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REVIEW PAPER
Piriformis syndrome – anatomical causes. Diagnosis and treatment
 
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1
Human Anatomy Research Group, Medical University, Lublin, Poland
 
2
Department of Correct, Clinical and Imaging Anatomy, Medical University, Lublin, Poland
 
3
1st Military Clinical Hospital with the Outpatient Clinic, Lublin, Poland
 
 
Corresponding author
Jagoda Niczyporuk   

Human Anatomy Research Group, Medical University of Lublin, Jaczewskiego 4, 20-400, Lublin, Poland
 
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
Sciatica is a clinical condition characterized by pain radiating along the roots of the sciatic nerve, extending from the lumbosacral spine and buttock, through the posterior surface of the thigh and lower leg down to the foot. One of the frequent cause is piriformis syndrome where the sciatic nerve is compressed by the piriformis muscle. There are many diagnostic tests and imaging studies available, but the most crucial aspect is to exclude other causes of sciatica. The aim of the review is to present the literature describing causes, diagnosis and treatment of the piriformis syndrome.

Review methods:
The review is based on 46 papers found in PubMed and PubMedCentral databases using key words: ‘piriformis syndrome’ and ‘anatomical causes/diagnosis/treatment’, published between 1947–2023.

Brief description of the state of knowledge:
The variability in the course of the sciatic nerve and anatomical variations of the piriformis muscle have different impacts on the onset of piriformis syndrome. The diagnosis of this condition primarily aims to exclude other causes of sciatica, as there are no precisely confirmed diagnostic criteria. The preferred treatment is non-operative. When this is unsuccessful, surgical intervention may be considered.

Summary:
There are numerous causes of piriformis syndrome. There is a discrepancy in the results of various studies regarding the impact of different anatomical variations of the sciatic nerve on the onset of symptoms of this condition. The primary goal of research should now be to conduct a large, representative study on patients diagnosed with sciatica, focusing on the presence of anatomical variations.

 
REFERENCES (43)
1.
Boote J. Newsome R. Reddington M. Cole A. Dimairo M. Physiotherapy for Patients with Sciatica Awaiting Lumbar Micro-discectomy Surgery: A Nested. Qualitative Study of Patients’ Views and Experiences. Physiother Res Int. 2017;22(3). doi:10.1002/PRI.1665.
 
2.
Siddiq MAB. Clegg D. Hasan S Al. Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain. 2020;33(4):305. doi:10.3344/KJP.2020.33.4.305.
 
3.
Park JH. Jeong HJ. Shin HK. Park SJ. Lee JH. Kim E. Piriformis ganglion: An uncommon cause of sciatica. Orthop Traumatol Surg Res. 2016;102(2):257–260. doi:10.1016/J.OTSR.2015.11.018.
 
4.
Probst D. Stout A. Hunt D. Piriformis Syndrome: A Narrative Review of the Anatomy. Diagnosis. and Treatment. PM&R. 2019;11:54–63. doi:10.1002/PMRJ.12189.
 
5.
Bochenek A. Reicher M. Anatomia człowieka. t. I. 13th ed. PZWL. 2016.
 
6.
Chang C. Jeno SH. Varacallo M. Anatomy. Bony Pelvis and Lower Limb: Piriformis Muscle. StatPearls. Published online November 13. 2023. Accessed November 29. 2023. https://www.ncbi.nlm.nih.gov/b....
 
7.
Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep. 2015;14(1):41–44. doi:10.1249/JSR.0000000000000110.
 
8.
Larionov A. Yotovski P. Filgueira L. Novel anatomical findings with implications on the etiology of the piriformis syndrome. Surg Radiol Anat. 2022;44(10):1397–1407. doi:10.1007/S00276–022–03023–5.
 
9.
Goidescu OC. Enyedi M. Tulin AD. et al. Overview of the anatomical basis of the piriformis syndrome-dissection with magnetic resonance correlation. Exp Ther Med. 2022;23(2):113. doi:10.3892/ETM.2021.11036.
 
