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Old 12-24-2012, 08:33 PM   #1
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Possible Piriformis Syndrome?

I was just wondering if anyone has dealt with a case of piriformis syndrome where it caused sciatica, numbness, but not a whole lot of pain. Actually, the only time it really feels painful is in my right leg during long car rides. That's when it hurts the most. I have numbness from my thighs down to my feet. Has anyone experienced this with piriformis syndrome? Predominately, numbness and nothing else.

 
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Old 12-25-2012, 02:00 PM   #2
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Re: Possible Piriformis Syndrome?

Often people with piriformis issues will complain of pain in the "hip" when walking.

What makes you think these symptoms are piriformis syndrome rather than a compressed lower lumbar or sciatic nerve?

 
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Old 12-26-2012, 12:23 AM   #3
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Re: Possible Piriformis Syndrome?

[QUOTE=teteri66;5108732]Often people with piriformis issues will complain of pain in the "hip" when walking.

What makes you think these symptoms are piriformis syndrome rather than a compressed lower lumbar or sciatic nerve?[/QUOTE]

I understand where you're coming from and that's exactly what I thought too at first and I fought really hard to get my doctor to give me a lumbar spine MRI, but then in the end it came back completely normal and there was absolutely no explanation for the numbness in my legs. I've had MRIs done for my entire spine for my cervical to my lumbar and one for my brain, which all came back normal. I also had a spinal tap done, which came back entirely normal. All my blood tests came back normal.

Now , there are a couple reasons as for why I think it's piriformis syndrome and not something else. I really used to work out my legs...HARD and I could totally have seen me injuring myself in this way because I used to run almost 12 miles a week give or take. The numbness also primarily seems to effect my thighs. Running or walking also makes it worse to the point where it hurts to walk. I had trouble walking up the stairs when it was at it's worst. My leg also hurts very badly when I sit for long periods of time in a car and it feels like it's coming from somewhere deep within the muscles of my thigh.

I also had another theory regarding this and it deals with why clothing bothers me. It seems the more the clothing rests in the area where this muscle is located the worse I tend to feel and the quicker I tend to experience numbness. There is also the fact that stretching out this particular muscle has brought me great relief. I wasn't able to feel my toes before, but now since I've started stretching I can and where I couldn't feel anything before I was getting a tingling sensation.

 
Old 12-26-2012, 07:47 AM   #4
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Re: Possible Piriformis Syndrome?

I don't usually suggest someone go to a sports medicine orthopedic doctor, but perhaps in this case it would make sense. If you perform piriformis stretches a couple times per day, does it make the situation better?

Your symptoms do really sound like piriformis syndrome, particularly since you had all those MRIs that have ruled out a disc problem or stenosis. Piriformis syndrome is usually made worse by sitting a long time without a break. Stair climbing often proves very difficult.

Just to confirm, you have numbness in both legs? This is not common with piriformis syndrome, but not unheard of either.

There is a doctor by the name of Aaron Filler who invented a type of imaging that was designed to better view nerve entrapments. It is called MRneurography. His clinic is called the Institute of Nerve Medicine. You can read about it online, and there is information pertaining to how he diagnoses piriformis syndrome that may be helpful to you.

If you could find the right person, deep tissue massage and bodywork can be a great benefit. Also, have you been check for foot pronation? This contributes to piriformis dysfunction.

 
Old 12-26-2012, 08:58 PM   #5
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Re: Possible Piriformis Syndrome?

Hey Wll, my symptoms were actually passed off originally as piriformis muscle tear and treated for over a year by my pcp till I was seen by my knee ortho for a different issue and disagreed and treated me with steroid injections and sent me to a colleague spine specialist, which is where I finally had to have surgery from my disc (same disc l5-s1) actually having herniated twice out of the same site. The piriformis muscle tear/pull can mimic the same symptoms of a herniated disc which was my issue. Good luck!

 
Old 12-27-2012, 01:06 AM   #6
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Re: Possible Piriformis Syndrome?

[QUOTE=teteri66;5108939]I don't usually suggest someone go to a sports medicine orthopedic doctor, but perhaps in this case it would make sense. If you perform piriformis stretches a couple times per day, does it make the situation better?

Your symptoms do really sound like piriformis syndrome, particularly since you had all those MRIs that have ruled out a disc problem or stenosis. Piriformis syndrome is usually made worse by sitting a long time without a break. Stair climbing often proves very difficult.

Just to confirm, you have numbness in both legs? This is not common with piriformis syndrome, but not unheard of either.

There is a doctor by the name of Aaron Filler who invented a type of imaging that was designed to better view nerve entrapments. It is called MRneurography. His clinic is called the Institute of Nerve Medicine. You can read about it online, and there is information pertaining to how he diagnoses piriformis syndrome that may be helpful to you.

If you could find the right person, deep tissue massage and bodywork can be a great benefit. Also, have you been check for foot pronation? This contributes to piriformis dysfunction.[/QUOTE]

I had never heard of a sports medicine orthopedic doctor until you suggested it, so thank- you for that and maybe I'll try that next. My numbness is in both my legs; however, once I began taking medication that helped ease the pain I was feeling and I started pushing myself harder I began to notice that my right leg was far worse than my left.

I'm pretty convinced I probably have this syndrome. It seems to fit the most. It was the only thing that really seemed to explain all of my symptoms. I even suggested it to my previous doctor, who refused to test me for it because I also had some upper body symptoms, although I don't feel the two are related and I feel that this was the reason for a delay in my diagnosis. My arm tends to go numb when I sleep on it, but that problem didn't appear until well after the leg numbness, which makes me think they're not related. I also have reason to believe that problems with my cervical spine could have been causing the arm numbness since my chiropractor had said my cervical spine was out of alignment. The atlas had been pushed too far to the left and I've had several problems with it since.

