I am on a quest. . . .to prove that I have piriformis syndrome and not a spinal related problem. The trouble is that I am over 2 years down the line and almost no further forward because as Dubious and others have mentioned here, consultants and doctors don't even believe it exists ! ! ! I think I have downloaded EVERYTHING there is on piriformis syndrome and (my complaint) post traumatic piriformis syndrome.There is so much evidence that the problem exists that it is an absolute disgrace that educated individuals choose to ignore and worse, mock , sufferers, who have a hard enough task dealing with the every day pain.

Hi Helen,
Piriformis syndrome is truly a painful condition , especially for such a long time! The bout that I had (see my post on this thread) lasted for some time and it was really excruciating to sit!
Medical doctors may not be as expertised at treating this condition and may simply try to mask the pain with painkillers and anti-inflammatories.
What turned it around for me was a very competent chiropractor.
I hope you have an opportunity to have a consultation with a chiropractor who is repudable and knowledgable. S/he may be able to rule out other possibilities and/or contributing factors as well. The condition can be reversed with proper care.
Good luck to you!
Hope4thebest

It turns out that PT and streching exercises have long been the mainstream therapy for Piriformis syndrome. That said, there are some "refractory cases" in which exercises alone may not be enough. See, Piriformis syndrome, diagnosis and treatment, Kirschner JS, Foye PM, Cole JL, Muscle Nerve 2009 Jul;40(1):10-8.

Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey- New Jersey Medical School, Administrative Complex Building 1, 30 Bergen Street, Newark, New Jersey 07101-1709, USA. jkirschnerMD@gmail.com

Comment in:

Muscle Nerve 2010 Mar;41(3):428-9; author reply 429-30.

Abstract
Piriformis syndrome (PS) is an uncommon cause of sciatica that involves buttock pain referred to the leg. Diagnosis is often difficult, and it is one of exclusion due to few validated and standardized diagnostic tests. Treatment for PS has historically focused on stretching and physical therapy modalities, with refractory patients also receiving anesthetic and corticosteroid injections into the piriformis muscle origin, belly, muscle sheath, or sciatic nerve sheath. Recently, the use of botulinum toxin (BTX) to treat PS has gained popularity. Its use is aimed at relieving sciatic nerve compression and inherent muscle pain from a tight piriformis. BTX is being used increasingly for myofascial pain syndromes, and some studies have demonstrated superior efficacy to corticosteroid injection. The success of BTX in treating PS supports the prevailing pathoanatomic etiology of the condition and suggests a promising future for BTX in the treatment of other myofascial pain syndromes. [Emphasis added.]

PMID: 19466717 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/19466717

For one explanation as to why PT and stretching exercise might not work in all cases, consider the folllowing: Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome, Windisch G, Braun EM, Anderhuber F, Surg Radiol Anat. 2007 Feb; 29(1):37-45. Epub 2007 Jan 10.

Institute of Anatomy, Medical University Graz, Harrachgasse 21, 8010, Graz, Austria. gunther.windisch@meduni-graz.at

Abstract
Patients with lumbosacral and buttock pain provide tacit support for recognizing the piriformis muscle as a contributing factor to the pain (piriformis syndrome). One hundred and twelve cadaveric specimens were observed to elucidate the anatomical variations of the piriformis muscle referred to the diagnostic and treatment of the piriformis syndrome. The distance between the musculotendinous junction and the insertion was measured and the piriformis categorized into three types: Type A (71, 63.39%): long upper and short lower muscle belly; Type B (40, 35.71%): short upper and long lower muscle belly; Type C (1, 0.9%): fusion of both muscle bellies at the same level. The diameter of the piriformis tendon at the level of the musculotendinous junction ranged from 3 to 9 mm (mean: 6.3 mm). The piriformis showed the following possible fusions with adjacent tendons. In type one (60, 53.57%) a rounded tendon of the piriformis reached the upper border of the greater trochanter. In type two (33, 29.46%) it first joined into the gemellus superior tendon and at last both fused with the obturator internus tendon and inserted into the medial surface of the greater trochanter. A fusion of the piriformis, obturator internus and gluteus medius tendon with the same insertion area as above was observed in type three (15, 13.39%) and finally in type four (4, 3.57%) the tendon fused with the gluteus medius to reach the upper surface of the greater trochanter. Based on this survey anatomical causes for the piriformis syndrome are rare and a more precise workup is necessary to rule out more common diagnosis. [Emphasis added.]

