Abstract
Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis
syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil
2002;83:295-301. Objectives: To validate an operational definition of piriformis syndrome based on prolongation
of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess
efficacy of conservative therapy and surgery to relieve symptoms and reduce disability.
Design: Before-after trial of cohorts identified by operational definition. Setting: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed
at 3 hospitals. Patients: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. Intervention: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection,
physical therapy, and serially reported pain and disability assessments. Forty-three
patients (6.47%) had surgery. Main Outcome Measures: Likert pain scale. Subjective estimates of disablement in activities of daily living
and instrumental activities of daily living. Results: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively.
Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or
more from injection and physical therapy at a mean follow-up of 10.2 months. Average
improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell
from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement.
Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean
improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR
test to 1.35 ± 2.17 months postoperatively. FTP patients generally improved 10% to
15% more than others after conservative treatment. Conclusions: The FAIR test correlates well with a working definition of piriformis syndrome and
is a better predictor of successful physical therapy and surgery than the working
definition. The FAIR test, coupled with injection and physical therapy and/or surgery,
appears to be effective means to diagnose and treat piriformis syndrome. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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Article info
Publication history
Accepted:
March 28,
2001
Received in revised form:
March 28,
2001
Footnotes
☆No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.
☆☆Reprint requests to Loren M. Fishman, MD, 3 E 83rd St, New York, NY 10028, e-mail: [email protected]
Identification
Copyright
© 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
