Is sciatica just a symptom after an injury or possibly a separate damage and diagnosis for the case?

Our Answer:

 In a recent slip and fall case, sciatica was mentioned as one symptom among several. However, when sciatica exists among certain other issues, it may be more than an isolated symptom.

 PIRIFORMIS SYNDROME

 Slip and fall injuries frequently involve impact to the hip and or buttock. In addition, rotational forces at the hip can be sudden & forceful and occur in circumstances where the limb is fixed and unable to move in concert with muscle contraction. Sciatica is a common complaint in such cases. There are several commonly seen causes (traumatic and non-traumatic) of sciatica. Piriformis muscle dysfunction as a cause of sciatica is not that common and thus can be missed as a diagnosis. So, what is Piriformis Syndrome and why is it important?

 Sciatica is pain and/or numbness in the sciatic nerve distribution. This means that discomfort may occur anywhere along the pathway served by this nerve. So, pain and/or numbness anywhere from the low back, through the buttock and down the back of the leg may occur. Discomfort may also involve the foot. Muscle weakness may also occur. It is important to note that discomfort and/or weakness may occur anywhere along the affected pathway. Sciatic irritation may affect one area differently than another. Some parts of the nerve pathway may be spared. So, one may experience pain in one area, numbness in another and another area may be spared.

 The most commonly recognized causes of sciatica are anatomical including disc protrusion, bone spur formation and/or spinal stenosis (narrowing of the spinal canal). After a slip and fall, the absence of these (or similar) anatomical findings may mean that the complaint of sciatica will be under-appreciated or even considered exaggeration or malingering. While a less common cause, soft tissue injury to the piriformis muscle (or other muscles), can easily cause sciatic symptoms, hence the term “Piriformis Syndrome.”

 The piriformis muscle is top-most of four muscles in the area through which the sciatic nerve travels. These four muscles are somewhat layered like slats in window blinds. The sciatic nerve most commonly passes under the first “slat” which is the piriformis muscle and over the next muscle. There is a fair amount of variation in all of this “layering” person to person, but the relationship between muscle injury and nerve irritation stays the same.

 External rotation of the hip results in the foot rotated out while standing. Being an external rotator of the hip, the piriformis can be strained or torn if forced into external rotation too quickly or if forced to contract when the limb cannot move the way it should (into external rotation). This situation is akin to one attempting to lift a suitcase that is much heavier than anticipated. Muscle strain or even tearing may result. Recent advances in imaging and neuromuscular testing created hope that diagnostic criteria for Piriformis Syndrome would emerge. So far, such techniques have been found more useful to exclude other causes rather than pinpoint a specific muscular pathology.

 Symptoms serve as an excellent guide to making the diagnosis. Most affected individuals will note some combination of hip pain, buttock pain and sciatica. Women may also complain of panful intercourse. Pain is often worsened by prolonged sitting or when arising from a seated position. There is also frequently pain with palpation over the buttock and/or point of the hip. Any combination of the above may signal the existence of Piriformis Syndrome.

 Treatment involves multiple common physical therapy modalities such as moist heat, stretching, electrical stimulation and massage. Treatment is usually successful. However, left unidentified, this condition may not get the diagnostic and therapeutic attention it deserves.

 Piriformis Syndrome is important to identify as it represents a specific clinical diagnosis (and an additional damage in the case) as opposed to simply being hidden in a list of symptoms of “soft tissue injury” as often occurs.

 Piriformis Syndrome is another example of where the Medical/Legal Consultant may be the first physician to make the previously overlooked diagnosis and subsequently increase case value as well as facilitate improved medical care for your injured client.

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