Piriformis Syndrome and Neuropathic Fibular Pain Caused by Anomalous Sciatic Anatomy

Abstract

Sacro-iliac joint arthritis was a cause of sciatica at the turn of the last century (1); however the piriformis muscle, which spans the joint, became synonymous with sciatica evoked by passive internal rotation, hip flexion and abduction maneuvers.  Piriformis syndrome was ascribed to contact of the muscle with upper sacral nerves and the sciatic trunk as they transited the IF (2).  Sectioning a tight iliotibial band (3), piriformis myotomy and fascial band releases (4), and physiotherapy have all been advocated as effective modes of therapy. Although over-diagnosed (5), there are subsets of affected patients with anomalous anatomy.