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Piriformis Muscle Injections: Fluoroscopy 

Piriformis Muscle Injections: Fluoroscopy
Piriformis Muscle Injections: Fluoroscopy
Multimodality Imaging Guidance in Interventional Pain Management

Robert B. Bolash

and Kenneth B. Chapman


Piriformis syndrome is an entrapment neuropathy caused by compression or irritation of the sciatic nerve as it courses in proximity to the piriformis muscle. Conservative treatment modalities for piriformis syndrome include the use of anti-inflammatory analgesic medications or muscle relaxants. Physical therapy is often employed to correct the abnormal pelvic biomechanics and focus on stretching the piriformis muscle. Prior to proceeding with invasive surgical approaches, this chapter advocates the use of piriformis muscle injection. The technique both confirms the diagnosis and offers therapeutic value while avoiding the risks, expense, and potential adverse outcomes associated with surgical interventions. A combined fluoroscopic and nerve stimulator guided technique is recommended to identify bony landmarks, verify the perisciatic location, confirm intramuscular spread of the injectate, and avoid intravascular injection of particulate steroid. Transient sciatic nerve block caused by spillover of the local anesthetic administered into the piriformis muscle is a common complication.

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