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Injection for Piriformis Syndrome

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Regional Nerve Blocks in Anesthesia and Pain Therapy

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Abstract

Piriformis syndrome is an underdiagnosed cause of buttock and leg pain that can be difficult to treat. In view of the distribution of the nerves and blood vessels that accompany the piriformis muscle through the greater sciatic foramen, it is understandable why contracture of a single muscle, the piriformis, can have such widespread effects. The diagnosis is mainly made on clinical grounds. Piriformis syndrome is associated with pain (and paresthesias) in the buttocks, hips, and lower limbs. Electrophysiological testing and nerve blocks play important roles when the diagnosis is uncertain. Clinicians should be aware that there are many etiological factors involved, which it may be possible to modify or treat. Most patients respond to conservative measures, including nerve blocks. Anesthesiologists are commonly involved in the management of piriformis syndrome, due to their expertise in pain management and in carrying out nerve blocks. Injections of local anesthetics, steroids, and botulinum toxin into the piriformis muscle can serve both diagnostic and therapeutic purposes.

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References

  1. Beatty RA. The piriformis muscle syndrome: a simple diagnostic maneuver. Neurosurgery. 1994;34:512–4.

    CAS  PubMed  Google Scholar 

  2. Fanucci EA, Masala SA, Sodani GA, et al. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process. Eur Radiol. 2001;11:2543–8.

    CAS  PubMed  Google Scholar 

  3. Foster MR. Piriformis syndrome. Orthopedics. 2002;25:821–5.

    PubMed  Google Scholar 

  4. Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am. 2004;35:65–71.

    PubMed  Google Scholar 

  5. Parziale JR, Hudgins TH, Fischman LM. The piriformis syndrome. Am J Orthop (Belle Mead NJ). 1996;25:819–23.

    CAS  PubMed  Google Scholar 

  6. Silver JK, Leadbetter WB. Piriformis syndrome: assessment of current practice and literature review. Orthopedics. 1998;21:1133–5.

    CAS  PubMed  Google Scholar 

  7. Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual, The lower extremities, vol. 2. Baltimore: Williams & Wilkins; 1992. p. 186–214.

    Google Scholar 

  8. Hollinshead WH. Buttock, hip joint and thigh. In: Hollinshead WH, editor. Anatomy for surgeons, The back and limbs, vol. 3. 3rd ed. New York: Harper and Row; 1982. p. 666–8, 702.

    Google Scholar 

  9. Retzlaff EW, Berry AH, Haight AS, et al. The piriformis muscle syndrome. J Am Osteopath Assoc. 1974;73:799–807.

    CAS  PubMed  Google Scholar 

  10. McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med. 1999;27:261–74.

    CAS  PubMed  Google Scholar 

  11. Yeoman W. The relation of arthritis of the sacroiliac joint to sciatica: with an analysis of 100 cases. Lancet. 1928;2:1119–22.

    Google Scholar 

  12. Mixter WJ, Barr JS. Ruptures of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:210.

    Google Scholar 

  13. Durrani Z, Winnie AP. Piriformis muscle syndrome: an underdiagnosed cause of sciatica. J Pain Symptom Manage. 1991;6:374–9.

    CAS  PubMed  Google Scholar 

  14. Reichel G. Treatment of piriformis syndrome with botulinum toxin. Pain Headache. 2003;14:140–58.

    CAS  Google Scholar 

  15. Huber HM. The piriformis syndrome — a possible cause of sciatica. Schweiz Rundsch Med Prax. 1990;79:235–6. German.

    CAS  PubMed  Google Scholar 

  16. Pfeifer T, Fitz WF. The piriformis syndrome. Z Orthop Ihre Grenzgeb. 1989;127:691–4. German.

    CAS  PubMed  Google Scholar 

  17. Hopayian K. Sciatica in the community — not always disc herniation. Int J Clin Pract. 1999;53:197–8.

    CAS  PubMed  Google Scholar 

  18. Reichel G, Gaerisch Jr F. Piriformis syndrome. A contribution to the differential diagnosis of lumbago and coccygodynia. Zentralbl Neurochir. 1988;49:178–84. German.

    CAS  PubMed  Google Scholar 

  19. Fishman LM, Dombi GW, Michaelsen C, et al. Piriformis syndrome: diagnosis, treatment, and outcome — a 10-year study. Arch Phys Med Rehabil. 2002;83:295–301.

