[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) › Piriformis tendon [Muscular system](https://durgical.com/en/anatomy/system/muscular-system/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) # Piriformis tendon The piriformis tendon attaches to the top of the greater trochanter, the bony point of the outer hip. Official name: Tendon of piriformis [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=lower_limb&select=piriformis_tendon&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The tendon of the piriformis, attaching to the top of the greater trochanter. ## What it does Carries the pull of the piriformis to the [femur](https://durgical.com/en/anatomy/femur/) to turn the thigh outward. ## Key points - Key to the buttock: the superior gluteal vessels and nerve exit above it; the sciatic, inferior gluteal, pudendal and posterior femoral cutaneous nerves and the inferior gluteal and internal pudendal vessels exit below - In the posterior approach to the hip the piriformis tendon is the landmark for the short rotators; they are released and later repaired to lower the risk of dislocation - Tests for [piriformis](https://durgical.com/en/anatomy/piriformis-muscle/) syndrome have limited accuracy; it remains a diagnosis made after excluding spinal causes ## Key facts **Attaches** Upper border of the greater trochanter, often blending with the conjoint tendon of the obturator internus and gemelli **Function** Lateral rotation of the extended hip and abduction of the flexed hip; the sciatic nerve usually leaves the [pelvis](https://durgical.com/en/anatomy/region/pelvis/) just below it **Tight in** Hip flexion, adduction and medial rotation (FAIR position) ## Relations **Above** [Gluteus medius](https://durgical.com/en/anatomy/gluteus-medius-muscle/) and [gluteus minimus](https://durgical.com/en/anatomy/gluteus-minimus-muscle/); the superior gluteal vessels and [superior gluteal nerve](https://durgical.com/en/anatomy/superior-gluteal-nerve/) leaving above it **Below** [Superior gemellus](https://durgical.com/en/anatomy/superior-gemellus-muscle/) and [obturator internus](https://durgical.com/en/anatomy/obturator-internus/); the [sciatic nerve](https://durgical.com/en/anatomy/sciatic-nerve/) emerging below it **Superficial** [Gluteus maximus](https://durgical.com/en/anatomy/gluteus-maximus-muscle/) **Deep** Back of the [hip capsule](https://durgical.com/en/anatomy/articular-capsule-of-hip-joint/) ## How to find it Not palpable as a separate structure: it lies deep to the gluteus maximus, running from the [sacrum](https://durgical.com/en/anatomy/sacrum/) to the top of the greater trochanter; ultrasound shows it, with the sciatic nerve just below, for guided injections. ## Examination - FAIR test: buttock pain with the hip flexed, adducted and medially rotated - Freiberg sign: buttock pain on passive medial rotation of the straight hip - Pace sign: pain and weakness on resisted abduction and lateral rotation with the person seated ## On imaging MRI or MR neurography can show an enlarged muscle and the course of the sciatic nerve relative to it; ultrasound guides injections. ## Common problems - Piriformis syndrome: deep buttock pain, sometimes with sciatica-like pain down the leg, thought to come from the muscle irritating the sciatic nerve. - Pain with long sitting. - In some people the nerve passes through or above the muscle, a normal variation. ## How it is diagnosed Mostly by exam, after ruling out other causes such as a spinal disc problem. MRI of the [spine](https://durgical.com/en/anatomy/region/spine/) and pelvis; sometimes a diagnostic injection. ## Treatment - Physical therapy with stretching and strengthening; avoiding long sitting. - Ultrasound-guided injection into the muscle. - Rarely, surgery to release the muscle when other treatment fails. ## Clinical notes - In deep gluteal syndrome the sciatic nerve may be trapped by the piriformis, the other short rotators or fibrous bands - Image-guided injection into the piriformis (local anaesthetic, corticosteroid or botulinum toxin) is used both to treat and to support the diagnosis of piriformis syndrome - A posterior hip dislocation often tears the piriformis and the other short rotators and can stretch the sciatic nerve beneath them, mostly its fibular division ## Anatomical variants - The sciatic nerve or its common fibular part passes through or above the muscle in a minority, about 1 in 5 in many series (figures vary) - The muscle may fuse with the gluteus medius or gluteus minimus ## Memory aid Short external rotators, top to bottom: 'P-GO-GO-Q' (Piriformis, Gemellus superior, Obturator internus, Gemellus inferior, [Obturator externus](https://durgical.com/en/anatomy/obturator-externus/), [Quadratus femoris](https://durgical.com/en/anatomy/quadratus-femoris-muscle/)). ## Test yourself Think of the answer, then tap the question to see it. ## Where does the piriformis tendon insert? On the upper border of the greater trochanter, often blending with the conjoint tendon of the obturator internus and gemelli. ## Which structures leave the pelvis above the piriformis? The superior gluteal vessels and the superior gluteal nerve. ## Which nerves leave the pelvis below the piriformis? The sciatic, inferior gluteal, pudendal and posterior femoral cutaneous nerves. ## Which position does the FAIR test use for piriformis syndrome? Hip flexion, adduction and internal (medial) rotation; buttock pain is positive. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/tendon-of-piriformis/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** musculus piriformis TA2 2604 **Official Spanish (DeCS)** Tendón del piriforme DeCS D013710 **English (TA2)** Tendon of piriformis ## Related - [Piriformis](https://durgical.com/en/anatomy/piriformis-muscle/) - [Femur](https://durgical.com/en/anatomy/femur/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=14088); [Anatomy, Bony Pelvis and Lower Limb: Piriformis Muscle](https://www.ncbi.nlm.nih.gov/books/NBK519497/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/tendon-of-piriformis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/tendon-of-piriformis/