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Adam L. Bartret led a radiological study testing whether variant sciatic nerve routes near the piriformis muscle were associated with piriformis syndrome. The researchers classified anatomy on 783 hip magnetic resonance imaging studies and compared recorded clinical diagnoses. Variants occurred in about 19% of hips, with no statistically significant diagnostic association in this cohort.^[ref]

The study illustrates the distinction between identifying an anatomical variant and showing that it causes pain. A visible difference can be incidental; conversely, this observational result does not establish that every possible compression mechanism is absent.

The piriformis muscle is a deep skeletal muscle connecting the anterior sacrum to the upper femur. It passes through the greater sciatic foramen and helps rotate the extended thigh outward and abduct the flexed thigh. Its position makes it a useful landmark: the sciatic nerve usually emerges below it, although the relationship varies between people.^[ref]

An anatomical variant alone does not establish a cause of pain. Adam L. Bartret and colleagues classified sciatic nerve routes on 783 hip magnetic resonance imaging examinations; variants occurred in about 19%, without a statistically significant association with a recorded diagnosis of piriformis syndrome. This observation separates a visible anatomical difference from evidence that the difference explains symptoms.^[ref]

Piriformis syndrome is a clinical syndrome in which pain, sometimes with numbness or radiating leg symptoms, is attributed to irritation or compression of the sciatic nerve near the piriformis muscle. The nerve and muscle lie close together in the deep buttock region, making a mechanical interaction anatomically plausible.^[ref]

Anatomical plausibility is not proof of the explanation in a particular case. A 2018 study reviewed magnetic resonance imaging and clinical records to compare people with usual and variant relationships between the sciatic nerve and piriformis muscle. It found no significant difference in the recorded frequency of piriformis syndrome, buttock pain or sciatic symptoms between the anatomical groups.^[ref] The study illustrates why an unusual scan finding must be distinguished from demonstrated symptomatic nerve compression.