    PubMed  Google Scholar 

  20. Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74:69–72.

    CAS  PubMed  Google Scholar 

  21. Fishman LM, Anderson C, Rosner B. Botox and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil. 2002;81:936–42.

    PubMed  Google Scholar 

  22. Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Rockville: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1994 (Clinical practice guideline no. 14. AHCPR Publication No. 95–0642).

    Google Scholar 

  23. Benson ER, Schutzer SH. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am. 1999;81:941–9.

    CAS  PubMed  Google Scholar 

  24. Meknas K, Christensen A, Johansen O. The internal obturator muscle may cause sciatic pain. Pain. 2003;104:375–80.

    PubMed  Google Scholar 

  25. Puranen J, Orava S. The hamstring syndrome — a new gluteal sciatica. Ann Chir Gynaecol. 1991;80:212–4.

    CAS  PubMed  Google Scholar 

  26. Netter FH. Anatomie. In: Firbas W, editor. Farbatlanten der Medizin, Bewegungsapparat I: Anatomie, Embryologie, Physiologie und Stoffwechselkrankheiten, vol. 7. Stuttgart: Thieme; 1992. p. 79–84.

    Google Scholar 

  27. Peng PH. Piriformis syndrome. In: Peng PH, editor. Ultrasound for pain medicine intervention: a practical guide, Pelvic pain, vol. 2. Philip peng educational series. 1st ed. iBook, California CA: Apple Inc; 2013.

    Google Scholar 

  28. Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec. 1937;70:1–5.

    Google Scholar 

  29. Uluutku MH, Kurtoğlu Z. Variations of nerves located in deep gluteal region. Okajimas Folia Anat Jpn. 1999;76:273–6.

    CAS  PubMed  Google Scholar 

  30. Cassidy L, Walters A, Bubb K, Shoja M, Tubbs SR, Loukas M. Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment. Surg Radiol Anat. 2012;34:479–86.

    PubMed  Google Scholar 

  31. Childers MK. Use of botulinum toxin type A in pain management. Columbia/Austin: Academic Information Systems/Greenleaf Book Group; 2002.

    Google Scholar 

  32. Porta M. A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain. 2000;85:101–5.

    CAS  PubMed  Google Scholar 

  33. Pace JB. Commonly overlooked pain syndromes responsive to simple therapy. Postgrad Med. 1975;58:107–13.

    CAS  PubMed  Google Scholar 

  34. Pace JB, Nagle D. Piriform syndrome. West J Med. 1976;124:435–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  35. Robinson DR. Piriformis syndrome in relation to sciatic pain. Am J Surg. 1947;73:355–8.

    CAS  PubMed  Google Scholar 

  36. Pećina M. Contribution to the etiological explanation of the piriformis syndrome. Acta Anat (Basel). 1979;105:181–7.

    Google Scholar 

  37. Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 2009;40:10–8.

    PubMed  Google Scholar 

  38. Smith J, Hurdle MF, Locketz AJ, Wisniewski SJ. Ultrasound-guided piriformis injection: technique description and verification. Arch Phys Med Rehabil. 2006;87:1664–7.

    PubMed  Google Scholar 

  39. Goldner JL. Piriformis compression causing low back and lower extremity pain. Am J Orthop (Belle Mead NJ). 1997;26:316–8.

    CAS  Google Scholar 

  40. Douglas S. Sciatic pain and piriformis syndrome. Nurse Pract. 1997;22:166–8.

    CAS  PubMed  Google Scholar 

  41. Thiele GH. Coccygodynia and pain in the superior gluteal region. JAMA. 1937;109:1271–5.

    Google Scholar 

  42. Stark P, Hildebrandt-Stark HE. Calcific tendinitis of the piriform muscle. Rofo. 1983;138:111–2.

    CAS  PubMed  Google Scholar 

  43. Benzon HT, Katz JA, Benzon HA, Iqbal MS. Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology. 2003;98:1442–8.

    PubMed  Google Scholar 

  44. Chen WS, Wan YL. Sciatica caused by piriformis muscle syndrome: report of two cases. J Formos Med Assoc. 1992;91:647–50.

