Assessment presentation
II.2
Introduction
Piriformis syndrome is neuromuscular
disorder that occurs when the piriformis
muscle compresses or irritates the sciatic
nerve-the largest nerve in the body.
Compression of the sciatic nerve causes
pain-frequently described as tingling or
numbness-in the buttocks and along the
nerve, often down to the leg.
Important to remember!!
* This syndrome remains controversial because, in most cases, the diagnosis is clinical,
and no confirmatory tests exist to support the clinical findings
Incidence and etiology
• 6:1 prevalent in females than in males could be to the anatomic
variation of the female pelvis Likewise, women tend to have a greater Q
angle.
2 months ago, the patient fell down the stairs (10 stairs) on her buttock
After sitting for 1 hour or more, the pain was worse and
occasionally she noted numbness in the left lateral thigh with
paresthesia down the posterior aspect of the calf.
•Palpation of buttocks
•ROM inspection of the trunk and lumbar spine
•Resistence test in abduction and lateral rotation of the hip
•Slump test
•Straight leg raising
• left buttock pain was elicited upon left hip flexion and internal rotation
of left hip
•Freiberg’s sign: Pain with passive medial rotation of the extended hip causes a
stretch of the piriformis muscle
•Piriformis test
•Relaxed hands run over the skin around the sciatic nerve distribution indicating
alteration of sensation
•In disc herniation the Achilles tendon reflex is weak or absent
Outcomes of Assessment
• Full range of motion, flexion, and extension of the trunk
and lumbar spine
• Palpation of buttocks painful and tense
• Weakness in abduction and lateral rotation of the hip
• Slump test negative
• Left buttock pain was elicited upon left hip flexion and
internal rotation of left hip
• Positive Lasèque’s sign (the medial rotated and
adducted hip the straight leg is raised, than foot
dorsiflexed, followed by lifting up the chin) with pain in
the leg
• Piriformis test positive
• Achilles Tendon reflex ???
…rule out diff.diagnoses
• Stressing the sacrospinous and sacrotuberous
ligaments is pain free
• The SIPS move equal during nutation/ counter-
nutation
• Slump test, sneezing, coughing causes no pain
• Usually referred pain from coxofemoral
conditions do not go below the knee joint and
the ROM of the hip would be decreased
Treatment Goals