Anatomical, Clinical and Electrical Observations in Piriformis Syndrome

doi:10.1186/1749-799X-5-3

Journal of Orthopaedic Surgery and Research

Volume 5

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Research article

Anatomical, Clinical and Electrical Observations in Piriformis Syndrome

Roger M Jawish¹^,2 , Hani A Assoum² and Chaker F Khamis³

¹Medical School, St Joseph University, Beirut, Lebanon

²Department of Orthopaedic, Sacré Coeur Hospital, BP 116 Hazmieh, Lebanon

³Department of Electrodiagnostic, Sacré Coeur Hospital, BP 116 Hazmieh, Lebanon

author email corresponding author email

Journal of Orthopaedic Surgery and Research 2010, 5:3doi:10.1186/1749-799X-5-3


Published:	21 January 2010

Abstract

Background

We provided clinical and electrical descriptions of the piriformis syndrome, contributing to better understanding of the pathogenesis and further diagnostic criteria.

Methods

Between 3550 patients complaining of sciatica, we concluded 26 cases of piriformis syndrome, 15 females, 11 males, mean age 35.37 year-old. We operated 9 patients, 2 to 19 years after the onset of symptoms, 5 had piriformis steroids injection. A dorsolumbar MRI were performed in all cases and a pelvic MRI in 7 patients. The electro-diagnostic test was performed in 13 cases, between them the H reflex of the peroneal nerve was tested 7 times.

Results

After a followup 1 to 11 years, for the 17 non operated patients, 3 patients responded to conservative treatment. 6 of the operated had an excellent result, 2 residual minor pain and one failed. 3 new anatomical observations were described with atypical compression of the sciatic nerve by the piriformis muscle.

Conclusion

While the H reflex test of the tibial nerve did not give common satisfaction in the literature for diagnosis, the H reflex of the peroneal nerve should be given more importance, because it demonstrated in our study more specific sign, with six clinical criteria it contributed to improve the method of diagnosis. The cause of this particular syndrome does not only depend on the relation sciatic nerve-piriformis muscle, but the environmental conditions should be considered with the series of the anatomical anomalies to explain the real cause of this pain.