Piriformis syndrome can be a worker’s compensation injury. Pain in the buttock radiating down the leg is commonly called sciatica. The most common cause for sciatica is irritation of the spinal nerves in or near the lumbar spine due to neural foraminal stenosis often cause by a bulging or herniated disc. However, sometimes the nerve irritation is not in the spine but further down the leg due to an injury to the piriformis muscle. Piriformis syndrome mimics a herniated disc pain and while it can be disabling it rarely leads to surgery.
The piriformis muscle connects the top of the thigh bone or hip to the sacrum or tail bone. The piriformis muscle helps to turn the foot and leg outward. Problems in the piriformis muscle can cause painful problems with the sciatic nerve because the sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis and down the leg. The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica.
Work related causes of piriformis injury can be a traumatic injury due to a fall onto the buttock, or it could be from repetitive job duties over time resulting in piriformis swelling and pressure on the sciatic nerve, which becomes inflamed. Healing resulting in scar tissue can cause a more chronic or permanent injury.
Diagnosis of piriformis syndrome starts with a history and physical exam, and some radiology including x-rays and MRI. The most accurate way to tell if the piriformis muscle is the cause of pain is with a diagnostic injection into the muscle. The muscle is deep inside the buttock, so the injection requires X-ray guidance with a fluoroscope, a CT scanner, or an open MRI machine. Once the needle is placed in the muscle, an anesthetic can be injected into the muscle to paralyze the piriformis muscle. If the pain goes away after the injection, your doctor can be reasonably sure that the pain you are feel is from piriformis syndrome.
Treatment consists of physical therapy and possibly injections of lidocaine, cortisone or botox. Surgery may be considered but usually only as a last resort. The first is to cut the piriformis tendon where it attaches on the greater trochanter (the bump on the side of your hip). The other method is to cut through the piriformis muscle to take pressure off the sciatic nerve.
In Milwaukee, Wisconsin McCormick Law Office attorneys are successful when trustworthy opinions from doctors tie piriformis syndrome to job duties over time or a single traumatic injury giving rise to loss of earning capacity benefits. Believe in better.