    CAS  PubMed  Google Scholar 

  45. Rodrigue T, Hardy RW. Diagnosis and treatment of piriformis syndrome. Neurosurg Clin N Am. 2001;12:311–9.

    CAS  PubMed  Google Scholar 

  46. Filler AG, Haynes BA, Jordan SE, et al. Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine. 2005;2:99–115.

    PubMed  Google Scholar 

  47. Hanania M. New technique for piriformis muscle injection using a nerve stimulator. Reg Anesth. 1997;22:200–2.

    CAS  PubMed  Google Scholar 

  48. Hanania M, Kitain E. Perisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome. Reg Anesth Pain Med. 1998;23:223–8.

    CAS  PubMed  Google Scholar 

  49. Mizugushi T. Division of the piriformis muscle for the treatment of sciatica. Postlaminectomy syndrome and osteoarthritis of the spine. Arch Surg. 1976;111:719–22.

    Google Scholar 

  50. Pace JB, Henning C. Episacroiliac lipoma. Am Fam Physician. 1972;6:70–3.

    CAS  PubMed  Google Scholar 

  51. Arai Y, Kawakami T, Soga H, Okada Y. Psoas abscess associated with iliac vein thrombosis and piriformis and gluteal abscesses. Int J Urol. 1999;6:257–9.

    CAS  PubMed  Google Scholar 

  52. Katati M, Vilchez R, Piñar L, et al. Haematoma of the piriformis muscle simulating a giant presacral tumour: unusual case of lumbosacral radiculopathy. Acta Neurochir (Wien). 1998;140:403–4.

    CAS  Google Scholar 

  53. Ku A, Kern H, Lachman E, Nagler W. Sciatic nerve impingement from piriformis hematoma due to prolonged labor. Muscle Nerve. 1995;18:789–90.

    CAS  PubMed  Google Scholar 

  54. Chusid MJ, Hill WC, Bevan JA, Sty JR. Proteus pyomyositis of the piriformis muscle in a swimmer. Clin Infect Dis. 1998;26:194–5.

    CAS  PubMed  Google Scholar 

  55. Peh WC, Reinus WR. Piriformis bursitis causing sciatic neuropathy. Skeletal Radiol. 1995;244:474–6.

    Google Scholar 

  56. Höckel M. Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies. Am J Obstet Gynecol. 1999;180:306–12.

    PubMed  Google Scholar 

  57. LaBan MM, Meerschaert JR, Taylor RS. Electromyographic evidence of inferior gluteal nerve compromise: an early representation of recurrent colorectal carcinoma. Arch Phys Med Rehabil. 1982;63:33–5.

    CAS  PubMed  Google Scholar 

  58. Obach J, Aragones JM, Ruano D. The infrapiriformis foramen syndrome resulting from intragluteal injection. J Neurol Sci. 1983;58:135–42.

    CAS  PubMed  Google Scholar 

  59. Beauchesne RP, Schutzer SF. Myositis ossificans of the piriformis muscle: an unusual cause of piriformis syndrome. A case report. J Bone Joint Surg Am. 1997;79:906–10.

    CAS  PubMed  Google Scholar 

  60. Rask MR. Superior gluteal nerve entrapment syndrome. Muscle Nerve. 1980;3:304–7.

    CAS  PubMed  Google Scholar 

  61. Tillmann B. Variations in the pathway of the inferior gluteal nerve (author’s transl). Anat Anz. 1979;145:293–302. German.

    CAS  PubMed  Google Scholar 

  62. Kipervas IP, Ivanov LA, Urikh EA, Pakhomov SK. Clinico-electromyographic characteristics of piriform muscle syndromes. Zh Nevropatol Psikhiatr Im S S Korsakova. 1976;76:1289–92. Russian.

    CAS  PubMed  Google Scholar 

  63. Kirkaldy-Willis WH, Hill RJ. A more precise diagnosis for low-back pain. Spine (Phila Pa 1976). 1979;4:102–9.

    CAS  Google Scholar 

  64. Steiner C, Staubs C, Ganon M, Buhlinger C. Piriformis syndrome: pathogenesis, diagnosis, and treatment. J Am Osteopath Assoc. 1987;87:318–23.

    CAS  PubMed  Google Scholar 

  65. Papadopoulos SM, McGillicuddy JE, Albers JW. Unusual cause of “piriformis muscle syndrome”. Arch Neurol. 1990;47:1144–6.

