Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, deep-seated right-sided gluteal pain radiating into the posterior thigh. Symptoms are exacerbated by prolonged sitting, stair climbing, and internal rotation of the hip. Patient denies lumbar radiculopathy, bowel/bladder dysfunction, or saddle anesthesia. Pain is described as aching and paresthetic in nature.
Clinical Examination Findings
Physical exam reveals focal tenderness over the right greater sciatic notch. Positive FAIR test (Flexion, Adduction, Internal Rotation) reproducing sciatic-type symptoms. Positive Pace sign with resisted abduction and external rotation. Negative straight leg raise (SLR) test. Normal neurological exam of the lower extremities with intact motor strength, sensation, and deep tendon reflexes.
Treatment Protocol
Initiate conservative management including physical therapy focusing on piriformis stretching and myofascial release. Prescribe NSAIDs for inflammation and muscle relaxants as needed. Consider ultrasound-guided piriformis muscle injection with local anesthetic and corticosteroid if symptoms persist. Advise ergonomic modifications for sitting.