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Condition/Disorder Synonyms

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  • Deep gluteal syndrome

  • Fat wallet syndrome

  • Wallet sciatica

  • Sciatic nerve impingement with (out) inflammation

  • Hip lateral rotator tendinitis

  • Hip lateral rotator tendinosis

  • Pseudosciatica

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ICD-9-CM Code

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  • 355.0 Lesion of sciatic nerve

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ICD-10-CM Code

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  • G57.00 Lesion of sciatic nerve, unspecified lower limb

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Preferred Practice Pattern1

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Key Features

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Description

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  • Neuropathic pain from compression of the sciatic nerve as it courses through the piriformis muscle or myofascial pain from a tight, hypertrophic, and tender piriformis without nerve entrapment

  • Major muscles at the posterior hip function together based on how much the hip is flexed

    • gluteals

    • piriformis

    • gemelli

    • obturator internus

    • quadratus femoris

  • These muscles are usually involved whenever there is low back pain or a lower extremity problem that requires compensation of motion

  • The sciatic nerve may even pass through the piriformis (17% of an assumed normal population)

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Essentials of Diagnosis

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  • Diagnosis is usually made by patient history and clinical exam

  • Most often an independent diagnosis and not associated with disease process

  • May be an independent diagnosis or associated with other musculoskeletal and/or postural disorders

  • Must be isolated from gluteus medius, other hip lateral rotators, and sciatic nerve impingement

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General Considerations

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  • Anatomic variations of the divisions of the sciatic nerve above, below, and through the belly of the piriformis muscle may be causative factors

  • The piriformis is routinely implicated in cases of sciatica, although it is only one of several muscles in this area that cause sciatica

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Demographics

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  • Higher incidence in females (6:1)

  • Increased incidence with

    • Prolonged sitting (occupational, driving, flying, etc. for long periods)

    • Activities requiring extensive and repetitive lateral hip rotation

    • Compensatory foot biomechanics (increased locomotor pronation)

    • Athletes

      • Skiers (Classic Nordic or skate skiing)

      • Long-distance cyclists

      • Tennis players

    • Spinal stenosis (can lead to bilateral piriformis tenderness)

    • Shortened sacrotuberous and or sacrospinous/iliolumbar ligaments

    • Trauma to the buttocks or gluteal region

    • Pregnancy

    • Postural changes

    • Increased weight

    • Change in foot biomechanics during ambulation

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Clinical Findings

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Signs and Symptoms

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  • Pain and instability is often imprecise, but often present in the hip, coccyx, buttock, groin, or distal part of the affected leg

  • Tingling/numbness in affected buttock: may be present with sitting on the toilet, bleachers, or narrow bicycle seat

  • Pain with forced hip external rotation

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Functional Implications

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  • Pain on ambulation/running with uncompensated pronation

  • Increased pain with increased activity or prolonged sitting

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Possible Contributing Causes

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  • Accessory piriformis muscle fibers

  • Attachment of the piriformis to the sacrotuberous ligament

  • Hypertrophy of the piriformis

  • Muscle imbalance of strength and flexibility ...

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