    CAS  PubMed  Google Scholar 

  66. Bendszus M, Rieckmann P, Perez J, Koltzenburg M, Reiners K, Solymosi L. Painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosities. Neurology. 2003;61:985–7.

    CAS  PubMed  Google Scholar 

  67. Freiberg H. Sciatic pain and its relief by operations on muscle and fascia. Arch Surg. 1937;34:337–50.

    Google Scholar 

  68. Stewart JD. The piriformis syndrome is overdiagnosed. Muscle Nerve. 2003;28:644–6.

    PubMed  Google Scholar 

  69. Wynant GM. Chronic pain syndromes and treatment III. The piriformis syndrome. Can Anaesth Soc J. 1979;26:305–8.

    Google Scholar 

  70. Solheim LF, Siewers P, Paus B. The piriformis muscle syndrome. Sciatic nerve entrapment treated with section of the piriformis muscle. Acta Orthop Scand. 1981;52:73–5.

    CAS  PubMed  Google Scholar 

  71. Blaser-Sziede R. Piriformissyndrom — kritische Beurteilung der Literatur und Diskussion der klinischen Zusammenhänge. Man Ther. 2006;10:159–69.

    Google Scholar 

  72. Edwards FO. Piriformis syndrome. In: Academy of Applied Osteopathy Yearbook. Carmel, CA: Academy of Applied Osteopathy; 1962:39–41.

    Google Scholar 

  73. TePoorten BA. The piriformis muscle. J Am Osteopath Assoc. 1969;69:150–60.

    CAS  PubMed  Google Scholar 

  74. Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010;19:2095–109.

    PubMed Central  PubMed  Google Scholar 

  75. Karl Jr RD, Yedinak MA, Hartshorne MF, et al. Scintigraphic appearance of the piriformis muscle syndrome. Clin Nucl Med. 1985;10:361–3.

    PubMed  Google Scholar 

  76. Sayson SC, Ducey JP, Maybrey JB, Wesley RL, Vermilion D. Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain. 1994;59:149–52.

    CAS  PubMed  Google Scholar 

  77. Yoon SJ, Ho J, Kang HY, et al. Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome. Pharmacotherapy. 2007;27:657–65.

    CAS  PubMed  Google Scholar 

  78. Barton PM, Grainger RW, Nicholson RL, et al. Toward a rational management of piriformis syndrome. Arch Phys Med Rehabil. 1988;69:784–9.

    Google Scholar 

  79. Barton PM. Piriformis syndrome: a rational approach to management. Pain. 1991;47:345–52.

    CAS  PubMed  Google Scholar 

  80. Fishman SM, Caneris OA, Bandmann TB, Audette JF, Borsook D. Injection of the piriformis muscle by fluoroscopic and electromyographic guidance. Reg Anesth Pain Med. 1998;23:554–9.

    CAS  PubMed  Google Scholar 

  81. Hughes SS, Goldstein MN, Hicks DG, Pellegrini Jr VD. Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip: report of five cases. J Bone Joint Surg Am. 1992;74:1553–9.

    CAS  PubMed  Google Scholar 

  82. Fishman LM, Zybert PA. Electrophysiologic evidence of piriformis syndrome. Arch Phys Med Rehabil. 1992;73:359–64.

    CAS  PubMed  Google Scholar 

  83. Dumitru D, Nelson MR. Posterior femoral cutaneous nerve conduction. Arch Phys Med Rehabil. 1990;71:979–82.

    CAS  PubMed  Google Scholar 

  84. Spinner RJ, Thomas NM, Kline DG. Failure of surgical decompression for a presumed case of piriformis syndrome. Case report. J Neurosurg. 2001;94:652–4.

    CAS  PubMed  Google Scholar 

  85. Nainzadeh N, Lane ME. Somatosensory evoked potentials following pudendal nerve stimulation as indicators of low sacral root involvement in a postlaminectomy patient. Arch Phys Med Rehabil. 1987;68:170–2.

    CAS  PubMed  Google Scholar 

  86. Broadhurst NA, Simmons DN, Bond MJ. Piriformis syndrome: correlation of muscle morphology with symptoms and signs. Arch Phys Med Rehabil. 2004;85:2036–9.

