- Etiology/Pathophysiology
- Compression or irritation of the sciatic nerve by the piriformis muscle at the greater sciatic notch.
- Causes: Muscle hypertrophy (athletes), trauma, prolonged compression (e.g., sitting on a thick wallet → “Wallet neuritis”), or anatomical variations (sciatic nerve piercing the muscle).
- Can mimic L5/S1 radiculopathy but typically spares the lower back.
- Clinical Features
- Deep gluteal pain radiating down the posterior thigh/leg (sciatica-like symptoms).
- Pain worsened by prolonged sitting, squatting, or climbing stairs.
- Physical Exam:
- Tenderness at the sciatic notch.
- Pain reproducible with FAIR test (hip Flexion, Adduction, Internal Rotation).
- Variable Straight Leg Raise (SLR).