Patient presents with complaints consistent with piriformis syndrome, characterized by buttock pain, sciatica pain radiating down the leg, and sometimes numbness or tingling in the affected extremity.  Onset of symptoms was gradual, described as a deep aching or burning pain in the buttock, exacerbated by prolonged sitting, driving, or activities that involve external hip rotation.  Physical examination revealed tenderness over the piriformis muscle region, positive Freiberg sign (pain with passive internal hip rotation), and a positive Pace sign (pain with resisted abduction and external rotation of the hip).  Differential diagnosis includes lumbar disc herniation, sacroiliac joint dysfunction, and other causes of sciatica.  Magnetic resonance imaging (MRI) of the lumbar spine was ordered to rule out disc pathology and other nerve root compression.  Initial treatment plan includes nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management, piriformis muscle stretches, physical therapy focusing on strengthening surrounding hip musculature and improving flexibility, and patient education on activity modification to avoid aggravating factors.  Diagnosis of piriformis syndrome is supported by clinical findings, and further evaluation will be conducted if symptoms do not improve with conservative management.  Medical billing codes will reflect evaluation and management services, musculoskeletal examination, and therapeutic exercise instruction.  Follow-up appointment scheduled in two weeks to assess response to treatment and discuss further management options, including potential referral for injection therapy or other interventions if indicated.