Piriformis syndrome

Piriformis syndrome is an elusive clinical entity. It is likely that this condition is overlooked and overdiagnosed with equal propensity. It is characterized by buttock pain with a variable component of sciatic nerve irritation and probably represents the most common cause of extraspinal sciatica. Systematic clinical assessment will generally lead to the correct diagnosis. Most cases can be managed with conservative treatment. Judicious use of local injections around the piriformis can have both diagnostic and therapeutic benefits. Surgical release of the piriformis and decompression of the sciatic nerve may be indicated for select recalcitrant cases. With careful patient selection, successful outcomes have been recorded in the majority of cases. Details of the assessment, anatomy, and management of this condition are outlined.