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Posted by John M. Williams
The piriformis muscle syndrome: a simple diagnostic maneuver
Neurosurgery 1994 Mar;34(3):512-4
Beatty RA; Department of Neurosurgery, University of Illinois, College
of Medicine, Chicago.
Current maneuvers to diagnose the piriformis syndrome are less than
ideal. Freiberg's maneuver of forceful internal rotation of the
extended thigh elicits buttock pain by stretching the piriformis
muscle, and Pace's maneuver elicits pain by having the patient abduct
the legs in the seated position, which causes a contraction of the
piriformis muscle. This report describes a maneuver performed by the
patient lying with the painful side up, the painful leg flexed, and
the knee resting on the table. Buttock pain is produced when the
patient lifts and holds the knee several inches off the table. The
maneuver produced deep buttock pain in three patients with piriformis
syndrome. In 100 consecutive patients with surgically documented
herniated lumbar discs, the maneuver often produced lumbar and leg
pain but not deep buttock pain. In 27 patients with primary hip
abnormalities, pain was often produced in the trochanteric area but
not in the buttock. The maneuver described in this report was helpful
in diagnosing the piriformis syndrome. It relies on contraction of the
muscle, rather than stretching, which the author believes better
reproduces the actual syndrome.
The piriformis syndrome
Am J Orthop 1996 Dec;25(12):819-23
Parziale JR; Hudgins TH; Fishman LM; Brown University, School of
Medicine, Providence, Rhode Island, USA.
Piriformis syndrome is an often misdiagnosed cause of sciatica, leg,
or buttock pain, and disability. The sciatic nerve may be compressed
within the buttock by the piriformis muscle, with pain increased by
muscular contraction, palpation, or prolonged sitting. A thorough
medical history and physical examination are essential to proper
diagnosis. Diagnostic testing may be used to differentiate piriformis
syndrome from other causes of sciatica, lower extremity weakness, and
pain. This article reviews the pathophysiology and management of
piriformis syndrome.
Caveat: Those who may wish to attempt the diagnostic tool listed in
the first abstract are cautioned that only minimal pressure is
necessary. I learned that the hard way.
The second abstract is an excellent all-around informational piece and
the full article can be ordered from MedLine.
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