerve entrapment. Pain 58:269–272

    Article CAS PubMed Google Scholar

  21. Chen WS, Wan YL (1992) Sciatica caused by piriformis muscle syndrome: report of two cases. J Formos Med Assoc 91:647–650

    CAS PubMed Google Scholar

  22. Chong KW, Tay BK (2004) Piriformis pyomyositis: a rare cause of sciatica. Singap Med J 45:229–231

    CAS Google Scholar

  23. Collier FC (1985) Acute monetary sciatica. Lancet 1079

  24. Colmegna I, Justiniano M, Espinoza LR, Gimenez CR (2007) Piriformis pyomyositis with sciatica: an unrecognized complication of “unsafe” abortions. J Clin Rheumatol 13:87–88

    Article PubMed Google Scholar

  25. Cook MW, Levin LA, Joseph MP, Pinczower EF (1996) Traumatic optic neuropathy. A meta-analysis. Arch Otolaryngol Head Neck Surg 122:389–392

    CAS PubMed Google Scholar

  26. Cramp F, Bottrell O, Campbell H et al (2007) Non-surgical management of piriformis syndrome: a systematic review. Phys Ther Rev 12:66–72

    Article Google Scholar

  27. Dalmau-Carola J (2005) Myofascial pain syndrome affecting the piriformis and the obturator internus muscle. Pain Pract 5:361–363

    Article PubMed Google Scholar

  28. Dhote R, Tudoret L, Bachmeyer C, Legmann P, Christoforov B (1996) Cyclic sciatica. A manifestation of compression of the sciatic nerve by endometriosis. A case report. Spine 21:2277–2279

    Article CAS PubMed Google Scholar

  29. Dionne CE, Dunn KM, Croft PR et al (2008) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 33:95–103

    Article PubMed Google Scholar

  30. Durrani Z, Winnie AP (1991) Piriformis muscle syndrome: an underdiagnosed cause of sciatica. J Pain Symptom Manage 6:374–379

    Article CAS PubMed Google Scholar

  31. El Rubaidi OA, Horcajadas AA, RodrÌguez RD, Galicia Bulnes JM (2003) Sciatic nerve compression as a complication of the sitting position. Neurocirugia 14:426–430

    CAS PubMed Google Scholar

  32. Ernst E (2002) Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995–2001. Med J Aust 176:376–380

    PubMed Google Scholar

  33. Ernst E (2003) The safety of massage therapy. Rheumatology 42:1101–1106

    Article CAS PubMed Google Scholar

  34. Ernst E (2005) Ophthalmological adverse effects of (chiropractic) upper spinal manipulation: evidence from recent case reports. Acta Ophthalmol Scand 83:581–585

    Article PubMed Google Scholar

  35. Ernst E (2007) Adverse effects of spinal manipulation: a systematic review. J R Soc Med 100:330–338

    Article CAS PubMed Google Scholar

  36. Filler AG, Haynes J, Jordan SE et al (2005) Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine 2:99–115

    Article PubMed Google Scholar

  37. Fishman LM, Dombi GW, Michaelsen C et al (2002) Piriformis syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil 83:295–301

    Article PubMed Google Scholar

  38. Fishman LM, Zybert PA (1992) Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil 73:359–364

    Article CAS PubMed Google Scholar

  39. Fishman LM, Schaefer MP (2003) Piriforms syndrome: the piriformis syndrome is underdiagnosed. Muscle Nerve 28:646–649

    Article PubMed Google Scholar

  40. Foster MR (1999) Clinical trials for piriformis syndrome. Orthopedics 22:561–569

    CAS PubMed Google Scholar

  41. Foster MR (2002) Piriformis syndrome. Orthopedics 25:821–825

    PubMed Google Scholar

  42. Freiberg AH, Vinke TH (1934) Sciatica and the sacro-iliac joint. J Bone Joint Surg Am 16:126–136

    Google Scholar

  43. Freiberg AH (1937) Sciatic pain and its relief by operations on muscle and fascia. Arch Surg 34:337–350

    Google Scholar

  44. Gandhavadi B (1990) Bilateral piriformis syndrome associated with dystonia musculorum deformans. Orthopedics 13:350–351