    PubMed  Google Scholar 

  87. Jankiewicz JJ, Hennrikus WL, Houkom JA. The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature. Clin Orthop Relat Res. 1991;262:205–9.

    PubMed  Google Scholar 

  88. Lee EY, Margherita AJ, Gierada DS, Narra VR. MRI of piriformis syndrome. AJR Am J Roentgenol. 2004;183:63–4.

    PubMed  Google Scholar 

  89. Rossi P, Cardinali P, Serrao M, Parisi L, Bianco F, De Bac S. Magnetic resonance imaging findings in piriformis syndrome: a case report. Arch Phys Med Rehabil. 2001;82:519–21.

    CAS  PubMed  Google Scholar 

  90. Yue SK. Morphological findings of asymmetrical and dystrophic psoas and piriformis muscles in chronic lower back pain during CT guided botulinum toxin injections [abstract]. Reg Anesth Pain Med. 1998;23(3 Suppl):104.

    Google Scholar 

  91. Jankovic D. Case study: shock waves treatment of diabetic gangrene. Int Wound J. 2011;8:206–9.

    PubMed  Google Scholar 

  92. Ueno K, Matsuzawa H, Inoue A. 67Ga imaging of gluteal muscle inflammation secondary to pyogenic sacroiliitis (PSI). Rinsho Hoshasen. 1985;30:319–22. Japanese.

    CAS  PubMed  Google Scholar 

  93. Fanucci E, Masala S, Squillaci E, et al. Piriformis muscle syndrome: CT/MR findings in the percutaneous therapy with botulinic toxin. Radiol Med. 2003;105:69–75.

    PubMed  Google Scholar 

  94. Almanza MY, Poon-Chue A, Terk MR. Dual oblique MR method for imaging the sciatic nerve. J Comput Assist Tomogr. 1999;23:138–40.

    CAS  PubMed  Google Scholar 

  95. Dworkin RH, O’Connor AB, Bakonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007;132:237–51.

    CAS  PubMed  Google Scholar 

  96. Fishman LM, Konnoth C, Rozner B. Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose-finding study. Am J Phys Med Rehabil. 2004;83:42–50.

    PubMed  Google Scholar 

  97. Jan MH, Lin YF. Clinical experience of applying shortwave diathermy over the piriformis in sciatic patients. Taiwan Yi Xue Hui Za Zhi. 1983;82:1065–70. Chinese.

    CAS  PubMed  Google Scholar 

  98. Dreisilker U, Wess O, Novak P. Extrakorporal erzeugte Stoss- und Druckwellen — eine wirksame Therapieform für die Geweberegeneration. Orthop Rep Spez. 2007;147–51.

    Google Scholar 

  99. Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop. 1991;15:181–4.

    CAS  PubMed  Google Scholar 

  100. Piontkowski U, Sommer S. Combined EPAT/focussed shock wave therapy and trigger points in sports medicine. [Paper presented at the Eleventh International Society of Medical Shockwave Treatment (ISMST) Congress, Juan-les-Pins, 5–7 June 2008]. Abstract available at: http://www.ismst.com/pdf/abstracts11congress.pdf.

  101. Moretti B, Notarnicola A, Maggio G, et al. ESWT-induced healing of diabetic foot ulcers. [Paper presented at the Eleventh International Society of Medical Shockwave Treatment (ISMST) Congress, Juan-les-Pins, 5–7 June 2008]. Abstract available at: http://www.ismst.com/pdf/abstracts11congress.pdf.

  102. Schaden W, Thiele R, Kölpl C, et al. Shock wave therapy for acute and chronic soft tissue wounds: a feasibility study. J Surg Res. 2007;143:1–12.

    PubMed  Google Scholar 

  103. Cleveland R, Chitnis P, McClure SR. Acoustic field of ballistic shock wave therapy device. Ultrasound Med Biol. 2007;33:1327–35.

    PubMed  Google Scholar 

  104. Ueberle F, Delius M, Guo L. Using shock waves for transfer of molecules in cells. Biomed Tech (Berl). 2002;47(Suppl 1 Pt 1):382–5. German.

    Google Scholar 

  105. Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46:348–57.

