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Piriformis Syndrome and Nerve Injuries of Pelvis
Donna G. Blankenbaker, MD; Adam C. Zoga, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Pseudosciatica, wallet sciatica, deep gluteal syndrome
            • Definitions

              • Entrapment or compression of, or trauma to, lumbosacral plexus or pelvic nerve causing symptoms in innervated tissues
              • Piriformis syndrome: Neuritis of proximal sciatic nerve due to compression by piriformis muscle

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      • Ultrasonographic Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Hernando MF et al: Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiol. 44(7):919-34, 2015
                                              2. Jeong HS et al: Long-term assessment of clinical outcomes of ultrasound-guided steroid injections in patients with piriformis syndrome. Ultrasonography. 34(3):206-10, 2015
                                              3. Natsis K et al: Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 36(3):273-80, 2014
                                              4. Lee FC et al: High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg. 114(1):206-11, 2011
                                              5. Chhabra A et al: MR neurography of neuromas related to nerve injury and entrapment with surgical correlation. AJNR Am J Neuroradiol. 31(8):1363-8, 2010
                                              6. Jawish RM et al: Anatomical, clinical and electrical observations in piriformis syndrome. J Orthop Surg Res. 5(1):3, 2010
                                              7. Kanakis DN et al: Piriformis syndrome - an attempt to understand its pathology. Clin Neuropathol. 29(2):65-70, 2010
                                              8. Petchprapa CN et al: MR imaging of entrapment neuropathies of the lower extremity. Part 1. The pelvis and hip. Radiographics. 30(4):983-1000, 2010
                                              9. Takahara T et al: Diffusion-weighted MR neurography of the sacral plexus with unidirectional motion probing gradients. Eur Radiol. 20(5):1221-6, 2010
                                              10. Halpin RJ et al: Piriformis syndrome: a real pain in the buttock? Neurosurgery. 65(4 Suppl):A197-202, 2009
                                              11. Kirschner JS et al: Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 40(1):10-8, 2009
                                              12. Zhang Z et al: Morphological analysis in patients with sciatica: a magnetic resonance imaging study using three-dimensional high-resolution diffusion-weighted magnetic resonance neurography techniques. Spine (Phila Pa 1976). 34(7):E245-50, 2009
                                              13. Fishman LM et al: BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil. 81(12):936-42, 2002
                                              14. Fishman LM et al: Piriformis syndrome: diagnosis, treatment, and outcome--a 10-year study. Arch Phys Med Rehabil. 83(3):295-301, 2002
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Pseudosciatica, wallet sciatica, deep gluteal syndrome
                                                        • Definitions

                                                          • Entrapment or compression of, or trauma to, lumbosacral plexus or pelvic nerve causing symptoms in innervated tissues
                                                          • Piriformis syndrome: Neuritis of proximal sciatic nerve due to compression by piriformis muscle

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  • Ultrasonographic Findings

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Hernando MF et al: Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiol. 44(7):919-34, 2015
                                                                                          2. Jeong HS et al: Long-term assessment of clinical outcomes of ultrasound-guided steroid injections in patients with piriformis syndrome. Ultrasonography. 34(3):206-10, 2015
                                                                                          3. Natsis K et al: Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 36(3):273-80, 2014
                                                                                          4. Lee FC et al: High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg. 114(1):206-11, 2011
                                                                                          5. Chhabra A et al: MR neurography of neuromas related to nerve injury and entrapment with surgical correlation. AJNR Am J Neuroradiol. 31(8):1363-8, 2010
                                                                                          6. Jawish RM et al: Anatomical, clinical and electrical observations in piriformis syndrome. J Orthop Surg Res. 5(1):3, 2010
                                                                                          7. Kanakis DN et al: Piriformis syndrome - an attempt to understand its pathology. Clin Neuropathol. 29(2):65-70, 2010
                                                                                          8. Petchprapa CN et al: MR imaging of entrapment neuropathies of the lower extremity. Part 1. The pelvis and hip. Radiographics. 30(4):983-1000, 2010
                                                                                          9. Takahara T et al: Diffusion-weighted MR neurography of the sacral plexus with unidirectional motion probing gradients. Eur Radiol. 20(5):1221-6, 2010
                                                                                          10. Halpin RJ et al: Piriformis syndrome: a real pain in the buttock? Neurosurgery. 65(4 Suppl):A197-202, 2009
                                                                                          11. Kirschner JS et al: Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 40(1):10-8, 2009
                                                                                          12. Zhang Z et al: Morphological analysis in patients with sciatica: a magnetic resonance imaging study using three-dimensional high-resolution diffusion-weighted magnetic resonance neurography techniques. Spine (Phila Pa 1976). 34(7):E245-50, 2009
                                                                                          13. Fishman LM et al: BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil. 81(12):936-42, 2002
                                                                                          14. Fishman LM et al: Piriformis syndrome: diagnosis, treatment, and outcome--a 10-year study. Arch Phys Med Rehabil. 83(3):295-301, 2002