What is the role of injections in the treatment of piriformis syndrome?

Updated: Sep 16, 2020
  • Author: Milton J Klein, DO, MBA; Chief Editor: Ryan O Stephenson, DO  more...
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Answer

Injections with steroids, local anesthetics, and botulinum toxin type B (12,500 U) have been reported in the literature for the management of piriformis syndrome. [25, 26, 27, 28, 29, 30] No single technique is universally accepted. Localization techniques include manual localization of the muscle or localization with fluoroscopic, ultrasonographic, and electromyographic guidance. The piriformis muscle, after localization with a digital rectal examination, can be injected with a 3.5-inch (8.9-cm) spinal needle. Care should be taken to avoid direct injection of the sciatic nerve. Randomized comparison of ultrasound-guided imaging versus nerve stimulator with fluoroscopic imaging for piriformis muscle injections shows similar outcomes and without statistically significant differences in imaging or needling technique or total procedure time. [31]

In a prospective, double-blind, randomized, controlled trial, Misirlioglu et al found that although local anesthetic injections were effective in piriformis syndrome, the addition of corticosteroid to the local anesthetic did not increase the treatment’s efficacy. [32]


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