Case

A patient presents to their physiatrist with pain to their buttocks as well as radiating down the posterior side of their right thigh, leg and foot. They also report locomotive issues with tripping over their right foot multiple times during the day. Physical examination shows weakness of dorsiflexion of the right foot.

Question 2/3 - A paracentral radiculopathy is ruled out by radiology imaging and to determine if a piriformis syndrome is present the physiatrist performs a physical examination.

To determine if there is pain with contraction of the piriformis muscle, what motion against resistance should the patient perform?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

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Incorrect. The primary thigh flexors are the psoas major and iliacus muscles located in the lumbar and pelvis region (discussed in MS1 Foundations).

The rectus femoris, pectineus and tensor fascia lata muscles located anterior on the thigh also have some flexor action.

Incorrect. The thigh extensors include the muscles in the posterior compartment of the thigh (e.g. biceps femoris, semitendinosus, semimembranosus) and gluteus maximus muscles.

Incorrect. The thigh adductors are the medial thigh compartment muscles (i.e. adductor longus, brevis, and magnus along with gracilis)

Incorrect. Thigh abduction is primarily the action of the three gluteal muscles (maximus, medius and minimus) along with the tensor fascia latae muscle.

Incorrect. Internal (medial) rotation is achieved primarily by the action of gluteus medius, minimus, and the tensor fascia latae muscles.

Correct! Thigh external rotation (i.e. lateral rotation) occurs primarily through the action of the lateral rotator group of muscles which includes the piriformis muscle along with some action of the gluteus maximus muscle.

Trying to achieve lateral rotation against resistance causes contraction of piriformis. If this muscle is inflamed in a piriformis syndrome there will be considerable pain with this action, more so than other thigh motions.