PMID: 17216293 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/17216293


And for those who require a more invasive approach, relief of three to six months is apparently possible. See, Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose-finding study, Fishman LM, Konnoth C, Rozner B, Am J Phys Med Rehabil. 2004 Jan;83(1):42-50; quiz 51-3.

Columbia College of Physicians and Surgeons, New York, New York, USA.

Abstract
OBJECTIVE: To measure dosage effects of botulinum neurotoxin type B with physical therapy in piriformis syndrome. DESIGN: Prospective study of consecutive patients complaining of buttock pain and sciatica, measuring serial H-reflex tests in flexion, adduction, and internal rotation; visual analog scale; and adverse effects at 0, 2, 4, 8, and 12 wks. We used an electrophysiologic criterion for piriformis syndrome: a 1.86-msec prolongation of the H-reflex with the flexion, adduction, and internal rotation test. Four piriformis syndrome groups were identified. Serial groups were injected once with either 5000, 7500, 10,000, or 12,500 units of botulinum neurotoxin type B in successive months under electromyographic guidance in four separate locations of the affected piriformis muscle, with a 1-mo safety observation period between groups. Patients received physical therapy twice weekly for 3 mos. RESULTS: The flexion, adduction, and internal rotation test and visual analog scale declined significantly, correlating at 72% sensitivity and 77% specificity. A total of 24 of 27 study patients had >/=50% pain relief. Mean visual analog scale score declined from 6.7 to 2.3. A volume of 12,500 units of botulinum neurotoxin type B was superior to 10,000 units at 2 wks postinjection. The most severe adverse effects were dry mouth and dysphagia, approaching 50% of patients at 2 and 4 wks. CONCLUSION: Physical therapy and 12,500 units of botulinum neurotoxin type B seem to be safe and effective treatment for piriformis syndrome. In addition, the flexion, adduction, and internal rotation test seems to be an effective means of diagnosing piriformis syndrome and assessing its clinical improvement. Injection may benefit patients for >3 mos.

PMID: 14709974 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/14709974

AND

The effectiveness of clonidine-bupivacaine repeated nerve stimulator-guided injection in piriformis syndrome, Naja Z, Al-Tannir M, El-Rajab M, Ziade F, Daher Y, Khatib H, Tayara K, Clin J Pain 2009 Mar-Apr;25(3):199-205.

Department of Anesthesia and Pain Medicine, Makassed General Hospital, Beirut, Lebanon. zouhnaja@yahoo.com

Abstract
OBJECTIVES: Piriformis syndrome (PS) is often refractory to conventional therapies. Guided injection techniques generally necessitate a computed tomography or fluoroscopic guidance that may not be available in most pain management centers in addition to its relative high cost. The aim of this clinical trial is to investigate whether clonidine-bupivacaine nerve-stimulator guided injections are effective in achieving long-lasting pain relief in PS compared with bupivacaine guided injection. METHODS: A pilot study conducted on 18 patients (15 females, 3 males) diagnosed with PS showed the adequacy of nerve stimulator guided technique assessed via confirmatory visualized tomography scan demonstrating a worthy coverage of the piriformis muscle in about 84% of the cases. This randomized double-blind trial included 80 patients with PS who received a nerve stimulator-guided piriformis injection (group C received 9 mL bupivacaine 0.5% and 1 mL clonidine 150 mcg/mL; group B received 9 mL bupivacaine 0.5% and 1 mL saline). Pain characteristics and analgesics consumption were the primary end points assessed for 6 months. RESULTS: Group C showed significantly lower pain scores and analgesics consumption than group B (P<0.0001). Pain at 6 months was significantly greater in group B (78%) than in group C (8%) (P<0.01). For every 18 months of PS pain, the outcomes demonstrated that a patient needed 1 additional injection to the initial injection. DISCUSSION: Repeated clonidine-guided piriformis injection relieved PS symptoms and reduce analgesic consumption for a 6-month period. It is a cost-effective useful treatment for PS refractory to traditional therapeutic approaches.