    CAS PubMed Google Scholar

  45. Guyomarc’h HF, Labanere C (2004) Piriformis muscle syndrome: differential diagnosis with sciatalgia in the athlete: three cases and a review of the literature. J Traumatol Surg 21:133–145

    Article Google Scholar

  46. Hallin RP (1983) Sciatic pain and the piriformis muscle. Postgrad Med 74:69–72

    CAS PubMed Google Scholar

  47. Hanania M, Kitain E (1998) Perisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome. Reg Anesth Pain Med 23:223–228

    Article CAS PubMed Google Scholar

  48. Hopayian K (1999) Sciatica in the community—not always disc herniation. Int J Clin Pract 53:197–198

    CAS PubMed Google Scholar

  49. Hughes SS, Goldstein MN, Hicks DG, Pellegrini VDJ (1992) Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip: report of five cases. J Bone Joint Surg Am 74:1553–1559

    CAS PubMed Google Scholar

  50. Hulbert A, Deyle GD (2009) Differential diagnosis and conservative treatment for piriformis syndrome: a review of the literature. Curr Orthop Pract 20:313–319

    Article Google Scholar

  51. Indrekvam K, Sudmann E (2002) Piriformis muscle syndrome in 19 patients treated by tenotomy—a 1- to 16-year follow-up study. Int Orthop 26:101–103

    Article CAS PubMed Google Scholar

  52. Jabs DA (2005) Improving the reporting of clinical case series. Am J Ophthalmol 139:900–905

    Article PubMed Google Scholar

  53. Jankiewicz JJ, Hennrikus WL, Houkom JA (1991) The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging: a case report and review of the literature. Clin Orthop Relat Res 262:205–209

    PubMed Google Scholar

  54. Jenicek M (1999) Clinical case reporting in evidence-based medicine. Butterworth-Heinemann, Oxford

    Google Scholar

  55. Jroundi L, El Quessar A, Chakir N, El Hassani MR, Jiddane M (2003) The piriformis syndrome: a rare cause of non discogenic sciatica. A case report. J Radiol 84:715–717

    CAS PubMed Google Scholar

  56. Julsrud ME (1989) Piriformis syndrome. J Am Podiatr Med Assoc 79:128–131

    CAS PubMed Google Scholar

  57. Karl RD Jr, Yedinak MA, Hartshorne MF et al (1985) Scintigraphic appearance of the piriformis muscle syndrome. Clin Nucl Med 10:361–363

    Article PubMed Google Scholar

  58. Karppinen J, Malmivaara A, Tervonen O et al (2001) Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients. Spine 26:E149–E154

    Article CAS PubMed Google Scholar

  59. Kent DL, Haynor DR, Longstreth WTJ, Larson EB (1994) The clinical efficacy of magnetic resonance imaging in neuroimaging. Ann Intern Med 120:856–871

    CAS PubMed Google Scholar

  60. Kirschner JS, Foye PM, Cole JL (2009) Piriformis syndrome, diagnosis and treatment. Muscle Nerve 40:10–18

    Article PubMed Google Scholar

  61. Kobbe P, Zelle BA, Gruen GS (2008) Case report: recurrent piriformis syndrome after surgical release. Clin Orthop Relat Res 466:1745–1748

    Article PubMed Google Scholar

  62. Konstantinou K, Dunn KM (2008) Sciatica: review of epidemiological studies and prevalence estimates. Spine 33:2464–2472

    Article PubMed Google Scholar

  63. Kosukegawa I, Yoshimoto M, Isogai S, Nonaka S, Yamashita T (2006) Piriformis syndrome resulting from a rare anatomic variation. Spine 31:E664–E666

