What is the most effective treatment for piriformis (muscle) syndrome: releasing the piriformis tendon, partial resection of the piriformis muscle, or complete resection of the piriformis muscle?

From the Research

The best treatment for piriformis syndrome is typically to release the piriformis tendon, as this approach reduces compression on the sciatic nerve while preserving muscle function, and is supported by the most recent and highest quality study 1. When considering surgical options for piriformis syndrome, it's essential to weigh the potential benefits and risks of different approaches. The goal of surgery is to relieve compression on the sciatic nerve, which can be achieved through various methods, including releasing the piriformis tendon or removing a portion of the piriformis muscle. However, complete removal of the piriformis muscle is generally not recommended due to the potential for hip instability and functional deficits.

Some key points to consider when evaluating treatment options for piriformis syndrome include:

• Conservative approaches, such as physical therapy, stretching exercises, and anti-inflammatory medications, should be tried before considering surgery 2.
• Partial muscle removal may be considered in specific cases where there's significant scarring or anatomical abnormalities 3.
• Endoscopic release of the piriformis muscle has been shown to be a effective and minimally invasive approach, with a high success rate and low complication rate 1.
• The decision about surgical approach should be individualized based on specific patient factors, imaging findings, and response to previous treatments.

In terms of the most effective surgical approach, the literature suggests that releasing the piriformis tendon is a preferred method, as it allows for relief of compression on the sciatic nerve while preserving muscle function. This approach is supported by the most recent and highest quality study 1, which found that endoscopic release of the piriformis muscle was a effective and minimally invasive approach. Overall, the treatment of piriformis syndrome should be tailored to the individual patient, taking into account their specific symptoms, medical history, and response to previous treatments.