Piriformis Syndrome Tests

Piriformis Syndrome is very a popular condition and this syndrome is not clearly understood. There is minimal information related to the subject of piriformis syndrome and it can be confused with sciatica or lower back pain. Sometimes, it is hard to differentiate between piriformis syndrome and a lumbar spinal disc herniation, which both can cause sciatica.

Straight Leg Raising Test

The straight leg raising test is the gold standard as a clinical test to diagnose a disc herniation irritating the sciatic nerve. Elevation of a painful limb causes sciatica and radicular pain. Other clinical tests are described but not frequently used. If the test is positive, the physician should consider spine problems. A herniated disc is typically the source of sciatic pain.

The piriformis muscle arises from the anterolateral part of the sacrum and is inserted into the posterior aspect of the greater trochanter (deep into the buttock). Pain associated with piriformis syndrome is usually deep in the buttock and posterior thigh. Pain may also be found at the posterior aspect of the leg due to irritation of the sciatic nerve (sometimes misdiagnosed as lumbar spine disc pathology). The patient will complain of pain in the buttock, the posterior thigh, and express feeling “pins and needles” down the leg.

Piriformis Tests

There are two tests commonly used to diagnose Piriformis Syndrome: the Lasegue’s Maneuver (stretching the nerve) and stretching the piriformis. The Lasegue’s Maneuver will reproduce the pain by the hip being flexed to 90 degrees and the knee extended. This test can also be done with the patient on the side. When stretching the piriformis muscle, the physician will assess if passive stretching of the muscle is predisposed to or causes pressure on the sciatic nerve. By adducting and internally rotating the hip, this maneuver will stretch the piriformis and compress the nerve, reproducing the patient’s symptoms. Also, during this maneuver when the examiner adds pressure to the posterior part of the buttock, the patient will complain of severe tenderness and pain.