Posttraumatic piriformis syndrome

[helenlegs11]

I had a fall 2 years ago and have been diagnosed with DDD (Iam 53), but NO disc related nerve impingment. I can forward flex etc (and touch the floor) staight leg raise, fine. But I have horrendous sciatica. It includes, numbness, tingeling, pins and needles as well as the zapping, electric shock sciatic pain. All the usual sciatic stuff I guess.
I do have a history of a back problem and had a successful microdiscectomy 7 years ago (L5/S1) I had residual numbness in my toes after my op but never needed a day off work once recovered.
Since my falI have complained of buttock pain, never back pain, and actually had a significant lump in the (still) painful area after my fall for a few months. The pain is into my groin and hip as well as the sciatica which gets so bad that I am unable to put my heel to the ground.
A physiotherapist diagnosed piriformis syndrome last October. She did a lot of work on me including deep trigger point massage to the piriformis and later acupuncture into the muscle as well. IT HURT LIKE !* !* ! especially the acupuncture. I had to stop because the very slight relief I got was not worth the pain endured. Her diagnosis and what I have read about piriformis syndrome seems spot on to me I can relate to it totally, BUT the Dr. who said DDD is responsible for my sciatica etc does not recognise my physiotherapists diagnosis.
I have no urge to take matters further over what I, without question, believe to be a wrong diagnosis (DDD) but I would like to know what a universal medical opinion of my symptoms might be.
Thank you.  

[helenlegs11]

Thank you so much for your response, I think I am the perfect candidate to prove or disprove this piriformis debate.(unfortunately, I think the debate may have been abandoned) .
  As a neurologist I can imagine your proffessional interest in nerve entrapment,( wherever it may occur along the nerve),including PS is great. Mine is greater ! I would eagerly take part in any clinical trial, if  spinal & neurology clinicians decided to investigate further. I have read a fair bit about PS now, including clinical trials, where surgery has helped patients enormously   .www.ejbjs.org/cgi/content/full/81/7/941 and many others.
I am thinking of having an MR neurography scan to help clarify my issue but it is costly and I haven't been able to work since my fall.
Re your points, I can understand the problem of post surgery scaring causing sciatica but it seems ridiculous in my case, as I had NO problems post surgery for 5 years and then suddenly after a fall and subsequent huge muscle spasm ? ? ?
Oh well, it's MY problem, I just wish some people in your profession were more open to  this clinical entity. My job was in architecture and design. If I ignored a small part of information that might be relevant, and later it proved very relevant, the whole structure may collaps,( costly ). It's a good job that in this case, cost is not too much of an issue just pain,suffering, depression and a huge battle to get someone just to listen to me.
Thanks again for taking the time to answer my question.
Helen

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is nor the implications of the EEG. However I will try to provide you with some useful information.

Pyriformis syndrome in general is a controversial and not as you know a universally accepted diagnosis. It is often a diagnosis made by non-physicians (chiropracters, physical therapists), though some physicians make this diagnosis as well. It is not a diagnosis that can be made with specific tests, so when the diagnosis is made it's a clinical diagnosis. Some believe that it results from compression of the sciatic nerve as it passes under the pyriformis muscle. Symptoms include buttock pain made worse by falling or after trauma, and pain radiating down the leg (what is often termed sciatica). Some have gone so far as to do surgery to release this compression, but there is no evidence to support that treatment is effective, and often does more harm than good.

Sciatica most often results from a radiculopathy. A radiculopathy is a pinched nerve: this can be pinched by arthritis, herniated disc, or scarring (such as from after surgery). When there is a clear compression of a nerve root, leading to weakness, significant pain, numbness, surgery is a potential treatmetn option, but more often than not this is treated with physical therapy, controlled exercise, anti-inflammatories, medications for neuropathic pain, sometimes injections, etc. Superficial acupunture may be helpful, but more aggressive needle insertions are likely harmful.

I can not comment further on your diagnosis without being able to evaluate you/obtain a history, continued follow-up with your physicians is recommended.

Thank you for the opportunity to answer your questions, I hope you find this information useful.