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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
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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

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References

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