Severe buttock and leg pain.
Piriformis injections are indicated for patients who experience severe buttock and posterior leg pain characteristic of Piriformis Syndrome, a chronic condition that involves the lower sacral muscle. Piriformis syndrome may constitute up to 6-8% of low back pain conditions associated with sciatica, which refers to pain, weakness, numbness, or tingling in the leg. Tightness of the piriformis muscle may cause nerve and vessel entrapment because of its proximity to the large sciatic nerve and blood vessels, causing a deep aching sensation in the mid-gluteal region (buttock) that is associated with pain radiating down the back of the leg.
How Piriformis Injections Work
A piriformis injection involves deposition of a mixture of local anesthetic and steroid medication into the muscle, which will helps reduce pain and inflammation around the nerves that pass near the piriformis muscle. This will also reduce other symptoms such as numbness, tingling or swelling. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.
Patients benefit from this procedure because after the injection, inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.
General Procedure Piriformis Injection
A piriformis injection is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.
The patient is asked to lie prone (on their abdomen) on the table. The skin on the affected buttock is sterilized. Next, a small area of skin is injected with numbing medicine (local anesthesia). When ready, the physician directs a small needle into the piriformis muscle, using x-ray guidance. Other imaging techniques may be used, such as ultrasound, or electromyography to identify the muscle and the sciatic nerve. A small amount of dye is injected to insure proper needle position. The physician asks the patient to move their leg during the procedure. This consists of rotating the leg outward and moving it straight to the side away from the other leg. A mixture of local anesthetic and anti-inflammatory (steroid) is injected into the muscle. The needle is then slowly withdrawn.
Patients are then monitored in the recovery area and discharged on the same day. Numbness or weakness in the leg are temporary and will disappear in a few hours. After discharge, patients are asked to evaluate the relief they experience during the next week and report for follow-up. It may take at least 72 hours before the full effect of the steroid is observed. Repeat injections may be performed up to three times, if needed, every two weeks.
A Piriformis Injection is a minimally invasive, safe, and effective means of treating buttock and leg pain that is unresponsive to other forms of treatment. If you want more information about treating chronic low back pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain. Make an appointment with the NYC’s top board-certified interventional pain management physician to know if piriformis injections are a treatment option for you.