Piriformis Syndrome or Sciatica — Identify the Real Cause of Sciatic Nerve Pain

Join this channel to support the channel https://www.youtube.com/channel/UCOHfqHMhHvfQCYJDXfpSAiw/join Piriformis syndrome or a true sciatica. Are they the same or different? Sciatica means pain radiating along the course of the sciatic nerve, which runs from the lower back to the buttock and the back of the thigh and into the lower leg and the foot. It usually affect one side of the body and we usually call it lumbar radiculopathy. The largest number of sciatica occurs from disc herniation. Sciatica is not a diagnosis. It is a symptom of underlying condition. For example, in piriformis syndrome, you can have sciatica due to piriformis muscle pushing on the nerve. So in this case, we call the condition piriformis syndrome. The diagnosis is piriformis syndrome. But if the sciatica, which is a symptom, comes from herniated disc, then we call it herniated disc, and we call the condition of the sciatica lumbar radiculopathy. So let's explain the condition in some details. Piriformis syndrome is a condition that has sciatic nerve symptoms due to compression of the sciatic nerve around the buttock and the hip. This condition is usually connected to the piriformis muscle and its relationship to the sciatic nerve. The muscle runs from the sacrum to the hip, and it is in close proximity to the sciatic nerve. The nerve exit below it, and the nerve is anterior to it. Swat causes the piriformis syndrome. Anatomic anomalies such as a split piriformis or vascular structures or variation of the sciatic nerve path. Also, the syndrome can cause by tightness or a spasm of the piriformis muscle that will squeeze the sciatic nerve, usually from overuse problems such as in bicycling. That pressure on the nerve will cause a swelling and inflammation. How about the clinical diagnosis? You will have pain in the posterior gluteal region and the buttock shooting down the back of the leg in the path of the sciatic nerve causes symptom-like sciatica with burning, tingling and shooting pain. You can use some provocative tests such as the FAIR test, flexion, adduction and internal rotation of the hip will produce the symptoms due to tension of the piriformis muscle. Or the Lassog test, in which the straight leg raising pain is aggravated by forced ankle dorsiflexion. Piriformis syndrome needs to be differentiated from sciatica. Both could have the same symptoms, but both have different causes. The diagnosis should be done by a seclusion of a spine problem that compresses on the spinal nerve root and causes sciatica. The main cause of a true sciatica is a disc herniation. So when the patient complains of sciatica, the doctor need to ask themselves a question. Is this sciatica due to compression on the sciatic nerve itself? Or is it due to compression on the nerve roots of the sciatic nerve? So you will get an MRI to rule out the spine as a cause of compression on the nerve roots of the sciatic nerve. And if the patient does not have herniated disc, then the patient will probably have a piriformis syndrome. Treatment of piriformis syndrome. First you start with conservative treatment with anti-inflammatory medication. Physiotherapy and stretching of the piriformis. Injection, you can do the injection under ultrasound or under fluoroscopy. Make sure the patient will have somebody to drive them because the sciatic nerve may get numb and they may not be able to drive. And surgery in the last resort. You will do release of the piriformis muscle. You will do sciatic nerve neurolysis. You will do that as the last resort and after exclude a spine condition and after you have a positive test from injection of the piriformis. Means the patient have to say, "I felt better after the injection." Piriformis syndrome is a diagnosis of exclusion. Quizzes 1} What does the term sciatica describe? a. A specific disease b. A tumor of the sciatic nerve c. Pain along the sciatic nerve pathway d. Hip joint arthritis Answer: c Explanation: Sciatica is a symptom describing radiating pain along the sciatic nerve. 2} The most common cause of true sciatica is: a. Piriformis tightness b. Hip osteoarthritis c. Lumbar disc herniation d. Sacroiliac inflammation Answer: c Explanation: Most sciatica results from lumbar disc herniation compressing a nerve root. 3) Sciatica affecting one side of the body is often termed: a. Peripheral neuropathy b. Lumbar radiculopathy c. Myelopathy d. Facet syndrome Answer: b Explanation: Unilateral radiating leg pain due to root compression is lumbar radiculopathy. 4) In piriformis syndrome, the nerve typically exits in relation to the muscle: a. Above the muscle b. Below the muscle c. Through the muscle tendon d. Inside the muscle belly Answer: b Explanation: The sciatic nerve usually exits below the piriformis. 5) The sciatic nerve lies relative to the piriformis muscle as: a. Posterior to it b. Anterior to it c. Superior to it d. Within it Answer: b Explanation: The nerve is anterior to the piriformis in typical anatomy.