Piriformis and Obturator Internus Injection

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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.

However, the term piriformis syndrome has been scrutinized recently for a few reasons. It is better termed as a subset of the deep gluteal syndrome.

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

    Article  CAS  PubMed  Google Scholar 

  • Bartret AL, Beaulieu CF, Lutz AM. Is it painful to be different? Sciatic nerve anatomical variants on MRI and their relationship to piriformis syndrome. Eur Radiol. 2018;28:4681–6.

    Article  PubMed  Google Scholar 

  • Beaton LE, Anson BJ. The sciatic nerve and the piriformis muscle. Their interrelation and possible cause of coccygodynia. J Bone Joint Surg Am. 1938;20-A:686–8.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Carro LP, Hernando MF, Cerezal L, et al. Deep gluteal space problems: piriformis syndrome, ischiofemoral im**ement and sciatic nerve release. Muscles Ligaments Tendons J. 2016;6:384–96.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Dalmau-Carola J. Myofascial pain syndrome affecting the piriformis and the obturator internus muscle. Pain Pract. 2005;5(4):361–3.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • Filler AG, Haynes J, 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. 2005a;2(2):99–115.

    Article  PubMed  Google Scholar 

  • 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. 2005b;2:99–115.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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. quiz 51-43.

    Article  PubMed  Google Scholar 

  • Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74(2):69–72.

    Article  CAS  PubMed  Google Scholar 

  • Hernando MF, Cerezal L, Pérez-Carro L, Abascal F, Canga A. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiol. 2015;44:919–34.

    Article  PubMed  Google Scholar 

  • Hopayian K, Danielyan A. Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features. Eur J Orthop Surg Traumatol. 2018;28(2):155–64.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • Jankovic D, Peng P, van Zundert A. Piriformis syndrome: etiology, diagnosis and management. Can J Anesth. 2013;60:1003–12.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • Martin HD, Reddy M, Gómez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg. 2015;2:99–107.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Michel F, Decavel P, Toussirot E, et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56:371–83.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J. 2020;102-B:556–67.

    Article  PubMed  Google Scholar 

  • Peng PWH. Piriformis syndrome. In: Peng PWH, editor. Ultrasound for pain medicine intervention: a practical guide. Pelvic pain. Philip Peng educational series. iBook, vol. 2. 1st ed. Cupertino, CA: Apple; 2013.

    Google Scholar 

  • Probst D, Stout A, Hunt D. Piriformis syndrome: a narrative review of the anatomy, diagnosis, and treatment. PM R. 2019;11(Suppl 1):S54–63.

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  • Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clin Anat. 2010;23:8–17.

    Article  PubMed  Google Scholar 

  • Windisch G, Braun EM, Anderhuber F. Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat. 2007;29:37–45.

    Article  PubMed  Google Scholar 

  • Yeoman W. The relation of arthritis of the sacroiliac joint to sciatica, with an analysis of 100 cases. Lancet. 1928;2(5492):1119–22.

    Article  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

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Peng, P., Jankovic, D. (2022). Piriformis and Obturator Internus Injection. In: Jankovic, D., Peng, P. (eds) Regional Nerve Blocks in Anesthesia and Pain Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-88727-8_37

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  • DOI: https://doi.org/10.1007/978-3-030-88727-8_37

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-88726-1

  • Online ISBN: 978-3-030-88727-8

  • eBook Packages: MedicineMedicine (R0)

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