FLUOROSCOPIC GUIDED PIRIFORMIS INJECTION

Indications

The piriformis muscle runs behind the hip joint and aids in external hip rotation or turning your leg outward. The catch here is that the piriformis crosses over the sciatic nerve. The piriformis muscle can become tight from, for example, too much sitting (a problem many working people can relate to). The muscle can also be strained by spasm or overuse. In piriformis syndrome, this tightness or spasm causes the muscle to compress and irritate the sciatic nerve. This strain brings on lower-back and buttock pain, sometimes severe. The diagnosis is tricky because piriformis syndrome can very easily be confused with sciatica.

The difference between these diagnoses is that traditional sciatica is generally caused by some spinal issue, like a compressed lumbar disc. Piriformis syndrome becomes the go-to diagnosis when sciatica is present with no discernible spinal cause. Runners, cyclists, and rowers are the athletes most at risk for piriformis syndrome. Other people at risk are anyone who overpronates the foot in their gait. It can also occur after treatment for spinal stenosis, and neurogenic claudication with the mild® procedure as the once leaning forward walking motion is replaced with a straighter, more upright gait, thereby staining the sciatic nerve with the piriformis muscle.

What to expect

Treatment of the syndrome is quick and brief. It is done on an outpatient basis usually in the office using fluoroscopy (x-ray) or ultrasound guidance. Proper placement of a single needle to the depth of the piriformis muscle, located deep to the Gluteus Maximus and Minimus muscles in the buttock area is why imaging guidance is needed. Once access to the buttock area is breached, the skin is prepped, and skin numbed with the needle placed by way of imaging confirmation. Contrast may be used to ensure proper placement. Injection of local anesthetic to help relieve the pain and spasm (trigger point) of the piriformis muscle with a steroid for inflammation is undertaken, and the spread noted via imaging. A band-aid is applied for dressing and physical therapy, home stretching and exercises are instructed.