‘Hand on hip’ sign: A novel screening test and diagnostic tool in piriformis syndrome (original) (raw)

Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2017

To update the evidence on the clinical features of the piriformis syndrome since the first systematic review published in 2010. A systematic review of all case, cross-sectional and prevalence studies. The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Piriformis syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis syndrome is at a stage previousl...

Piriformis Syndrome: A Clinical Review

Journal of Evolution of Medical and Dental Sciences, 2013

Piriformis Syndrome is a cause for Low back pain which is most of the times misdiagnosed as it may mimic with various other conditions. Abnormal condition of the Piriformis muscle such as hypertrophy, inflammation, or anatomic variations may lead to this condition. Reported incidence rates for Piriformis Syndrome among patients with low back pain vary widely, from 5% to 36%. Etiology of Piriformis Syndrome is also variable. It can be primary due to anatomical problems or secondary due to various other causes like trauma, local ischemia, limb-length discrepancy etc. Diagnosis of Piriformis Syndrome is complex. History with various clinical tests along with MRI, EMG (Electromyography) and Diagnostic blocks may help to diagnose this condition. Here is a review of Piriformis syndrome for better understanding of the problem so that the diagnosis and management are appropriate.

Piriformis syndrome: Diagnosis, treatment, and outcome—a 10-year study

Archives of Physical Medicine and Rehabilitation, 2002

Objectives: To validate an operational definition of piriformis syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Fortythree patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of .881 and .832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD ϭ .2275) to 12.96% poststudy (SD ϭ .1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 Ϯ 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of piriformis syndrome and is a better predictor of successful physical therapy and surgery than the working definition. The FAIR test, coupled with injection and physical therapy and/or surgery, appears to be effective means to diagnose and treat piriformis syndrome.

The clinical features of the piriformis syndrome: a systematic review

European Spine Journal, 2010

Background Piriformis syndrome (PS), 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 few studies of diagnostic accuracy have had very small samples, a significant risk of bias or both. It has been suggested that PS may account for cases of sciatica where routine investigations fail to demonstrate herniated intervertebral disc or lumbar canal stenosis, the conventionally accepted causes. Aims First, to estimate the frequencies of clinical features in patients reported as having PS. The existing evidence is composed largely of case studies so the objective was to make the best possible use of this limited evidence. Second, to identify research questions that are more specific than hitherto in order to progress future research. Methods A systematic review of any study type that reported extractable data relevant to diagnosis was undertaken. The search included all studies up to 1 March 2008 in four databases: AMED, CINAHL, Embase, and Medline. In the absence of guidance or a consensus statement on the conduct of systematic reviews of case studies, appropriate methodologies for quality assessment and data synthesis were developed. Quality criteria focused on the completeness of reporting history and physical signs routinely assessed in sciatica and those said to be indicative of PS. Frequencies were calculated from individual data studies. Several denominators were used, thereby providing a range of estimates dependent on potential reporting biases. These denominators were: all cases, those cases with explicit reporting only, those with corroboration of the syndrome, and those with explicit reporting and corroboration. Two reviewers performed all screening, data extraction, and analysis independently. Results Two hundred and twenty seven unique titles were identified. Fifty five studies were included: 51 provided details on individual patients (individual data studies), three provided only frequencies in case series (aggregated data studies), and one study reported some individual and some aggregated data. Quality of reporting was poor. Only 22 individual data studies scored all items on quality assessment and all but one of the aggregated data studies were so inadequate that their results were not considered further. Four features occurred most commonly across all denominators chosen: 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 and with measuring if they occur significantly together to warrant delineation of a syndrome.

A LITERATURE REVIEW ON: PIRIFORMIS SYNDROME AND ITS CAUSES (Atena Editora)

A LITERATURE REVIEW ON: PIRIFORMIS SYNDROME AND ITS CAUSES (Atena Editora), 2022

The piriformis muscle, located on the posterior wall of the lesser pelvis, is an essential structure for the study of the pelvic region. It originates on the pelvic surface of the sacrum (second to fourth vertebrae), ilium, and sacrotuberous ligament. The anatomical relationships that the sciatic nerve maintains during its passage through the greater sciatic foramen make it susceptible to injuries and painful symptoms, through compression or pinching of the nerve by the piriformis muscle, which may originate from anatomical variations and pathophysiological conditions, characterizing the Syndrome of Piriformis (SP) which is a neuromuscular disorder, caused by compression or irritation of the sciatic nerve, in its relationship with the Piriformis muscle. The incidence of this piriformis syndrome is reported in the literature as prevalent in female patients. GOAL: The objective of the present review is to carry out a systematic and panoramic reading of the published works on Piriformis Syndrome. The aim of this work is to specifically assess which are the main etiological factors that cause the syndrome. METHODOLOGY: the methodology used consists of a literature review about the piriformis muscle syndrome, through a bibliographic research, emphasizing aspects related to age, sex and the determining factors of causes. : Piriformis Syndrome, Piriformis Muscle, Piriformis Muscle Syndrome diagnosis, Sciatica. When accessing the database, 53 articles were found, relating to the last five years (2013 to 2022). And, after careful reading, 2 books and 35 articles were selected, 19 of which refer to case reports and were used for data collection.RESULTS AND DISCUSSION: In view of the data, there is a predominance of PS in women, in 65% of cases. Regarding the causes, there is a codominance between anatomical variations and ergonomic injuries, totaling 52.16%. The predominant age group is between 17 and 43 years old, in 56.52% of cases. CONCLUSION: Of the 19 articles used, 80% were published in the last 3 years, indicating an increase in cases and frequency of analysis. As for the causes of PS, there was a prevalence of anatomical variations and ergonomic problems (26.08% each).

