A rare cause for sciatalgia: Piriformis syndrome

Year 2021, Volume: 12 Issue: 3, 82 - 84, 18.08.2021

İlker Akbaş , Abdullah Osman Kocak , Alpaslan Ünlü , Sinem Doğruyol , Sultan Tuna Akgol Gur

https://doi.org/10.33706/jemcr.883699

Cited By: 1

Abstract

The clinical symptoms comprising piriformis syndrome emerge as a result of the compression of the sciatic nerve due to anatomical variations or pathological conditions related to the piriformis muscle. The underlying cause in 6% of cases of lumbar pain, piriformis syndrome might be also defined as entrapment neuropathy of the sciatic nerve. While piriformis syndrome is not rare, it is not well known. As the clinical symptoms may be misleading, it can easily be overlooked, or lead the clinician to an incorrect diagnosis (such as discopathy). In this report, our objective was to present the case of a 18-year-old female patient who presented to the emergency department with sciatalgia and received a diagnosis of piriformis syndrome caused by pyomyositis of the piriformis muscle. The patient arrived at the emergency department reporting severe pain and paresthesia in the right pelvis, thigh, and leg with the inability to walk due to pain. Vital signs were normal except for a high fever. Her Lasègue test was positive, and the patient had severe pain with both internal and external rotation. After radiological examination, the patient was diagnosed with an abscess in the piriformis muscle due to pyomyositis. It was determined that the cause of sciatalgia was piriformis syndrome, with the abscess in the piriformis muscle compressing the sciatic nerve. The abscess was drained after the patient was admitted to the hospital; the patient was then discharged without further complication. The need for high-cost therapeutic methods or even death may result in instances where piriformis syndrome is overlooked by emergency department clinicians, or when it is given the misleading diagnosis of sciatalgia.

Keywords

sciatalgia, pyomyositis, piriformis syndrome, piriformis abscess, differential diagnosis

References

• 1. Serinken M, Eken C, Gungor F, Emet M, Al B. Comparison of Intravenous Morphine vs Paracetamol in Sciatica: A Randomized Placebo Controlled Trial. Acad Emerg Med. 2016.
• 2. Cansever T, Kabatas S, Ilgaz Ö, Yilmaz C, Caner H. Piriformis sendromuna genel bakis. Türk Nöroşirürji Dergisi. 2010;20 (1):30-5.
• 3. Rossi P, Cardinali P, Serrao M, Parisi L, Bianco F, De Bac S. Magnetic resonance imaging findings in piriformis syndrome: a case report. Arch Phys Med Rehabil. 2001;82(4):519-21.
• 4. Byrd JT. Piriformis syndrome. Operative Techniques in Sports Medicine. 2005;13(1):71-9.
• 5. Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008;108(11):657-64.
• 6. Michel F, Decavel P, Toussirot E, Tatu L, Aleton E, Monnier G, et al. The piriformis muscle syndrome: an exploration of anatomical context, pathophysiological hypotheses and diagnostic criteria. Ann Phys Rehabil Med. 2013;56(4):300-11.
• 7. Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat. 2012;34(6):479-86.
• 8. Colmegna I, Justiniano M, Espinoza LR, Gimenez CR. Piriformis pyomyositis with sciatica: an unrecognized complication of "unsafe" abortions. J Clin Rheumatol. 2007;13(2):87-8.
• 9. Toda T, Koda M, Rokkaku T, Watanabe H, Nakajima A, Yamada T, et al. Sciatica caused by pyomyositis of the piriformis muscle in a pediatric patient. Orthopedics. 2013;36(2):e257-9.
• 10. Miller NJ, Duncan RD, Huntley JS. The conservative management of primary pyomyositis abscess in children: case series and review of the literature. Scott Med J. 2011;56(3):i-181.
• 11. Chiedozi LC. Pyomyositis. Review of 205 cases in 112 patients. Am J Surg. 1979;137(2):255-9.
• 12. Chong KW, Tay BK. Piriformis pyomyositis: a rare cause of sciatica. Singapore medical journal. 2004;45(5):229-31.
• 13. Kulcu DG, Naderi S. Differential diagnosis of intraspinal and extraspinal non-discogenic sciatica. J Clin Neurosci. 2008;15(11):1246-52.
• 14. Kraus E, Tenforde AS, Beaulieu CF, Ratliff J, Fredericson M. Piriformis syndrome with variant sciatic nerve anatomy: a case report. PM R. 2016;8(2):176-9.