This pathology designates the compression of the sciatic nerve by the piriformis muscle. The piriformis is a small pyramidal muscle located deep to the gluteal muscles in the upper region of the hip joint, is part of the set of 6 external rotators and extends from the sacrum to the greater trochanter (greater tuberosity of the proximal femur).
Pyriform / Pyramidal syndrome
Primary or secondary
The sciatic nerve originates from nerves in the lumbar spine, passes through the gluteal region where it has
a very close relationship with the piriformis muscle and continues to the lower limb (back of the thigh, leg and foot).
It can be caused by anatomical changes in the piriformis muscle or the sciatic nerve (s.
(Primary s. piriformis) or secondary to inflammation/spasm of the piriformis muscle. It is usually dynamic compression in certain positions or activities such as running or prolonged sitting.
It is characterized by intense pain and paresthesia (numbness) in the buttock (gluteal region), which can radiate to the lower limb giving rise to a “sciatica-like syndrome”. Most sciatica is not caused by pyramidal syndrome. The sciatic nerve may also be pinched a little lower down between the ischion (hip bone) and the lesser trochanter (small tuberosity of the proximal femur) causing what is called ischio-femoral syndrome. This is a diagnosis of exclusion without a conclusive test. Diagnosis is made through clinical history and physical examination, with the possibility of imaging tests (magnetic resonance imaging of the hip and lumbar spine) and nerve conduction studies. Compression of the sciatic nerve at the level of the spine (the most common cause of sciatic pain) must be screened for.
Conservative treatment involves avoiding activities that cause pain, anti-inflammatory
inflammatory medication and physiotherapy. Local corticosteroid, anaesthetic and botulinum toxin infiltrations can help control persistent symptoms.
In cases where conservative treatment fails, arthroscopy of the gluteal arthroscopy of the gluteal space is indicated for sciatic nerve release.