    Article PubMed Google Scholar

  64. Kouvalchouk J, Bonnet JM, de Mondenard JP (1996) Piriformis syndrome. Apropos of 4 cases treated by surgery and review of the literature. [French]. Rev Chir Orthop Reparatrice Appar Mot 82:647–657

    CAS PubMed Google Scholar

  65. Ku A, Kern H, Lachman E, Nagler W (1995) Sciatic nerve impingement from piriformis hematoma due to prolonged labor [letter]. Muscle Nerve 18:789–790

    CAS PubMed Google Scholar

  66. Kumar B, Sriram KG, George C (2002) Osteophyte at the sacroiliac joint as a cause of sciatica: a report of four cases. J Orthop Surg (Hong Kong) 10:73–76

    Google Scholar

  67. Lee EY, Margherita AJ, Gierada DS, Narra VR (2004) MRI of piriformis syndrome. Am J Roentgenol 183:63–64

    Google Scholar

  68. Lewis AM, Layzer R, Engstrom JW, Barbaro NM, Chin CT (2006) Magnetic resonance neurography in extraspinal sciatica. Arch Neurol 63:1469–1472

    Article PubMed Google Scholar

  69. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medhttp://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000100.Accessed 27 March 2010

  70. Limongelli P, Khorsandi SE, Pai M et al (2008) Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis. Arch Surg 143:1001–1007

    Article PubMed Google Scholar

  71. Lu MY, Dong BJ, Ma XY (1985) Piriformis syndrome and its operative treatment: an analysis of sixty cases. Zhonghua wai ke za zhi (Chinese journal of surgery) 23, 483-4, 510

    Google Scholar

  72. Mayrand N, Fortin J, Descarreaux M, Normand MC (2006) Diagnosis and management of posttraumatic piriformis syndrome: a case study. J Manipulative Physiol Ther 29:486–491

    Article PubMed Google Scholar

  73. Merlo IM, Poloni TE, Alfonsi E, Messina AL, Ceroni M (1997) Sciatic pain in a young sportsman. Lancet 349:846

    Article CAS PubMed Google Scholar

  74. Miller A, Stedman GH, Beisaw NE, Gross PT (1987) Sciatica caused by an avulsion fracture of the ischial tuberosity. a case report. J Bone Joint Surg Am 69:143–145

    CAS PubMed Google Scholar

  75. Mixter WJ, Barr JB (1934) Rupture of intervertebral disc with involvement of the spinal canal. N Engl J Med 211:110–115

    Article Google Scholar

  76. Molina N (2003) Piriformis syndrome. Dyn Chiroprhttp://www.dynamicchiropractic.com/mpacms/dc/article.php?id=9079.Accessed 4 April 2010

  77. Nakamura H, Seki M, Konishi S, Yamano Y, Takaoka K (2003) Piriformis syndrome diagnosed by cauda equina action potentials: report of two cases. Spine 28:E37–E40

    Article PubMed Google Scholar

  78. Ozaki S, Hamabe T, Muro T (1999) Piriformis syndrome resulting from an anomalous relationship between the sciatic nerve and piriformis muscle. Orthopedics 22:771–772

    CAS PubMed Google Scholar

  79. Pace JB, Nagle D (1976) Piriform syndrome. West J Med 124:433–439

    Google Scholar

  80. Papadopoulos EC, Khan SN (2004) Piriformis syndrome and low back pain: A new classification and review of the literature. Orthop Clin North Am 35:65–71

    Article PubMed Google Scholar

  81. Papadopoulos SM, McGillicuddy JE, Albers JW (1990) Unusual cause of ‘piriformis muscle syndrome’. Arch Neurol 47:1144–1146

    CAS PubMed Google Scholar

  82. Papadopoulos SM, McGillicuddy JE, Messina LM (1989) Pseudoaneurysm of the inferior gluteal artery presenting as sciatic nerve compression. Neurosurgery 24:926–928