10.
Chang A. Ly N. Varacallo M. Piriformis Injection. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 4. 2023.
 
11.
Son BC. Lee C. Piriformis Syndrome (Sciatic Nerve Entrapment) Associated With Type C Sciatic Nerve Variation: A Report of Two Cases and Literature Review. Korean J Neurotrauma. 2022;18(2):434. doi:10.13004/KJNT.2022.18.E29.
 
12.
Bartret AL. Beaulieu CF. Lutz AM. Is it painful to be different? Sciatic nerve anatomical variants on MRI and their relationship to piriformis syndrome. Eur Radiol. 2018;28(11):4681–4686. doi:10.1007/S00330–018–5447–6.
 
13.
Trotter M. The relation of the sciatic nerve to the piriformis muscle in American whites and negroes. Anat Rec. 1932;52(4):321–323. doi:10.1002/AR.1090520404.
 
14.
Pierce WC. Hewitt HE. Thomas S. Sixth Annual Report of the Committee of Collective Investigation of the Anatomical Society of Great Britain and Ireland. 1895–96. J Anat Physiol. 1896;31(Pt 1):31.
 
15.
Beaton L. Anson B. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec. 1937; 70(1): 1–5.
 
16.
Pećina M. Contribution to the Etiological Explanation of the Piriformis Syndrome. Acta Anat (Basel). 1979;105(2):181–187. doi:10.1159/000145121.
 
17.
Pokorný D. Jahoda D. Veigl D. Pinskerová V. Sosna A. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat. 2006;28(1):88–91. doi:10.1007/S00276–005–0056-X.
 
18.
Güvençer M. Akyer P. Iyem C. Tetik S. Naderi S. Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve. Surg Radiol Anat. 2008;30(6):467–474. doi:10.1007/S00276–008–0350–5.
 
19.
Brooks JBB. Silva CAC. Soares SA. Kai MR. Cabral RH. Fragoso YD. Anatomical variations of the sciatic nerve in a group of Brazilian cadavers. Revista Dor. 2011;12(4):332–336. doi:10.1590/S1806–00132011000400009.
 
20.
Natsis K. Totlis T. Konstantinidis GA. Paraskevas G. Piagkou M. Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 2014;36(3):273–280. doi:10.1007/S00276–013–1180–7.
 
21.
Adibatti M. Sangeetha V. Study on variant anatomy of sciatic nerve. J Clin Diagn Res. 2014;8(8):AC07-AC9. doi:10.7860/JCDR/2014/9116.4725.
 
22.
Berihu BA. Debeb YG. Anatomical variation in bifurcation and trifurcations of sciatic nerve and its clinical implications: in selected university in Ethiopia. BMC Res Notes. 2015;8(1):633. doi:10.1186/S13104–015–1626–6.
 
23.
Haładaj R. Pingot M. Polguj M. Wysiadecki G. Topol M. Anthropometric Study of the Piriformis Muscle and Sciatic Nerve: A Morphological Analysis in a Polish Population. Med Sci Monit. 2015;21:3760–3768. doi:10.12659/MSM.894353.
 
24.
Shastrakar R. Nakhate M. Sawant VG. STUDY OF VARIATION IN THE HIGH DIVISION OF SCIATIC NERVE AND ITS RELATIONSHIP WITH THE PIRIFORMIS MUSCLE. Med Res Chron. 2015;2(3):359–365. Accessed December 1. 2023. https://medrech.com/index.php/....
 
25.
Lewis S. Jurak J. Lee C. Lewis R. Gest T. Anatomical variations of the sciatic nerve. in relation to the piriformis muscle. Translational Research in Anatomy. 2016;5:15–19. doi:10.1016/J.TRIA.2016.11.001.
 
26.
Varenika V. Lutz AM. Beaulieu CF. Bucknor MD. Detection and prevalence of variant sciatic nerve anatomy in relation to the piriformis muscle on MRI. Skeletal Radiol. 2017;46(6):751–757. doi:10.1007/S00256–017–2597–6.
 
27.
Marco C. Miguel-Pérez M. Pérez-Bellmunt A. et al. Anatomical causes of compression of the sciatic nerve in the pelvis. Piriform syndrome. Revista espanola de cirugia ortopedica y traumatologia (English ed). 2019;63(6):424–430. doi:10.1016/J.RECOT.2019.06.002.
 
