Piriformis syndrome in a patient after cesarean section under spinal anesthesia.
OBJECTIVE
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.


METHODS
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.
Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. vallejomc@anes.upmc.edu
Manuel C
MC
Vallejo
Dean J
DJ
Mariano
Bupesh
B
Kaul
Neera
N
Sah
Sivam
S
Ramanathan
D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002081:Buttocks / Q000294:innervation; D002585:Cesarean Section / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006621:Hip Joint / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000628:therapy; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010388:Pelvis / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012584:Sciatic Nerve; D020426:Sciatic Neuropathy / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013577:Syndrome