    Article CAS PubMed Google Scholar

  83. Park HW, Jahng JS, Lee WH (1991) Piriformis syndrome—a case report. Yonsei Med J 32:64–68

    CAS PubMed Google Scholar

  84. Pecina HI, Boric I, Smoljanovic T, Duvancic D, Pecina M (2008) Surgical evaluation of magnetic resonance imaging findings in piriformis muscle syndrome. Skelet Radiol 37:1019–1023

    Article Google Scholar

  85. Pecina M (1979) Contributions to the etiological explanation of the piriformis syndrome. Acta Anat 105:181–187

    Article CAS PubMed Google Scholar

  86. Pokorny D, Jahoda D, Veigl D, Pinskerov V, Sosna A (2006) Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 28:88–91

    Article PubMed Google Scholar

  87. Raney EM, Freccero DM, Dolan LA et al (2008) Evidence-based analysis of removal of orthopaedic implants in the pediatric population. J Pediatr Orthop 28:701–704

    PubMed Google Scholar

  88. Retzlaff EW, Berry AH, Haight AS et al (1974) The piriformis muscle syndrome. J Am Osteopath Assoc 73:799–807

    CAS PubMed Google Scholar

  89. Rich BSE, McKeag D (1992) When sciatica is not disk disease: detecting piriformis syndrome in active patients. Neurorehabil Neural Repair 20:104–108

    Google Scholar

  90. Richardson RR, Garon JE, Sianis GJ (1992) Sciatic entrapment neuropathy by tendinized muscle—the pyriformis syndrome: a case report. J Neurol Orthop Med Surg 13:142–145

    Google Scholar

  91. Robinson DR (1947) Pyriformis syndrome in relation to sciatic pain. Am J Surg 73:355–358

    Article CAS PubMed Google Scholar

  92. Rodrigue T, Hardy RW (2001) Diagnosis and treatment of piriformis syndrome. Neurosurg Clin N Am 12:311–319

    CAS PubMed Google Scholar

  93. Rossi P, Cardinali P, Serrao M et al (2001) Magnetic resonance imaging findings in piriformis syndrome: a case report. Arch Phys Med Rehabil 82:519–521

    Article CAS PubMed Google Scholar

  94. Rucco V, Onorato A (1998) Common pseudoradicular syndromes (pseudocrural and pseudosciatic pain). Europa Medicophysica 34:75–83

    Google Scholar

  95. Sayson SC, Ducey JP, Maybrey JB, Wesley RL, Vermilion D (1994) Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain 59:149–152

    Article CAS PubMed Google Scholar

  96. Silver JK, Leadbetter WB (1998) Piriformis syndrome: assessment of current practice and literature review. Orthopedics 21:1133–1135

    CAS PubMed Google Scholar

  97. Slipman CW, Vresilovic EJ, Palmer MA, Lipetz JS, Lenrow D (1999) Piriformis muscle syndrome: a diagnostic dilemma. J Musculoskelet Pain 7:73–83

    Article Google Scholar

  98. Soga J, Yakuwa Y, Osaka M (1999) Carcinoid syndrome: a statistical evaluation of 748 reported cases. J Exp Clin Cancer Res 18:133–141

    CAS PubMed Google Scholar

  99. Solheim LF, Siewers P, Paus B (1981) The piriformis muscle syndrome: sciatic nerve entrapment treated with section of the piriformis muscle. Acta Orthop Scand 52:73–75

    Article CAS PubMed Google Scholar

  100. Spinner RJ, Thomas NM, Kline DG (2001) Failure of surgical decompression for a presumed case of piriformis syndrome. Case report. J Neurosurg 94:652–654

