clinical features

Last reviewed 01/2018

• more common in females and is believed to result from an haematoma following trauma, the commonest mechanism being compression or scarring of the sciatic nerve following a simple fall onto the buttocks

Patients present with pain in the buttock, in the posterior hip or lower back

• pain may radiate into the thigh or lower leg, and there is an intolerance to sitting on the affected side
• pain can be aggravated by activity or standing and is often relieved on lying down
• may be associated numbness or paraesthesia radiating distally in the distribution of the sciatic nerve

Three signs have been described on physical examination

• Lasegue's sign, which is pain over the greater sciatic notch on palpation and when the hip is flexed to 90 degrees with the knee extended
  
  
• Freiberg's sign, which is pain on passive internal rotation of the hip
  
  
• Pace's sign, where pain and weakness are elicited on resisted abduction and external rotation of the thigh

The most consistent findings on physical examination are tenderness on palpation of the greater sciatic notch and pain with maximum flexion, adduction and internal rotation.

Reference:

• 1) Kobbe P, Zelle BA, Gruen GS. Case report: recurrent piriformis syndrome after surgical release. Clin Orthop Relat Res 2008; 466: 1745e8.