    PubMed  Google Scholar 

  106. Mariotto SW, Cavalieri E, Amelio E, et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide. 2005;12:89–96.

    CAS  PubMed  Google Scholar 

  107. Wess O. Physik and Technik der Stoss- und Druckwellentherapie. Med Orthop Techn. 2005;5:7–32.

    Google Scholar 

  108. Jankovic D. Mit der Stosswellen gegen das Piriformis Syndrom. Schmerztherapie. 2011;1:11–3.

    Google Scholar 

  109. Peng P, Narouze S. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures. Reg Anesth Pain Med. 2009;34:458–74.

    PubMed  Google Scholar 

  110. Jankovic D. Infiltration der Triggerpunkte des M. piriformis (“Piriformis Syndrom”). In: Jankovic D, editor. Regionalblockaden & Infiltrattionstherapie. Lehrbuch und Atlas. 4th ed. Berlin: ABW-Verlag; 2008. p. 306–9.

    Google Scholar 

  111. Finoff JT, Hurdle MFB, Smith J. Accuracy of ultrasound-guided versus fluoroscopically guided contrast controlled piriformis injections. A cadaveric study. J Ultrasound Med. 2008;27:1157–63.

    Google Scholar 

  112. Childers MK, Wilson DJ, Gnatz SM, Conway RR, Sherman AK. Botulinum toxin type A use in piriformis muscle syndrome: a pilot study. Am J Phys Med Rehabil. 2002;81:751–9.

    PubMed  Google Scholar 

  113. Huerto AP, Yeo SN, Ho KY. Piriformis muscle injection using ultrasonography and motor stimulation — report of a technique. Pain Physician. 2007;10:687–90.

    PubMed  Google Scholar 

  114. Peng PWH, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain — a description of techniques and review of the literature. Pain Physician. 2008;11:215–24.

    PubMed  Google Scholar 

  115. Macfarlane AJR, Bhatia A, Brull R. Needle to nerve proximity: what do the animal studies tell us? Reg Anesth Pain Med. 2011;36:290–302.

    PubMed  Google Scholar 

  116. Rigaud M, Filip P, Lirk P, Fuchs A, Gemes G, Hogan Q. Guidance of block needle insertion by electrical nerve stimulation: a pilot study of the resulting distribution of injected solution in dogs. Anesthesiology. 2008;109:473–8.

    PubMed Central  PubMed  Google Scholar 

  117. Chan VW, Brull R, McCartney CJ, Xu D, Abbas S, Shannon P. An ultrasonographic and histological study of intraneural injection and electrical stimulation in pigs. Anesth Analg. 2007;104:1281–4.

    PubMed  Google Scholar 

  118. Tsai TP, Vuckovic I, Dilberovic F, et al. Intensity of the stimulating current may not be a reliable indicator of intraneural needle placement. Reg Anesth Pain Med. 2008;33:207–10.

    PubMed  Google Scholar 

  119. Altermatt FR, Cummings TJ, Auten KM, Baldwin MF, Belknap SW, Reynolds JD. Ultrasonographic appearance of intraneural injections in the porcine model. Reg Anesth Pain Med. 2010;35:203–6.

    PubMed  Google Scholar 

  120. Abram SE. Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology. 1999;91:1937–41.

    CAS  PubMed  Google Scholar 

  121. Johansson A, Hao J, Sjölund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990;34:335–8.

    CAS  PubMed  Google Scholar 

  122. Lang AM. Botulinum toxin type B in piriformis syndrome. Am J Phys Med Rehabil. 2004;83:198–202.

    PubMed  Google Scholar 

  123. Indrevekam K, Sudmann E. Piriformis muscle syndrome in 19 patients treated by tenotomy — a 1- to 16-year follow-up study. Int Orthop. 2002;26:101–3.

    Google Scholar 

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Authors and Affiliations

  1. Director of Pain Management Centre DGS – Cologne – Huerth, Luxemburger Str. 323-325, 50354, Cologne – Huerth, Germany

    Danilo Jankovic MD

  2. Department of Anesthesia, McL 2-405 Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada

    Philip W. H. Peng MBBS, FRCPC

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  1. Danilo Jankovic MD
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  2. Philip W. H. Peng MBBS, FRCPC
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Correspondence to Philip W. H. Peng MBBS, FRCPC .

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Jankovic, D., Peng, P.W.H. (2015). Injection for Piriformis Syndrome. In: Regional Nerve Blocks in Anesthesia and Pain Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-05131-4_55

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