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Injections deliver medication directly to the piriformis muscle through a needle. The needle is placed into the piriformis muscle with image guidance such as fluoroscopy, ultrasound, CT, or MRI. [ 2 ] [ 30 ] Ultrasound is a popular choice due to a balance of accuracy, accessibility, lack of radiation exposure, and affordability.
Piriformis syndrome occurs when the piriformis irritates the sciatic nerve, which comes into the gluteal region beneath the muscle, causing pain in the buttocks and referred pain along the sciatic nerve. [8] This referred pain is known as sciatica. Seventeen percent of the population has their sciatic nerve coursing through the piriformis muscle.
The inferior gluteal nerve reliably emerged inferior to the piriformis muscle. The branching characteristics of the nerve falls into two broad categories.One category is short stalks which came under the piriformis and then gave rise to all of the terminal branches of the nerve which spanned the muscle of the gluteus maximus.
Ultrasound-guidance is a popular choice for injections, [5] but injections can also be done under CT or MRI-guidance. [4] [6] Controlled studies have found that for patients with suspected piriformis syndrome, botox injections into the piriformis are more effective than a placebo [22] and also more effective than just an anesthetic block alone.
It exits the pelvis through the greater sciatic foramen superior to the piriformis muscle. [2] [3] [4] It is accompanied by the superior gluteal artery and the superior gluteal vein. [2] It passes lateral-ward in between the gluteus medius muscle and the gluteus minimus muscle, [1] [5] accompanied by the deep branch of the superior gluteal ...
2003: arthroscopic piriformis muscle release [69] 2005: Magnetic resonance neurography and image-guided injections used in a clinical research study to improve nerve decompression outcomes [14] 2010: endoscopic sciatic nerve decompression [30] 2015: laparoscopic sacral plexus decompression; [18] robotic pudendal nerve decompression [70]