Piriformis syndrome in fibromyalgia: clinical diagnosis and successful treatment

Abstract

Piriformis syndrome is an underdiagnosed extraspinal association of sciatica. Patients usually complain of deep seated gluteal pain. In severe cases the clinical features of piriformis syndrome are primarily due to spasm of the piriformis muscle and irritation of the underlying sciatic nerve but this mysterious clinical scenario is also described in lumbar spinal canal stenosis, leg length discrepancy, piriformis myofascial pain syndrome, following vaginal delivery, and anomalous piriformis muscle or sciatic nerve. In this paper, we describe piriformis and fibromyalgia syndrome in a 30-year-old young lady, an often missed diagnosis. We also focus on management of the piriformis syndrome.

Figure 1

High frequency diagnostic ultrasonogram of both gluteal regions illustrates piriformis muscle thickness (right 12.2 and left 9.4 mm).

Figure 2

Intralesional steroid injection in right piriformis muscle. (a) x indicates point of needle entry at 1.5 cm lateral and 1.2 cm caudal to the lower 3rd of right sacroiliac joint and dotted line from right dimple of Venus to right greater trochanter runs parallel with superior margin of the right piriformis muscle; (b) after infiltration with 1% lidocaine spinal needle is placed; (c) 10 cc disposable syringe with injection methylprednisolone (40 mg/mL), 3 mL 1% lidocaine, and 2 mL 0.25% bupivacaine is in situ; (d) local gauze bandage after the procedure.