Skip to Main Content

++

  • Deep gluteal syndrome
  • Fat wallet syndrome
  • Wallet sciatica
  • Sciatic nerve impingement with (out) inflammation
  • Hip lateral rotator tendinitis
  • Hip lateral rotator tendinosis
  • Pseudosciatica

++

  • 355.0 Lesion of sciatic nerve

++

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

++
++

Description

++

  • 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)

++

Essentials of Diagnosis

++

  • 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

++

General Considerations

++

  • 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

++

Demographics

++

  • 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

++

Signs and Symptoms

++

  • 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

++

Functional Implications

++

  • Pain on ambulation/running with uncompensated pronation
  • Increased pain with increased activity or prolonged sitting

++

Possible Contributing Causes

++

  • Accessory piriformis muscle fibers
  • Attachment of the piriformis to the sacrotuberous ligament
  • Hypertrophy of the piriformis
  • Muscle imbalance of strength and flexibility of hip internal rotators and external rotators
  • Obturator internus dysfunction
  • Trauma
  • Anatomical anomalies

++

Differential Diagnoses

++

++

Imaging

++

...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.