When Radiculopathy Isn’t Radiculopathy: A Clinical Series (Pt. 3)

This article explores piriformis syndrome as a prime example of myogenic pseudo-radiculopathy, where muscle dysfunction mimics nerve root compression symptoms. Patients often present with buttock and posterior thigh pain that resembles lumbar radiculopathy, yet the symptoms lack a consistent dermatomal pattern and are not associated with objective neurological deficits. The piriformis muscle, a deep hip rotator, can become overloaded due to altered hip mechanics or lumbopelvic instability, leading to myofascial trigger points that refer pain down the leg. A major diagnostic challenge is the frequent presence of incidental degenerative changes on lumbar imaging, which can misdirect clinicians toward spine-focused interventions. Key distinguishing features of piriformis syndrome include pain reproduction with hip movement or prolonged sitting and a poor response to spine-directed treatments. The article emphasizes that correctly identifying this condition is crucial, as it responds well to conservative, minimally invasive treatments like myofascial release, stretching, and stabilization exercises. By establishing this model in the lower extremity, the article sets the stage to introduce subscapularis syndrome as a parallel, yet often overlooked, cause of pseudo-radiculopathy in the upper extremity, urging a broader application of this diagnostic framework.