Symptoms and Diagnosis of Piriformis Syndrome

There is no simple diagnostic test for piriformis syndrome causing irritation of the sciatic nerve. The condition is primarily diagnosed on the basis of the patient’s symptoms and on a physical exam.

Symptoms of Piriformis Syndrome

Most commonly, patients describe acute tenderness in the rear and sciatica-like pain down the back of the leg. Typical piriformis syndrome symptoms may include:

• A dull ache in the mid-rear
• Pain down the back of the leg (a radiculopathy or sciatica)
• Pain when walking up stairs or inclines
• Increased pain after prolonged sitting

Symptoms of piriformis syndrome often become worse after prolonged sitting, walking or running, and may feel better after lying down on the back.

Physical Exam to Diagnose Piriformis Syndrome

The physical exam will include examination of the hip and legs to see if movement causes increased low back pain or leg pain (sciatica pain). Typically, motion of the hip will recreate the pain.

X-rays and other spinal imaging studies cannot detect if the sciatic nerve is being irritated at the piriformis muscle. However, diagnostic tests (such as X-rays, MRI and nerve conduction tests) may be conducted to exclude other conditions that can cause similar symptoms to piriformis syndrome (such as a disc herniation).

• Article written by:
• John P. Revord, MD

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