8 Tests to Diagnose Piriformis Syndrome

If you have been experiencing pain, tingling or numbness in your buttocks that has begun to extend down your legs, you may want to have a piriformis syndrome test done. This is a rare syndrome that happens when the piriformis muscle interferes with the sciatic nerve. This band-like muscle is located at the top of the buttocks near the joint of the hip. The sciatic nerve stretches from the hip down the leg. When it is compressed, it can cause debilitating pain when sitting, walking or doing any other kind of activity involving the hip and leg. While it is not a common condition, there are several tests that can be done to diagnose the syndrome.

8 Tests to Diagnose Piriformis Syndrome

Your doctor will need to conduct a full physical exam, and may call for tests such as an MRI or CT scan to rule out other causes of your pain before writing a referral to a specialist. There are many ranges of motion tests that are used as part of the diagnostic process for piriformis syndrome that your doctor can perform too. The following is a list of the 8 general piriformis syndrome test.

Test #1 - Lasègue

This range of motion test (ROM) involves letting you laying on your back and flexing your hip at a 90 degree angle. If there is pain when you flex your knee straight, it is a positive sign for piriformis syndrome.

Test #2 - Freiberg

This is another ROM test. Your doctor will have you lying on your back before lifting and rotating your leg. Pain in the buttocks is considered a positive sign of the syndrome.

Test #3 - Pace

This ROM test requires you lie on the side without any pain. Then your doctor will move your hip and leg through several motions. Pain indicates piriformis syndrome.

Test #4 - Sciatic Notch Palpitation

This is not a ROM test but a manual test. While lying down, your doctor will press and release your sciatic notch with their finger. This notch is located on your pelvic bone and is where the piriformis muscle passes over the nerve. Again, pain will indicate a positive result for the syndrome.

Test #5 - Sensory Evaluation

This manual test requires your doctor lightly touch the affected leg, or he can use an implement to make your leg have sensation. They are looking for an increase in sensitivity, or a loss of sensation in the leg. The piriformis syndrome test result that is positive is loss of sensation. An increase in sensitivity may indicate another condition.

Test #6 - Muscle Evaluation

With this test, your doctor is going to examine and measure several aspects of the condition of your muscles in your leg and gluteus. The gluteus is the large muscle that gives your buttocks shape. They will check if the muscle has tightened, weakened or atrophied. An atrophied muscle is weak and will lose volume because it has not had regular uses. You may not have used the muscle because you have been compensating with others to avoid the pain the atrophied muscle experiences due to the syndrome. When your doctor presses on an atrophied or contracted muscle, there will be an increase in pain.

Test #7 - CT or MRI scan

Once your doctor has to eliminate other possible causes of your pain, they can request a CT or MRI scan. The advanced imaging of these scans allows your doctor see if there are any abnormalities or arthritic conditions that would be causing your pain. They will also be able to see the muscle itself and see if there is any misalignment to it. Which one they use will depend mostly on which test your insurance company will allow. Neither is considered to be capable of producing a definitive diagnostic result, but both allow for greater detail to be seen to rule out other causes.

Test #8 - Electromyography

This is often used when your doctor has to figure out if it is piriformis syndrome test or a herniated disc. This test allows for your doctor to stimulate muscles with an electric current. They may use electrodes to be taped to your skin for sending the current to the muscle, or they may insert a small needle directly into your muscle. If you do have piriformis syndrome, both the piriformis muscle and gluteus will have abnormal muscle reaction to the electrical stimulation, but the muscles around your piriformis can react normally.If the muscles around also have abnormal reaction, you may have a herniated disc. This is rarely performed as the first test because it is invasive and the other tests may show enough positive signs to diagnose piriformis syndrome.

Note: There are many tests for piriformis syndrome. Bear in mind that you have to get your doctor to refer you to a specialist for these tests. This is not just because the tests may involve advanced diagnostic equipment, but the rarity of this syndrome can cause that many doctors aren't trained to do a test of piriformis syndrome. The other issue is that many of the symptoms can also be caused by other types of syndromes and issues. Only a specialist will be able to make an informed diagnosis. Specialists who are familiar with the different types of testing for this syndrome include orthopedists, osteopaths and specialists in physical medicine.

If the Test Turns Out to Be Positive, What to Do Next

If your piriformis syndrome test is positive, then there are many things that your doctor will suggest to you to help relieve the symptoms. First and foremost treatment is to treat any pain caused by sitting or other activities that strain the sciatic nerve. You can use ice or heat therapies and take enough rest. Mild pain relievers such as NSAIDs may be prescribed. Doing physical therapy for the condition has been proven to help most people. There are special osteopathic treatments that have a high success rate too. If you are not experiencing enough relief through these steps, then your doctor may suggest using muscle relaxants, cortisol shots, and even Botox treatments to relieve pain. Surgery is an option, but it is considered to be a last resort if all other options fail to provide relief. 

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