Piriformis syndrome in a patient after cesarean section under spinal anesthesia

Reg Anesth Pain Med. 2004 Jul-Aug;29(4):364-7. doi: 10.1016/j.rapm.2004.01.014.


Objectives: The diagnosis, pathogenesis, and treatment of piriformis syndrome as a cause of persistent buttock and hip pain after spinal anesthesia are presented in this case report.

Case report: A 29-year-old woman presented 5 days after cesarean delivery with sudden onset of pain in the left buttock and left hip radiating to the posterior knee with fever. She was subsequently diagnosed with piriformis syndrome.

Conclusions: Back pain with radiation into the buttocks after spinal anesthesia is frequently attributed to the spinal procedure itself. However, prolonged sitting and weight bearing in the upright position after cesarean delivery can cause sciatic nerve compression at the sacroiliac joint with concomitant irritation, inflammation, and spasm of the piriformis muscle. Piriformis syndrome is frequently underdiagnosed in the obstetric population. Because the diagnosis of piriformis syndrome is based mainly on clinical signs and symptoms, the clinician must have a high index of suspicion.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anesthesia, Spinal / adverse effects*
  • Buttocks / innervation
  • Cesarean Section / methods*
  • Diagnosis, Differential
  • Female
  • Hip Joint / pathology
  • Humans
  • Magnetic Resonance Imaging / methods
  • Nerve Compression Syndromes / etiology*
  • Nerve Compression Syndromes / therapy
  • Pain / etiology
  • Pain Management
  • Pelvis / pathology
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Postoperative Complications / therapy
  • Sciatic Nerve*
  • Sciatic Neuropathy / diagnosis
  • Sciatic Neuropathy / etiology*
  • Sciatic Neuropathy / therapy
  • Syndrome