----- Original Message -----

From: Mary Smith

To: piriformissyndrome@yahoogroups.com

Sent: Friday, June 12, 2009 2:22 PM

Subject: Re: [Piriformis syndrome] New Member

Welcome to the group new members. Ah, the frustrations of diagnosis & treatment for whatever we  have. Many doctors still do not" believe" in P.S.. There are a couple of articles related to this in the File's folder "Articles about PS" ("PS Myths & Fallacies" & "Is PS over- diagnosed?") Many people are in pain, but the lack of a clear, simple, & definitive test makes diagnosis & treatment very difficult . Here is a recent example of the difficulty of diagnosis.

Brenda is one of our members, who had a bad fall. She had numerous MRI's (lumbar, thoracic and cervical), an EMG, EEG, CT of the brain, myelogram, and spinal epidurals. Other than showing a mild bulging disc at L4-L5,for which she had an L4-L5 decompression surgery, which didn't help  (all the tests have come back normal.) She was finally diagnosed w/ PS & refer to Mayo for surgery. But the surgeon refused to do the surgery because he doesn't believe in Piriformis Syndrome.

She then went to a Physiatrist. When she didn't improve, he did a FAIR-test EMG which came out negative for PS.  He was suspicious that PS wasn’t her primary diagnosis since the sciatic pain is clearly along only the S1 dermatome.  He said PS would normally cause a more diffuse sciatic pain along several dermatomes.  She then had an L5 nerve root block, upright MRI, and discogram.  The upright MRI showed significant nerve root compression and tethering at L4/L5 when she sat (but not  standing  or laying down), and the discogram showed a huge tear on the side of L4/L5 disc along with a weakness and pain to the back of the disc which match up with the upright MRI findings.  So it turns out her primary sciatic pain problem was actually a  L4/L5 disc along with a mild case of PS and some hip bursitis. Because of the large tear, she had to undergo an L5-S1 fusion a week ago. We wish her the best & hope the fusion resolves her pain.

As you can see, diagnosis is often difficult. I think there are two different types of PS. The first is an overuse syndrome among athletes, that responds well to PT or soft tissue work. The second type is caused by falls, abnormal anatomy, or unknown causes. This type is much harder to treat and should probably be called Pelvic Nerve Entrapment Syndrome rather than just PS because there is more going on than just a pirifomis muscle spasm.

I have more thoughts about your situation, but don't have time to write more now. I'll get back to you sometime this week end. Mary