Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-19T17:04:22.233Z Has data issue: false hasContentIssue false

Chapter 30 - Use of botulinum neurotoxin in the treatment of piriformis syndrome

Published online by Cambridge University Press:  05 February 2014

By
Loren M. Fishman  and
Sarah B. Schmidhofer
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett  and
Christopher Zachary
Loren M. Fishman
Affiliation:
Department of Rehabilitation and Regenerative Medicine, Columbia College of Physicians and Surgeons, New York, USA
Sarah B. Schmidhofer
Affiliation:
Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, USA
Daniel Truong
Affiliation:
The Parkinson’s and Movement Disorders Institute, Fountain Valley, California
Dirk Dressler
Affiliation:
Department of Neurology, Hannover University Medical School
Mark Hallett
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC
Christopher Zachary
Affiliation:
Department of Dermatology, University of California, Irvine
Get access

Summary

Introduction

Piriformis syndrome is entrapment of the sciatic nerve by the piriformis muscle, causing sciatica. One estimate puts the incidence of sciatica of non-disc origin as equal to or greater than that of herniated disc, based on comparison of the number of lumbar MRI scans versus the number of subsequent surgery for lumbar disc problems in 239 subjects in 2002 (Filler et al., 2005). The same study found intensive MRI evidence that piriformis syndrome accounted for a full 67% of sciatica of non-disc origin. Regardless of exact incidence, it seems fair to say that sciatica of non-disc origin is common and that in some circumstances the diagnosis of piriformis syndrome is controversial. Some investigators (Halpin and Ganju, 2009; Miller et al., 2012) find the syndrome undefined and infrequent.

In the 25-year period from 1987 to 2012, our own experience has included over 17 000 patients referred or self-referred for piriformis syndrome, approximately half of whom ultimately had the diagnosis confirmed. Since we are a referral center for the condition, our data cannot be used as a suitable sample from which to derive incidence or prevalence figures. However, the average length of time that our patients have had the pain related to piriformis syndrome has fallen from 6.5 years (Fishman et al., 2002a,b) to well below 2 years, suggesting, at least, that the syndrome is being recognized and treated more quickly than in the past, and that although recognized incidence is rising, prevalence is declining.

Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 259 - 268
Publisher: Cambridge University Press
Print publication year: 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beaton, LE, Anson, BJ (1937). Relation of sciatic nerve and subdivisions to piriformis muscle. Anat Rec, 70(Suppl 1), 1–3.CrossRefGoogle Scholar
Benzon, HT, Katz, JA, Hubert, A, Benzon, BA, Iqbal, MS (2003). Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anaesthesiology, 98, 1442–8.CrossRefGoogle Scholar
Childers, MK, Wilson, DJ, Gnatz, SM, Conway, RR, Sherman, AK (2002). Botulinum toxin type A use in piriformis muscle syndrome: a pilot study. Am J Phys Med Rehabil, 81, 751–9.CrossRefGoogle ScholarPubMed
Filler, AG, Haynes, J, Jordan, SE et al. (2005). 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, 2, 99–115.CrossRefGoogle ScholarPubMed
Fishman, LM, Ardman, CA (1997). Back Talk, How to Diagnose and Cure Low Back Pain and Sciatica. New York: Norton.Google Scholar
Fishman, LM, Zybert, PA (1992). Electrophysiological evidence of piriformis syndrome. Arch Phys Med Rehabil, 73, 359–64.CrossRefGoogle Scholar
Fishman, LM, Dombi, GW, Michaelsen, C et al. (2002a). Piriformis syndrome: diagnosis, treatment and outcome- a ten year study. Arch Phys Rehabil, 83, 295–302.CrossRefGoogle Scholar
Fishman, LM, Anderson, C, Rosner, B (2002b).Botox and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil, 81, 936–42.CrossRefGoogle ScholarPubMed
Fishman, LM, Konnoth, C, Rozner, B (2004). Botulinum neurotoxin type B and physical therapy in the treatment of piriformis syndrome: a dose-finding study. Am J Phys Med Rehabil, 83, 42–50.CrossRefGoogle ScholarPubMed
Fishman, SM, Caneris, OA, Bandman, TB, Audette, JF, Borsook, D (1998). Injection of the piriformis muscle by fluoroscopic and electromyographic guidance. Reg Anesth Pain Med, 23, 554–9.Google ScholarPubMed
Freiberg, AH (1937). Sciatic pain and its relief by operations on muscle and fascia. Arch Surg, 34, 337–50.CrossRefGoogle Scholar
Gotlin, R (1990). Piriformis muscle syndrome. In Proceedings of the New York Academy of Medicine Section on Physical Medicine and Rehabilitation, May.
Halpin, RJ, Ganju, A (2009). Piriformis syndrome: a real pain in the buttock?Neurosurgery, 65(Suppl), A197–202.CrossRefGoogle ScholarPubMed
Hanania, M (1997). New technique for piriformis muscle injection using a nerve stimulator. Reg Anesth Pain Med, 22, 200–2.CrossRefGoogle ScholarPubMed
Hanania, M, Kitain, E (1998). Perisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome. Reg Anesth Pain Med, 23, 223–8.Google ScholarPubMed
Jensen, MC, Brant-Zawadziki, MN, Obuchowski, N et al. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med, 331, 69–73.CrossRefGoogle ScholarPubMed
Kirschner, JS, Foye, PM, Cole, JL (2009). Piriformis syndrome, diagnosis and treatment. Muscle Nerve, 40, 10–18.CrossRefGoogle ScholarPubMed
Lang, AM (2004). Botulinum toxin type B in piriformis syndrome. Am J Phys Med Rehabil, 83, 198–202.CrossRefGoogle ScholarPubMed
Lockhart, RD, Hamilton, GF, Fyfe, FW (1959). Anatomy of the Human Body. Philadelphia, PA: Lippincott.Google Scholar
Martin, HD, Shears, SA, Johnson, JC, Smathers, AM, Palmer, IJ (2011). The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy, 27, 172–81.CrossRefGoogle ScholarPubMed
Masala, S, Crusco, S, Meschini, A et al. (2012). Piriformis syndrome: long term follow-up in patients treated with percutaneous injection of anaesthetic and corticosteroid under CT guidance.Cardiovasc Intervent Radiol, 35, 375–82.CrossRefGoogle ScholarPubMed
Miller, TA, White, KP, Ross, DC (2012). The diagnosis and management of Piriformis syndrome: myths and facts. Can J Neurol Sci, 39, 577–83.CrossRefGoogle ScholarPubMed
Mizuguchi, T (1976). Division of piriformis muscle for the treatment of sciatica. Arch Surg, 111, 719–22.CrossRefGoogle Scholar
Ogeng’o, JA, El-Busaidy, H, Mwika, PM, Khanbhai, MM, Munguti, J (2011). Variant anatomy of sciatic nerve in a black Kenyan population. Folia Morphol, 70, 175–9.Google Scholar
Pace, JB, Nagle, D (1976). Piriform syndrome. West J Med, 124, 435–9.Google ScholarPubMed
Pećina, M (1979). Contribution to the etiological explanation of the piriformis syndrome. Acta Anat (Basel), 105: 181–7.Google ScholarPubMed
Pećina, HI, Boric, I, Smoljanovic, T, Duvancic, D, Pecina, M (2008). Surgical evaluation of magnetic resonance imaging findings in piriformis muscle syndrome. Skel Radiol, 37, 1019–23.CrossRefGoogle ScholarPubMed
Porta, M (2000). A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain 85, 101–5.CrossRefGoogle ScholarPubMed
Sharma, T, Singla, RK, Lalit, M (2010). Bilateral eventration of sciatic nerve. J Nepal Med Assoc, 50, 309–12.Google ScholarPubMed
Solheim, LF, Siewers, P, Paus, B (1981). The piriformis muscle syndrome. J Orthop Scand, 52, 73–5.CrossRefGoogle ScholarPubMed
Sridhara, CR, Izzo, KL (1985). Peroneal nerve entrapment syndrome. Arch Phys Med Rehabil, 66, 789–91.Google Scholar
Sunderland, S (1868). Nerves and Nerve Injuries. Baltimore, MD: Williams & Wilkins.Google Scholar
US Pharmacopeial Convention (2012). United States Pharmacopeia. Rockville, MD: US Pharmacopeial Convention.Google Scholar
Waseem, Z, Boulias, C, Gordon, A et al. (2011). Botulinum toxin injections for low-back pain and sciatica. Cochrane Database Syst Rev, (1), CD008257.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×