Also, I had heard of MRneurography through the research that I've done, but I've also read that a lot of insurance companies refuse to pay for that test and declare it medically unnecessary even though it seems to be the most accurate test for piriformis syndrome. Do you know how much truth there is to the idea that insurance companies often deny coverage of this test?

 
Old 12-27-2012, 07:39 AM   #7
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Re: Possible Piriformis Syndrome?

I don't know for sure how many insurance companies would cover the cost of the neurography. I imagine it is labeled "experimental" since it is not widely available.

Do you see a chiropractor on a regular basis? If so, did you ask about piriformis syndrome? There are some simple "tests" that a physical therapist or doctor can put you through that gives an indication if it is piriformis. The problem is that there are a number of muscles and ligaments tightly packed into that hip/groin/pelvic area that can cause similar feeling symptoms....as well as a nerve compression of the L4, L5 or S1 nerve that can feel the same way.

I would agree that the leg and arm issues are likely not related. The only way it would be linked is if you have cord compression in the cervical area.

Did you have MRIs since the numbness began?

 
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Old 12-28-2012, 06:37 PM   #8
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Re: Possible Piriformis Syndrome?

[QUOTE=teteri66;5109302]I don't know for sure how many insurance companies would cover the cost of the neurography. I imagine it is labeled "experimental" since it is not widely available.

Do you see a chiropractor on a regular basis? If so, did you ask about piriformis syndrome? There are some simple "tests" that a physical therapist or doctor can put you through that gives an indication if it is piriformis. The problem is that there are a number of muscles and ligaments tightly packed into that hip/groin/pelvic area that can cause similar feeling symptoms....as well as a nerve compression of the L4, L5 or S1 nerve that can feel the same way.

I would agree that the leg and arm issues are likely not related. The only way it would be linked is if you have cord compression in the cervical area.

Did you have MRIs since the numbness began?[/QUOTE]



I have not had MRIs since the numbness in my arm began. I plan on asking my doctor to repeat the cervical spine MRI, since it seems like things may have changed since the last one. I was wondering if you knew anything about EMGs I know it tests the nerves. My question is my first neurologist only tested the lower half of my legs(the area around my calf ect.) Why would he have done that and not just the whole leg?

 
Old 12-28-2012, 07:18 PM   #9
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Re: Possible Piriformis Syndrome?

I've had several EMGs and I am trying to think back to my experience. I am guessing here but I think they just test for what they suspect may be the "issue" since it can be painful.

The first time I ever had one was decades before I had any spine issues, and at this point I can't remember what they were looking for. In any case, as I recall the needles were all placed very high up in the neck and it was very painful.

Since that point, with lumbar issues, they were all in the legs and lower back and it wasn't as bad...and of course, I was several decades older, too...

Also you will find that different doctors perform the tests differently. Sometimes they will do it just to confirm a suspected finding and they will just test a couple specific nerve and muscle areas. My second neurologist told me that the test was only as good as the person giving it and the person interpreting the results. He had additional fellowship training in Electromyography and I will say that his tests were more comprehensive than those I had with two other neurologists.

The EMG is given to rule out the possibility of some sort of muscular disease. Then the Nerve conduction velocity test is done to check for nerve injury. This is an electrical test that is used to determine how well the conduction of the nerve impulse goes as it courses down a nerve.

I haven't really answered your questions...but these are my observations!

Last edited by teteri66; 12-29-2012 at 07:42 AM.

 
Old 12-28-2012, 11:01 PM   #10
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Re: Possible Piriformis Syndrome?

[QUOTE=teteri66;5109886]I've had several EMGs and I am trying to think back to my experience. I am guessing here but I think they just test for what they suspect may be the "issue" since it can be painful.

The first time I ever had one was decades before I had any spine issues, and at this point I can't remember what they were looking for. In any case, as I recall the needles were all placed very high up in the neck and it was very painful.

Since that point, with lumbar issues, they were all in the legs and lower back and it wasn't as bad...and of course, I was several decades older, too...

Also you will find that different doctors perform the tests differently. Sometimes they will do it just to confirm a suspected finding and they will just test a couple specific nerve and muscle areas. My second neurologist told me that the test was only as good as the person giving it and the person interpreting the results. He had additional fellowship training in Electromyography and I will say that this tests were more comprehensive than those I had with two other neurologists.

The EMG is given to rule out the possibility of some sort of muscular disease. Then the Nerve conduction velocity test is done to check for nerve injury. This is an electrical test that is used to determine how well the conduction of the nerve impulse goes as it courses down a nerve.

I haven't really answered your questions...but these are my observations![/QUOTE]

Well, actually, you kind of did because what I was really wondering was if they did it a second time if they'd be able to find anything different and I guess the answer would be yes if they test different areas of the leg than before.

 
Old 12-29-2012, 07:44 AM   #11
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Re: Possible Piriformis Syndrome?

Did you know that in something like 15% of the population the sciatic nerve actually splits the piriformis?

 
Old 12-29-2012, 01:22 PM   #12
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Re: Possible Piriformis Syndrome?

[QUOTE=teteri66;5110057]Did you know that in something like 15% of the population the sciatic nerve actually splits the piriformis?[/QUOTE]

I wasn't aware that the percentage was quite that high. I knew that some people had abnormalities in their anatomy like that. I know that there are two different kinds of pirfiromis syndrome the primary and secondary and that an anatomic abnormality falls under the first type. My the new neurologist that I've been seeing definitely seems to agree with me that this and other neuromuscular problems are definitely possibilities and he's going to have me undergo another EMG, so hopefully this one will yield better results than the last. The only bad thing is that I have to wait almost another month before I can have that done.

 
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