28.
Jha AK. Baral P. Composite Anatomical Variations between the Sciatic Nerve and the Piriformis Muscle: A Nepalese Cadaveric Study. Case Rep Neurol Med. 2020;2020:1–6. doi:10.1155/2020/7165818.
 
29.
Wan-Ae-Loh P. Huanmanop T. Agthong S. Chentanez V. Evaluation of the sciatic nerve location regarding its relationship to the piriformis muscle. Folia Morphol (Warsz). 2020;79(4):681–689. doi:10.5603/FM.A2019.0140.
 
30.
Reynoso JP. De Jesus Encarnacion M. Nurmukhametov R. et al. Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study. Neurol Int. 2022;14(4):894–902. doi:10.3390/NEUROLINT14040072.
 
31.
Atoni AD. Oyinbo CA. Francis DAU. Tabowei UL. Anatomic Variation of the Sciatic Nerve: A Study on the Prevalence. and Bifurcation Loci in Relation to the Piriformis and Popliteal Fossa. Acta Med Acad. 2022;51(1):52–58. doi:10.5644/AMA2006–124.370.
 
32.
Bartret AL. Beaulieu CF. Lutz AM. Is it painful to be different? Sciatic nerve anatomical variants on MRI and their relationship to piriformis syndrome. Eur Radiol. 2018;28(11):4681–4689. doi:10.1007/S00330–018–5447–6.
 
33.
Khan H. Ling S. Ali S. et al. Sciatic Nerve Variants in Patients Diagnosed With Sciatica: Is There a Correlation? J Comput Assist Tomogr. 2019;43(6):953–957. doi:10.1097/RCT.0000000000000919.
 
34.
Bharadwaj UU. Varenika V. Carson W. et al. Variant Sciatic Nerve Anatomy in Relation to the Piriformis Muscle on Magnetic Resonance Neurography: A Potential Etiology for Extraspinal Sciatica. Tomography. 2023;9(2):475–484. doi:10.3390/TOMOGRAPHY9020039.
 
35.
Windisch G. Braun EM. Anderhuber F. Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat. 2007;29(1):37–45. doi:10.1007/S00276–006–0169-X.
 
36.
Koh E. Webster D. Boyle J. Case report and review of the potential role of the Type A piriformis muscle in dynamic sciatic nerve entrapment variant of piriformis syndrome. Surg Radiol Anat. 2020;42(10):1237– 1242. doi:10.1007/S00276–020–02440–8.
 
37.
Zhang W. Luo F. Sun H. Ding H. Ultrasound appears to be a reliable technique for the diagnosis of piriformis syndrome. Muscle Nerve. 2019;59(4):411–416. doi:10.1002/MUS.26418.
 
38.
Michel F. Decavel P. Toussirot E. et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56(5):371–383. doi:10.1016/J. REHAB.2013.04.003.
 
39.
Huang ZF. Lin BQ. Torsha TT. Dilshad S. Yang DS. Xiao J. Effect of Mannitol plus Vitamins B in the management of patients with piriformis syndrome. J Back Musculoskelet Rehabil. 2019;32(2):329–337. doi:10.3233/BMR-170983.
 
40.
Vij N. Kiernan H. Bisht R. et al. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med. 2021;11(1):1–8. doi:10.5812/AAPM.112825.
 
41.
Rosales J. García N. Rafols C. Pérez M. Verdugo MA. Perisciatic Ultrasound-Guided Infiltration for Treatment of Deep Gluteal Syndrome. Journal of Ultrasound in Medicine. 2015;34(11):2093–2097. doi:10.7863/ULTRA.14.12030
 
42.
Burke CJ. Walter WR. Adler RS. Targeted Ultrasound-Guided Perineural Hydrodissection of the Sciatic Nerve for the Treatment of Piriformis Syndrome. Ultrasound Q. 2019;35(2):125–129. doi:10.1097/ RUQ.0000000000000360
 
43.
Han SK. Kim YS. Kim TH. Kang SH. Surgical Treatment of Piriformis Syndrome. Clin Orthop Surg. 2017;9(2):136–144. doi:10.4055/ CIOS.2017.9.2.136.
 
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ISSN:1898-2395
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