Piriformis Syndrome: How were you diagnosed and what helps?

I think I have piriformis syndrome but doctor (from MRI) says it’s Osteoarthritis in hip. Doctors are not believers in Sciatica resting on piriformis muscle. HELP

@lesb0298, welcome. I've added your discussion to the Spine Health too. I think members like @mfratt @basslakebabe19 @loyal @kimberlynitz66 @jenniferhunter can share some tips and thoughts with you.

I think you might appreciate the helpful posts shared in this related discussion:
- Sacroiliac joint, piriformis, or sciatica? https://connect.mayoclinic.org/discussion/sacroiliac-joint-piriformis-or-sciatica/

Les, it sounds like your first stumbling block is to actually get a diagnosis. You believe your symptoms might be Piriformis Syndrome, but you haven't been diagnosed yet or able to get this confirmed. Is that correct? Have you been able to see a spine specialist?

@lesb0298, what leads you to believe it is not osteoarthritis? What next steps does your doctor suggest?

@lesb0298 mine turned out to be rheumatoid arthritis together either a labrum tear plus trochanteric bursitis all in the same hip! It wasn't piriformis after all. I didn't know that I had RA until I had an MRI. So now treating the PMR with predn as well as the RA with methotrexate. Once the methotrexate starts to work, hopefully I can reduce the prednisone,

@lesb0298 I have found a website with lots of good technical articles about physical problems. There is a lot to read, but it may help provide details about different issues that can have similar overlapping symptoms.

This article discusses issues related to the lumbar spine and pelvis, and there are many others at this site.

From mskneurology.com
- How to identify and treat lumbar plexus compression syndrome (LPCS)
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
A good physical therapist may be able to help narrow down some of this and make recommendations. Have you seen an orthopedic doctor about these symptoms? Colleen's suggestion of a spine specialist is good too because a spine problem can cause similar symptoms.

Thank you Colleen, I was diagnosed via an ultrasound guided injection back in 2017 “ish” with piriformis syndrome. It was never that bad that I could not walk. One year ago I had spinal fusion surgery which went well (totally different issue). My piriformis was not bothering me at all. Then went for a vein scan due to swollen foot and they had to twist my left leg (where this is) and I cried all the way home; almost like they pulled something out of where it should be. From that day I’ve been in this wheelchair, did PT specifically for piriformis syndrome which should not have been done honestly. Right now I have to see if Mayo does specifically a “diagnostic ultrasound” for the piriformis muscle. After many calls there is not a hospital or imaging center that does this specifically for a muscle; apparently it required a specific machine. That’s where I am right now.

Thank you Kimberly, I’ve found out that an MRI cannot diagnose piriformis syndrome. I need a “diagnostic ultrasound for this specific muscle”… and I’ve not found a place that does this near me, I’m sending a note to Mayo today if I can remember how to do that to see if they have a machine that does this,

Hi Jennifer, many thanks. I’ve been to 3 ortho’s. I’ve done PT specifically for piriformis syndrome which I later found out is not good to do. You don’t want to stretch the piriformis at all. Piriformis Syndrome is an issue where the spine is resting on the piriformis muscle and aggravating it, thus pain so great I can’t walk. An MRI cannot diagnose this so I’m sending a note today to Mayo to see if they do this “diagnostic ultrasound” specifically to diagnose piriformis syndrome.

Colleen, my ortho did a MRI and X-ray and diagnosed this as Osteoarthritis, however I had a diagnosis many years ago that I had piriformis syndrome and I’m convinced it’s back. I just don’t have a lot of faith in these doctors where I am. My ortho wants to replace my hip. I don’t want to do something that is not necessary, I need to get this piriformis bug out of my head first. I need a piriformis specialist to diagnose that I don’t have it. That’s when I’ll be content and do hip surgery. I’ve found that the ortho’s here do not really believe in the piriformis being an issue.

I'm confused. When I had piriformis syndrome, the treatments were PT, walking & x-ray guided steroid injection. As far as I can see, everywhere I look, that is still the recommendation.
---- https://www.spine-health.com/conditions/sciatica/symptoms-and-diagnosis-piriformis-syndrome

In over 5 years of struggling, none of these therapies was successful for more than a few weeks for me because the underlying cause was a hip badly deteriorated by severe osteoarthritis. At 54, the surgeon said I had the hips of an 85 year old. The problem was that the unstable hip was causing the piriformis to repeatedly press on the sciatic nerve. The solution was hip replacement, and 17 years later I have not had a recurrence of the piriformis issue.

I think you mentioned in another discussion that your ortho diagnosed osteoarthritis in your hip, and suggests it is the cause of your pain. The doctor should be able to show you the x-rays that show the damage, and compare them to a normal joint.

What exactly makes you question the arthritis diagnosis? Where did you learn about a specific MRI to diagnose piriformis syndrome?

I understand reluctance to undergo unnecessary surgery, but if you have exhausted the "usual" treatments without success, maybe it is time to consider the joint replacement. Has this been recommended by more than one of the orthopedists you saw?
Sue