Believe it or not, she has had a history of around 28 years of deep right severe buttock pain and sciatica symptoms with pain radiating down into the posterior thigh. It worsened recently over two years to the point where she has been nearly disabled in pain and seeking significant medical care. She had tried to improve this over the past many years with intermittent bouts of physical therapy and exercise and stretching. She would have intermittent flare ups of pain from time to time that were very intense. Sometimes, her symptoms would almost disappear, but about 50% of her days she is in significant pain. The pain was very intense at times as high as a 9/10. On average she would live in the 4-5 range. It affected her daily activity, and prevented her from sleeping at night and even waking her up if she was able to fall asleep.
She had no back pain. She had a significant work up of her spine, and it was normal. One of her astute doctors suspected that this might be piriformis syndrome and she was referred to pain management for injections into the piriformis muscle. She had several of these. These injections performed by Dr. Hasan Abed, one of our pain management anesthesia colleagues in the area gave her months of relief, but her pain always came back.
She tried many types of medication and physical therapy for the pain in the buttock, but they were not effective in eliminating her pain.
We evaluated this patient and agreed with the diagnosis of piriformis syndrome given her symptoms, physical examination, and response to the blocks. We offered a surgical resection of the piriformis muscle in the buttock that crosses over and can pinch the sciatic nerve in the buttock.
At two months after surgery she returns to the office and reports that she is pain free 90-95% of the time. The deep seated buttock pain and posterior thigh pain is essentially gone. It is no longer stopping her from her activities, it is no longer waking her up at night time. We could not be more excited for her!
If you or someone you know have been suffering with deep seated buttock pain with our without sciatic symptoms, and you have been told that your low back, spine, hip joint, and SI joint are normal, then you may need to consider the diagnosis of piriformis syndrome as the cause of your pain. Talk to your physicians about it.