Undiagnosed or overdiagnosed are common symptomatic of piriformis syndrome, which causes pain and tenderness in the buttocks and symptoms similar to sciatica. This perplexing disorder can be assessed and managed with the assistance of image-guided injections amidst this diagnostic challenge.
The ability to visualize the piriformis muscle and how it is related to the sciatic nerve in real time has made ultrasonography one of the most popular image-guided methods. An innovative approach to treating this condition has proven effective, minimally invasive, and well-tolerated by patients, providing insight into a condition that has confounded medical professionals for years.
The piriformis muscle, positioned deep within the buttock region, plays a pivotal role in hip movement. Piriformis syndrome can arise due to irritation of this muscle, often in conjunction with other structures or secondary to other disorders such as hip or sacroiliac joint problems. The symptoms are aggravated by sitting, and accurate diagnosis becomes paramount to effective treatment.
(A) Inspection of the right piriformis is performed with the patient prone, and the transducer (T) placed firmly over the piriformis in the long axis. With the knee flexed, an assistant can internally and externally rotate the leg, allowing visualization of the piriformis in motion throughout the subgluteal space. (B) A long-axis ultrasound image depicts the relation between the subcutaneous tissue, sacrum, gluteus maximus (Glut Max), piriformis, and sciatic nerve.
This excellent technical note, Piriformis Injection: An Ultrasound-Guided Technique, provides a guide for diagnosing and performing the Piriformis muscle injection for Piriformis Syndrome.
Target Area: The target area for the injection is the piriformis muscle, which is situated deep within the buttock region, adjacent to the sciatic nerve.
Injection Approach: The injection is performed from a lateral (side) approach to the sacrum, which is the triangular bone at the base of the spine. The goal is to administer the medication into the piriformis muscle while avoiding direct contact with the sciatic nerve.
Ultrasound Guidance: Using ultrasound to visualize the anatomical structures in real-time, including the piriformis muscle, the lateral edge of the sacrum, and the sciatic nerve to guide the injection.
Long Axis Visualization: The ultrasound transducer is positioned in a way that aligns with the long axis of the piriformis muscle. This allows for better visualization of the structures involved and ensures accurate needle placement.
Avoiding Nerve Contact: It's crucial to maintain continuous visualization of the piriformis muscle, the lateral edge of the sacrum, and the sciatic nerve during the injection. This is to prevent the needle from coming into direct contact with the sciatic nerve, as the goal is to inject the medication into the muscle and not the nerve itself.
Injection Site: The medication is injected into the adjacent piriformis musculature, not into the nerve sheath or the nerve itself.
Purpose of Injection: The injection is intended to reduce inflammation and provide pain relief in the piriformis muscle. It's not performed as a nerve block, which would involve targeting the nerve itself.
Overall, a piriformis injection can be an effective way to manage pain and discomfort caused by conditions affecting the piriformis muscle including Piriformis syndrome.
Elizabeth A. Bardowski, J. W. Thomas Byrd,Piriformis Injection: An Ultrasound-Guided Technique,
Arthroscopy Techniques, Volume 8, Issue 12,2019,Pages e1457-e1461 https://doi.org/10.1016/j.eats.2019.07.033. (https://www.sciencedirect.com/science/article/pii/S2212628719301744 )
MiniSim Piriformis Simulator facilitates knowledge and skills acquisition to perform the Piriformis, Sacral Hiatus, Sacroiliac joint, and Sciatic nerve blocks, allows injection practice, and teaches ultrasound anatomy recognition and needle-eye coordination to safely guide needle insertion.