What physical exam maneuver is associated with diagnosing piriformis syndrome?

The Freiburg sign is specifically associated with diagnosing piriformis syndrome. This condition occurs when the piriformis muscle compresses the sciatic nerve, leading to pain and neurological symptoms in the buttock and down the leg. The Freiburg sign is tested by having the patient lie on their back while the examiner externally rotates the hip and pushes down on the knee. If this maneuver reproduces the patient’s symptoms, it suggests a positive finding for piriformis syndrome.

This test is particularly relevant because it focuses on the anatomical and functional relationship between the piriformis muscle and the sciatic nerve, helping differentiate this condition from other causes of sciatic nerve pain. Other maneuvers, such as the straight leg raise, aim to test for different conditions, such as lumbar disc herniation or nerve root compression, rather than specifically assessing for issues with the piriformis muscle itself. Thus, the Freiburg sign is a key diagnostic tool for identifying piriformis syndrome.