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-848d4c4894-m9kch Total loading time: 0 Render date: 2024-06-04T01:32:28.872Z Has data issue: false hasContentIssue false

Chapter 35 - Use of Botulinum Neurotoxin in the Treatment of Piriformis Syndrome

Published online by Cambridge University Press:  02 November 2023

By
Loren M. Fishman
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
Get access

Summary

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. Symptoms of piriformis syndrome include buttock pain and tenderness and sciatica, with pain radiating distally. This chapter reviews the three main pathogenetic factors in the development of piriformis syndrome: anatomical variations, nerve compression and nerve adhesion. The approach to patient examination, and diagnosis using electrophysiogical methods (H-reflex), the FAIR test, electromyography and neural scanning using MRI are discussed.

Injections of botulinum neurotoxin (BoNT) are a successful and largely innocuous treatment for piriformis syndrome. The application of BoN) types A and B is detailed, and injection techniques are illustrated with anatomical diagrams and dosing recommendations. The importance of injection guidance techniques, focusing on electromyography, is stressed.

Keywords

Piriformis syndromesciatic nervesciaticabuttock painischiofemoral ligamentFAIR testMRI neural scanningbotulinum neurotoxinBoNT
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 290 - 298
Publisher: Cambridge University Press
Print publication year: 2023

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

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.Google Scholar
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.Google 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, LM, Wilkins, AN, Rosner, B. (2017). Electrophysiologically identified piriformis syndrome is successfully treated with incobotulinum toxin A and physical therapy. Muscle and Nerve, 56, 258–63.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.Google Scholar
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 Scholar
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.Google Scholar
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.Google Scholar
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
Mizuguchi, T (1976). Division of piriformis muscle for the treatment of sciatica. Arch Surg, 111, 719–22.Google Scholar
Pace, JB, Nagle, D (1976). Piriform syndrome. West J Med, 124, 435–9.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
Solheim, LF, Siewers, P, Paus, B (1981). The piriformis muscle syndrome. J Orthop Scand, 52, 73–5.Google ScholarPubMed
Sridhara, CR, Izzo, KL (1985). Peroneal nerve entrapment syndrome. Arch Phys Med Rehabil, 66, 789–91.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
×