eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Piriformis Syndrome: Follow-up

Author: Milton J Klein, DO, MBA, Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital, Allegheny General Hospital, and Ohio Valley General Hospital.
Contributor Information and Disclosures

Updated: Sep 14, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is necessary only if surgical intervention is warranted. Surgery is the last-resort treatment for severe cases of piriformis syndrome.

Further Outpatient Care

  • Piriformis syndrome usually is treated effectively with conservative measures. Please refer to the Treatment section for a discussion of treatment recommendations.

Deterrence

  • No method of preventing piriformis syndrome has been demonstrated. The best means of prevention is to maintain biomechanical balance through the restoration of a more physiologic weight-bearing distribution; this necessitates a level pelvis/sacral base and equal leg lengths, which can be achieved by using heel-lift therapy if necessary. This treatment approach also prevents recurrences of piriformis syndrome, especially if the underlying etiology is a leg-length discrepancy. The patient also must engage in a general stretching program that includes the bilateral piriformis muscles.

Complications

  • The most significant complication of piriformis syndrome is a failure to recognize, diagnose, and treat this disabling condition. If left untreated, a patient may undergo unsuccessful back surgery for a disk herniation; however, a coexisting occult piriformis syndrome can result in a failed back syndrome.
  • Another complication is inadvertent direct injection of the sciatic nerve, which usually results in a nondisabling and temporary sciatic mononeuropathy.

Prognosis

  • The prognosis of piriformis syndrome depends on early recognition and treatment. Because it is a soft-tissue syndrome, the condition has a tendency to become chronic, usually due to late diagnosis and treatment (which lead to a less favorable prognosis).

Patient Education

  • For conservative measures to be effective, the patient must be taught, via an aggressive, home-based stretching program, to maintain piriformis muscle flexibility. He/she must comply with the program even beyond the point of discontinuation of formal medical treatment.

Miscellaneous

Medicolegal Pitfalls

  • The greatest medical/legal concern is either misdiagnosis or a failure to diagnose piriformis syndrome. In most cases, the diagnosis is one of exclusion. Therefore, if piriformis syndrome is not in the differential diagnosis list, it may be overlooked. The patient becomes a chronic pain patient doomed to a lifetime of disability and chronic management with medication.
  • Because the diagnosis usually is elusive, missing the diagnosis does not constitute malicious negligence and, therefore, rarely would be sufficient grounds alone for a medical malpractice lawsuit.
  • Piriformis syndrome may be a secondary perpetuating factor underlying chronic, posttraumatic, intractable low back pain. Negligent misdiagnosis or delayed diagnosis of this condition has caused a significant degree of unnecessary disability and financial loss.

Special Concerns

  • In female patients, piriformis syndrome may be a cause of dyspareunia, but again, this connection becomes impossible to prove. Diagnosis of piriformis syndrome requires a high index of suspicion by either the primary care physician or the obstetric/gynecologic specialist/surgeon. A bimanual, simultaneous vaginal-rectal examination of female patients to determine this soft-tissue diagnosis helps the physician to prescribe appropriate treatment.
  • Although it is a misdiagnosed etiology of low back pain/sciatica, piriformis syndrome can be a significant cause of soft-tissue pain and disability. In order for the condition to be accurately diagnosed, a skillful, attentive physician must conduct a thorough history/physical examination. Once the clinical diagnosis has been made, a specific treatment can be formulated to provide the best outcome, one with a minimal degree of long-term disability.
 


More on Piriformis Syndrome

Overview: Piriformis Syndrome
Differential Diagnoses & Workup: Piriformis Syndrome
Treatment & Medication: Piriformis Syndrome
Follow-up: Piriformis Syndrome
Multimedia: Piriformis Syndrome
References
Further Reading
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Further Reading

Related eMedicine topics:
 Botulinum Toxin in Pain Management
Chronic Pain Syndrome
Chronic Pelvic Pain
Injection, Piriformis
Nerve Entrapment Syndromes
Nerve Entrapment Syndromes of the Lower Extremity
Piriformis Syndrome [Sports Medicine]

Clinical guidelines:
Pain (chronic). Work Loss Data Institute - Public For Profit Organization. 2003 (revised 2008 May 19). 475 pages. NGC:006564

The initial management of chronic pelvic pain. Royal College of Obstetricians and Gynaecologists - Medical Specialty Society. 2005 Apr. 12 pages. NGC:004471

Clinical trials:
Effectiveness of Oral Prednisone in Improving Physical Functioning and Decreasing Pain in People With Sciatica

Ultrasound Description of the Sciatic Nerve

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Keywords

piriformis syndrome, sciatica, sciatic nerve, piriformis, sciatic, sciatic nerve pain, piriformis muscle, sciatic pain, sciatica treatment, sciatica exercises, nerve compression, sciatic nerve treatment, piriformis sciatica, pyriformis, pyriformis syndrome, hip socket neuropathy, pseudosciatica, wallet sciatica, deep gluteal syndrome

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Contributor Information and Disclosures

Author

Milton J Klein, DO, MBA, Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital, Allegheny General Hospital, and Ohio Valley General Hospital.
Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Rajesh R Yadav, MD, Assistant Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas at Houston
Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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