Disease Overview

The piriformis muscle originates from the front of the 2nd, 3rd, and 4th sacral vertebrae, is distributed on the inner surface of the small pelvis, enters the buttocks through the greater sciatic foramen, and ends at the greater thickness of the femur. Long. Due to acute or chronic injury or anatomical variation, this muscle is prone to damaging inflammatory changes, irritating or compressing nerves, resulting in low back and leg pain, which is called piriformis syndrome. Symptoms and Signs

Piriformis syndrome is mainly characterized by sciatica. The pain radiates from the buttocks through the back of the thigh to the calf and foot. Because the symptoms are severe and affect walking, the patient seeks treatment earlier. , the decrease in muscle strength was mostly not serious. During the examination, the patient had painful claudication, mild calf muscle atrophy, and abnormal skin sensation below the calf. Sometimes cords (fibrous scars) or lumps (bone callus) can be palpated in the buttocks (near the Huantiao point). During the "4" test, external force is applied to aggravate or induce sciatica. The Tinel sign may be positive in the buttocks tenderness area. X-rays of patients with a history of acetabular fracture may show displaced bone fragments or callus.

Differential diagnosis

1. Lumbar disc herniation

This disease often presents with low back pain, semi-sciatic nerve head and lumbar spine compensatory scoliosis, which can be aggravated by abdominal pressure. Or the scope of sciatic nerve damage induced by sciatica is related to the location of the herniated intervertebral disc. The straight leg raising test may be positive in the basic test, while the "4" test may be negative.

2. Schwannoma

High sciatic nerve sheath tumors are relatively rare. The symptoms are progressively worsening and have nothing to do with activity or rest. There is a strong Tinel sign on the buttocks, but it is difficult to palpate the cord-like tumor locally. Sometimes uniform thickening along the surface of the sciatic nerve can be found on B-mode ultrasound images. Echo bands, surgery and pathological examination are the final means of diagnosis. Treatment options

Early-stage piriformis syndrome can be relieved through conservative treatment. If the cause cannot be resolved, severe scar adhesion has formed or there is callus compression or nerve path variation, surgical treatment is required. The effect of surgery is closely related to the duration of the disease. Conclusion

If you don’t need a doctor’s confirmation, first look for symptoms of sciatica, and second, look for painful claudication, calf muscle atrophy and abnormal skin sensation below the calf. Third, look at the pathological signs. Usually, the basic test of straight leg raising test is positive ( ), the "4" test ( ), and Tinel's sign (-). Surgery and pathological examination are the gold standard for diagnosis.