    Article CAS PubMed Google Scholar

  101. Stegbauer CC (1997) Sciatic pain and piriformis syndrome. Nurse Pract 22:166–180

    Google Scholar

  102. Stein JM, Warfield CA (1983) Two entrapment neuropathies. Hosp Pract 18:100A, 100E, 100H

    Google Scholar

  103. Steiner C, Staubs C, Ganon M, Buhlinger C (1987) Piriformis syndrome: pathogenesis, diagnosis, and treatment. J Am Osteopath Assoc 87:318–323

    CAS PubMed Google Scholar

  104. Stevens KJ, Banuls M (1994) Sciatic nerve palsy caused by haematoma from iliac bone graft donor site. Eur Spine J 3:291–293

    Article CAS PubMed Google Scholar

  105. Stewart JD (2003) The piriformis syndrome is overdiagnosed. Muscle Nerve 28:644–646

    Article PubMed Google Scholar

  106. Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F (2000) Methods for meta-analysis in medical research. Wiley, London

    Google Scholar

  107. Synek VM (1987) Short latency somatosensory evoked potentials in patients with painful dysaesthesias in peripheral nerve lesions. Pain 29:49–58

    Article CAS PubMed Google Scholar

  108. Synek VM (1987) The pyriformis syndrome: review and case presentation. Clin Exp Neurol 23:31–37

    CAS PubMed Google Scholar

  109. Terrasa S, Caccavo T, Ferraris J et al. (2007) Guía para la lectura crítica de una Serie de Casos. Evidencia en la Práctica Ambulatoria.http://www.foroaps.org/files/guia%20de%20serie%20de%20casos.pdf.Accessed 4 April 2010

  110. Tiel RL (2008) Piriformis and related entrapment syndromes: myth and fallacy. Neurosurg Clin N Am 19:623–627 vii

    Article PubMed Google Scholar

  111. Tiel RL, Kline DG (2006) Piriformis syndrome. J Neurosurg Spine 5:102–104

    Article PubMed Google Scholar

  112. Turtas S, Zirattu G (2006) The piriformis syndrome: a case report of an unusual cause of sciatica. J Orthop Traumatol 7:97–99

    Article Google Scholar

  113. Vallejo MC, Mariano DJ, Kaul B, Sah N, Ramanathan S (2004) Piriformis syndrome in a patient after cesarean section under spinal anesthesia. Reg Anesth Pain Med 29:X364–X367

    Google Scholar

  114. van Tulder M, Becker A, Bekkering T et al (2006) Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15(Suppl 2):S169–S191

    Article PubMed Google Scholar

  115. Vandenbroucke JP (2001) In defense of case reports and case series. Ann Intern Med 134:330–334

    CAS PubMed Google Scholar

  116. Vandertop WP, Bosma NJ (1991) The piriformis syndrome. A case report. J Bone Joint Surg Am 73:1095–1097

    CAS PubMed Google Scholar

  117. Waddell G (2004) The back pain revolution. Churchill Livingstone, London

    Google Scholar

  118. West S, King V, Carey TS et al. (2002) Systems to rate the strength of scientific evidence. Evidence Report/Technology Assessment Number 47.http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.70996.Accessed 4 April 2010

  119. West D, Togo A, Kirk AJ (2007) Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula an effective alternative to repeat thoracotomy? Interact Cardiovasc Thorac Surg 6:547–550

    Article PubMed Google Scholar

  120. Wyant GM (1979) Chronic pain syndromes and their treatment. III. The piriformis syndrome. Can Anaesth Soc J 26:305–308

    Article CAS PubMed Google Scholar

  121. Yoon SJ, Ho J, Kang HY et al (2007) Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome. Pharmacotherapy 27:657–665

    Article CAS PubMed Google Scholar

  122. Young J (1999) Lung volume surgery (LVRS) for chronic obstructive pulmonary disease (COPD) with underlying severe emphysema, A West Midlands Development and Evaluation Committee Report. University of Birmingham, Birmingham

    Google Scholar

  123. Yuen EC, So YT (1999) Sciatic neuropathy. Neurol Clin 17:617–631

    Article CAS PubMed Google Scholar

Download references

Acknowledgments

We thank Mrs Wendy Marsh, Head of Knowledge Services, Ipswich PCT for assistance with retrieval, and Prof. Milos Jenicek and Prof. Paul Glasziou for comments on the assessment of case studies. The study was partly funded by a grant from the Scientific Foundation Board of the Royal College of General Practitioners. The authors are independent of the funding body.