The Predisposing Factors of Piriformis Syndrome: Study in a Referral Hospital

MNJ (Malang Neurology Journal), 2019

Background: Piriformis syndrome is a neuromuscular condition characterized by hip and gluteal pain caused by abnormality of piriformis muscle. In clinical practice, this syndrome is usually misdiagnosed with other spinal disorders. There is no specific test in diagnosing piriformis syndrome, therefore by understanding the characteristics and predisposing factors, clinicians may be more aware in diagnosing this syndrome. Objective: To investigate the characteristics and predisposing factors of piriformis syndrome. Methods: A descriptive study was conducted on patients with gluteal pain in a referral hospital. Diagnosis was established by block injection on piriformis muscle and showed clinical improvement afterwards. Demographic characteristics, predisposing factors, and physical examination were analyzed. The data is collected and processed by SPSS 20.0. Results: The total of 65 patients were evaluated, with a male to female ratio 1:3. As much as 47.7% of patients were > 60 years old. Average weight was 60 kg and BMI (Body Mass Index) was within normal range (58.9%). Most subjects were housewives (55.4%) and the majority of subjects had history of microtrauma such as sitting on rigid surfaces (36.9%), walking or running long distances (18.5%), and cross-legged sitting (10.8%). Average sitting per day was approximately 5 hours. In 56.9% of subjects, exercises were conducted. There was no history of back pain in 81.5% of subjects. Conclusion: Our study showed age and housewives characteristics differ with other studies. The most predisposing factors were history of microtrauma, female, age, and normal BMI.

The Piriformis Syndrome: Evaluation of Seven Cases

The Piriformis Syndrome: Evaluation of Seven Cases, 2019

Low back pain is one of the causes of Piriformis syndrome. Low back pain is the second most common medical complaints encountered by physicians. More than 50% of the population will complain of low back pain at the same time. Piriformis syndrome may constitute up to 5% of cases of low back pain, buttock pain, and lower limb pain. This is a prospective and case-control study. In this study, we study 268 cases with low back pain; in 268 cases, seven cases had Piriformis syndrome. We studied pain, severity pain, radicular pain, limping, and painful sitting. Evaluation of musculoskeletal, BMI, and physical examination of Piriformis sign, Freiberg sign, and pace sign. Neurological evaluation was taken by paraclinical examination elevated through X-ray, computed tomography scan, magnetic resonance imaging, and electromyography. Data show as mean±SD and we used SSPS software for analysis. In 268 cases with conservative method, 100% of cases were cure treatment after 4 months, in contrast to surgery methods after 1 month. The result illustrated the significantly improved between two methods of treatment (P < 0.0025). In seven cases, four cases had a history of blunt trauma and one case had a history of surgery that after 6 months had complication of surgery and scare tissue that with the second surgery release of scare was done with 100% cure. Anomaly of Piriformis muscle was seen in one case that surgery was done. Tumor was seen in one case that had pressure effect on sciatic nerve that surgery was done. Heterotopic ossification was seen in two cases. BMI of all cases was in normal range. All cases with diagnosis of disc herniation were excluded from the study. They were need to surgical operation for herniated disc. Piriformis syndrome is differentiated primary from secondary type, in which it is done according to history and physical examination. According to the etiology of Piriformis syndrome, the treatments are different. If you see mass that compressed the sciatic nerve, you must remove it. If the patient had sacroiliitis, it must be treated in early phase. Surgery of Piriformis is not accepted by all surgeons. It is limited to release Piriformis tendon and insertion to femur.

Piriformis syndrome: a case series of 31 Bangladeshi people with literature review

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2016

To describe a series of piriformis syndrome patient among Bangladesh people with literature review. Consecutive 31 piriformis syndrome patients were enrolled. Besides history and clinical examination, piriformis muscle thickness was also measured with diagnostic ultrasound (3.5 MHZ). MRI of lumbar spine, X-rays of lumbo-sacral spine, and pelvis were performed in all patients. Statistical Package for the Social Sciences (SPSS), Windows 8.0, was used for statistical calculation, and univariate analysis of primary data was done. Data present with frequency table. For literature review concerning piriformis syndrome we used Embase, Pubmed, Medline, and Cochrane database. A total of 31 patients (21 female) with PS were enrolled, 21 housewives. Mean age 42.2 ± 14.5 years. All presented with buttock pain, aggravating with long sitting (31), lying on the affected side (31), during rising from a chair(24), and forward bending (28). Six reported pain improvement while walking. Gluteal tendern...

The piriformis muscle syndrome – anatomy, diagnosis and the role of physiotherapy. A Review

Medical Journal of Cell Biology

This review examines the role of the physiotherapist in diagnosing piriformis muscle syndrome (PS), taking into account the exact anatomy of the muscle and the arsenal of tests the physiotherapist can use. In the works we researched, talking about PS ignores the role of the physiotherapist as the first specialist the patient should turn to. Many works emphasize the physician’s physical examination and often surgical intervention. The participation of a physiotherapist in the process of diagnosing ailments such as PS requires further research, but already with a high degree of reliability, a physiotherapeutic examination can speed up the process of diagnosis and treatment.