Orthopedics-Online

Tests for Piriformis Syndrome - Which Are There?

introduction

In piriformis syndrome, the compression of the sciatic nerve under the piriformis muscle leads to severe pain in the buttock region, which can radiate into the lumbar area and the rear thigh up to the knee. Because of these symptoms, piriformis syndrome can more often be confused with a herniated disc of the lumbar spine.
For the treatment of this disease, conservative methods are particularly suitable, such as physiotherapy especially for the piriformis syndrome.
To diagnose piriformis syndrome, several tests have been established that target the function of the piriformis muscle.

Further information can be found at:

Piriformis Syndrome
Physiotherapy for piriformis syndrome

Piriformis muscle (Musculus piriformis)

The piriformis muscle (lat. pear-shaped muscle) belongs to the inner layer of the hip muscles and runs from the inside of the pelvis to the thigh bone. The muscle has the task of turning the thigh outwards while standing, stretches it and is responsible for the splay.

Please also read our topic on this Piriformis muscle.

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Piriformis muscle

Pear-shaped muscle -
Piriformis muscle
Iliac scoop -
Ala ossis ilii
Posterior sacrum holes -
Foramina sacralia posteriora
Sacrum -
Sacrum
Great Rolling Hill -
Greater trochanter
Small rolling hill -
Lesser trochanter
Femoral shaft -
Corpus femoris
Ischium -
Os ischii (ischium)
Fifth lumbar vertebra -
Vertebra lumbalis V

All medical illustrations

FAIR test

The FAIR test is an important and relatively reliable test to diagnose or rule out piriformis syndrome.
FAIR stands for flexion (diffraction), Adduction (Bringing an extremity to the center of the body) and internal rotation (turning inwards), i.e. the movements that make up the examination. The FAIR test cannot be used to determine with 100% certainty whether the symptoms are due to a piriformis syndrome, but it does provide an important clue in the diagnosis of such a syndrome.

To do this, the patient lies on the healthy side, with the leg below being stretched out straight and the upper body as flat as possible on the examination table. The leg of the sick side is bent at the knee and pulled towards the body so that the flexion (Flexion) in the hip joint is 60 °. The same leg is brought to the body at the same time in the hip joint (Adduction) and turned inwards (Internal rotation). The examiner now causes the piriformis muscle to stretch by pushing the overlying leg down towards the bed.

The FAIR test is positive if there is pain in the buttocks during the examination. As already mentioned, the test can also be positive for other diseases of the buttocks or the lumbar area, and a negative test result does not exclude a piriformis syndrome with certainty.

Freiberg test

A positive Freiberg sign is also an indication of piriformis syndrome and can therefore serve as a test.

The patient lies supine on an examination couch and lets the lower leg of the affected side hang down over the edge of the couch in the air. A passive internal rotation of the thigh is achieved by turning the lower leg outward. If pain occurs in the buttock region, the Freiberg test is positive because the test provokes the piriformis muscle to approach the sciatic nerves.

Beatty test

The Beatty test can provide information about the presence of piriformis syndrome if there are symptoms. In this clinical test, the patient lies on the healthy side and raises the bent knee above about 10 cm (Abduction) against the resistance of the examiner. If pain occurs in the buttocks area, the Beatty test is considered positive and there is a possibility that piriformis syndrome is present.

Pace test

During the pace maneuver, the affected leg is spread apart while the patient is seated (externally rotated). As a result, the contraction of the piriformis muscle and the resulting irritation of the sciatic nerve lead to pain in the buttock region and a piriformis syndrome may be present.

External rotation and abduction

In the state (with stretched hips) the piriformis muscle has the function of an external rotator, when the hip is flexed it acts as an abductor (Spreading function). Performing these movements against resistance can lead to pain in the buttocks, which, in addition to the tests mentioned, is also an indication of piriformis syndrome.