Conflicts of interest statement

None.

Author information

Authors and Affiliations

  1. School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK

    Kevork Hopayian, Fujian Song & Sidha Sambandan

  2. Department of the Medicine, Universidad Carabobo, Valencia, Venezuela

    Ricardo Riera

  3. Seahills, Leiston Rd, Aldeburgh, IP15 5PL, UK

    Kevork Hopayian

Authors
  1. Kevork Hopayian
    View author publications

    You can also search for this author in PubMedGoogle Scholar

  2. Fujian Song
    View author publications

    You can also search for this author in PubMedGoogle Scholar

  3. Ricardo Riera
    View author publications

    You can also search for this author in PubMedGoogle Scholar

  4. Sidha Sambandan
    View author publications

    You can also search for this author in PubMedGoogle Scholar

Corresponding author

Correspondence to Kevork Hopayian.

Appendices

Appendix 1: Anatomy of the PM

The PM originates from the pelvic surface of the sacral segments S2–S4, the sacro-iliac joint, the anterior sacro-spinous ligament and the sacro-tuberous ligament. It passes through the greater sciatic notch to insert onto the greater trochanter of the femur. The sciatic nerve exits the pelvis below the belly of the muscle. Many congenital variations exist: the nerve may divide proximally, the nerve or a division of the nerve may pass through the belly of the muscle through its tendons or between the part of a congenitally bifid muscle [85,86]. The PM externally rotates, abducts and partially extends into the hip.

Appendix 2: Data extraction form for individual patient data

Citation

Type of study

Patient identification number

  • Symptoms

    • Buttock pain

    • Low back pain

    • Difficulty in sitting or pain aggravated by sitting

    • Dyspareunia

  • Signs specific for PS

    • External tenderness over the greater sciatic notch

    • Internal tenderness of the PM on vaginal or rectal examination

    • Freiberg test

    • Pace test

    • Beatty test

    • Tonic external rotation of the hip

    • Flexion–adduction–internal rotation (FAIR) painful

  • Routine sciatica signs

    • Limited SLR or positive Lasegue

    • Knee or ankle tendon reflex diminished

    • Sensation along dermatomes L4, L5 and S1 diminished

    • Power in myotomes L3/L4 and L5/S1 diminished

Appendix 3: Items in the quality assessment in case studies of PS

Description

  1. 1.

    Were all relevant demographic features, namely, age and sex, described?

  2. 2.

    Were key features in the history reported? These are onset whether acute or gradual, site of pain, radiation, relieving and aggravating factors, duration, evolution of the condition and past medical history.

  3. 3.

    Were routine sciatica examinations reported: sensation, power, tendon reflexes, straight leg raising/Lasegue?

  4. 4.

    Was at least one examination specific for PS reported: external rotation of foot, Freiberg sign, Pace sign, Beatty sign, Flexion–Adduction–Internal Rotation (FAIR) test?

Case definition

  1. 5.

    Was there corroborating evidence?

Selection

  1. 6.

    Applies only for case series

Was the method of selection free of bias, for example, through recruitment of consecutive cases?

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hopayian, K., Song, F., Riera, R.et al.The clinical features of the piriformis syndrome: a systematic review. Eur Spine J19,2095–2109 (2010). https://doi.org/10.1007/s00586-010-1504-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:https://doi.org/10.1007/s00586-010-1504-9

Keywords

Search

Navigation