Surgical release of the piriformis and decompression of the sciatic nerve can be successful for recalcitrant cases, but is rarely necessary. There are numerous anomalies where the nerve may pass through or around portions of the piriformis muscle. Thus, if the piriformis muscle is released, this entire area must be carefully explored to assure adequate decompression of the sciatic nerve. The results of release are often remarkable with regard to pain relief and patient satisfaction, but this is not always the case. This reflects some of the difficulties with this diagnosis even with the most thorough clinical evaluation. Dr. Byrd reported his clinical experiences and results of open surgery back in 2005 (Related Study: Operative Techniques in Sports Medicine). In 2011, he devised an arthroscopic approach to replace the open technique as a less-invasive outpatient procedure. No complications have been encountered with this operation, but since work is being done close to the nerve as it exits the pelvis, there are potential risks of nerve injury or uncontrollable bleeding.