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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

  • 355.0 Lesion of sciatic nerve

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


  • 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


  • 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

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