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=Usually it is a herniated disc of the lumbar spine.

=The soft inner material leaks out or herniates through a tear in the fibrous outer layer, becoming a disc herniation

=a tear of the disc may allow the gel like material in the center of the disc to protrude, causing a herniation of the disc which process into the nerve root as it exits the spine

=irritates the close by nerve root. Sciatica is one of the most common symptoms of lumbar disc herniation.

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- Anatomic anomalies, such as: • Split periformis muscle. • Vascular structure. • Variation to the sciatic nerve path.

- The periformis syndrome may also be caused by tightness or spasm of the periformis muscle that will squeeze the sciatic nerve. The pressure is being placed on the nerve will cause swelling and inflammation. Clinical diagnosis of periformis syndrome:

- Pain in the posterior gluteal region and the buttock that is shooting down the leg in the area of the sciatic nerve that cause symptom-like sciatica.

- burning, tingling and shooting pain.

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1-      Leg length discrepancy

2-      Mechanical dysfunction

3-      SI joint infection

4-      Ankylosing spondylitis

5-      Crystal arthropathy

6-      Pyogenic arthropathy

7-      Post spinal fusion 8-Stress fractures of the sacrum.

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• Fair test: flexion, adduction, and internal rotation of the hip will produce the symptoms due to the tension of the periformis muscle
• Lasegue’s test: the straight leg raising pain is aggravated by forced ankle dorsiflexion. Periformis syndrome needs to be differentiated from sciatica.

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•straight leg raising sign: tension sign L5, S1 nerve roots, with the patient either sitting or supine, raising of the leg will produce the pain and paresthesia at 30°-70° of hip flexion.

• Lasegue’s test: the straight leg raising pain is aggravated by forced ankle dorsiflexion.

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Symptoms of sacroiliac joint dysfunction include

•Lower back, buttock, back of thigh and knee pain.

•Occasional groin pain

•Difficulty and discomfort while sitting.

•Patient frequently changes position to become comfortable.

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same symptoms as sciatica
Get an MRI to rule out the spine as a cause of compression on the nerve roots of the sciatic nerve. If the patient does not have a herniated disc, then the patient will probably have periformis syndrome.

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=Periformis syndrome is a condition that has sciatic nerve symptoms due to compression of the sciatic nerve around the buttock and the hip. This condition is usually connected to the periformis muscle and its relationship to the sciatic nerve. The sciatic nerve exits below and anterior to the periformis muscle.

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Symptoms and signs:

= A sharp shooting pain down the buttock, the thigh and the leg (usually on one side of the body) =numbness, tingling and burning

=the area of symptoms and pain usually depends upon the nerve that is involved

=sitting, coughing, sneezing, or moving can aggravate the pain, causes tensioning , stretching and lengthening the nerve .The pain will improve with standing.

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•Finger test
•Faber test
•Straight leg test