PMID: 19333169 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/19333169


Finally, while clearly tricky, successful sugical outcomes our possible in cases that have not responded to conventional treatments. See, Case report : recurrent piriformis syndrome after surgical release, Kobbe P, Zelle BA, Gruen GS, Clin Orthop Relat Res. 2008 Jul;466(7):1745-8. Epub 2008 Feb 9, FREE FULL TEXT @ http://www.ncbi.nlm.nih.gov/pmc/arti...rticle_151.pdf

Department of Orthopaedic Surgery, Division of Trauma, University of Pittsburgh School of Medicine, Kaufmann Building, Suite 1010, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. kobbep@upmc.edu

Abstract
Piriformis syndrome is an uncommon condition characterized by sciatic nerve entrapment at the greater sciatic notch. Nonoperative treatment such as physical therapy, nonsteroidal antiinflammatory drugs, and local injections often results in relief of symptoms. For patients who do not benefit from nonoperative therapy, surgical exploration and decompression of the sciatic nerve has been effective. However, the success of surgery may be diminished by scar formation or hematoma in the anatomically restricted sciatic notch. We report two patients with piriformis syndrome who responded primarily to surgical decompression and had recurrent symptoms resulting from scar tissue formation in the sciatic notch. On revision surgery, polytetrafluoroethylene pledgets were placed around the sciatic nerve to avoid compression and entrapment by scar tissue. Both patients had satisfactory outcomes at 3 years followup.

PMID: 18264837 [PubMed - indexed for MEDLINE]PMCID: PMC2505267

http://www.ncbi.nlm.nih.gov/pubmed/18264837

As set forth by Kobbe, et al:

On surgical exploration, both patients showed formation of extensive fibrous scar tissue around the sciatic nerve. In both cases, the piriformis muscle was completely released and there were no signs of hematoma formation in the sciatic notch. Previous reports did not address the problem of revision surgery for recurrent piriformis syndrome [2]. However, postoperative scar formation with subsequent sciatic nerve compression may considerably limit the functional outcomes of surgical piriformis release. The sciatic nerve may be entrapped in the anatomically small sciatic notch by only small amounts of postsurgical hematoma or scar formation. Whether arthroscopic release of the piriformis muscle as reported, may reduce the incidence of recurrent piriformis syndrome by minimizing soft tissue trauma and consequent scar formation has yet to be evaluated [4]. [p. 1747]

Notes
2. Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am. 1999;81:941–949.
4. Dezawa A, Kusano S, Miki H. Arthroscopic release of the piriformis muscle under local anesthesia for piriformis syndrome. Arthroscopy. 2003;19:554–557.

http://www.ncbi.nlm.nih.gov/pmc/arti...rticle_151.pdf

I hope this is useful.

Mike

You wrote that you found a chiropractor that helped you with your piriformis syndrome. Could you be more specific? Thank you. Paulette

I was wondering what you did to reverse your neuropathy?

Welcome to NeuroTalk:

I haven't seen Wing for quite a while. He does have 2 posts,
here however that may answer your question:

http://neurotalk.psychcentral.com/post9580-18.html
http://neurotalk.psychcentral.com/post9583-19.html

We also have other information at the PN forum, so please do
look around there and also on the Subforum linked at the top of the PN page.