Download Implications of Delayed Diagnosis of Piriformis Syndrome

Implications of Delayed Diagnosis of Piriformis
Syndrome
Nathan Kenyon, MD; Mohammad Agha, MD
University of Missouri, Department of Physical Medicine and Rehabilitation
INTRODUCTION
 Piriformis
originates anterior to S2-4 vertebrae and
inserts on greater trochanter of femur
 Action: lateral rotator of hip
 Innervation: branches of L5, S1, S2
 Estimated incidence of piriformis syndrome in
patients with sciatica is 6%
Left
PSW/
Fibs
Insertional
Activity
Recruitment
Gluteus maximus
0
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Vastus medialis
0
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Gastrocnemius
1+
Increased
Decreased
Tibialis Anterior
0
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Biceps femoris
(Long head)
0
Increased
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Lumbar
Paraspinals
0
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Repeat EMG Results at 12 months
CASE DESCRIPTION
 50
year-old male presented to a spine clinic 12
month history of pain in left mid-buttock with
radiation into the calf, no previous history of trauma
or surgery at hip joint
 Previous treatments: gabapentin, prednisone,
tramadol, hydrocodone, baclofen, physical therapy,
intra-articular hip injection, epidural steroid
injection, medial branch block
 Initially diagnostic ultrasound was performed which
revealed obturator internus inflammation; a steroid
injection was administered but did not decrease the
patient’s pain.
CLINICAL COURSE




Considered ischio-femoral impingement (IFI)
and obtained pelvis MRI which revealed
abnormal signal in sciatic nerve.
1 month prior had normal lower extremity
EMG.
Repeat EMG revealed evidence of chronic
denervation in left gastrocnemius, short head
of biceps femoris.
Referred to orthopedics and underwent left
piriformis tendon release with complete
resolution of pain
CONCLUSION
 Our
patient was prescribed several
medications and procedures which failed to
identify and treat the pain generator.
 Piriformis syndrome can be a challenging
diagnosis and difficult to treat. Delay in
recognition and treatment of piriformis
syndrome may result in unnecessary
treatments and prolong patient suffering.